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St Pauls Way Medical Centre Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 6 February 2018

Letter from the Chief Inspector of General Practice

OUTSTANDING

We carried out an announced comprehensive inspection at St Paul’s Way Medical Centre on 9 October 2017. Overall the practice is rated as outstanding.

Our key findings across all the areas we inspected were as follows:

  • This was the first inspection of the practice since their relocation to new, improved premises earlier in the year.
  • The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
  • The practice had strong, visible clinical and managerial leadership and governance arrangements and used innovative and proactive methods to improve patient outcomes, working with four other network practices and local providers to share best practice and develop integrated care.
  • In response to the significant clinical and social challenges the practice employ a higher than average ratio of GP's to patients (1:1700) and nurses.
  • The practice helped to promote and manage many population specific services and health education events targeted at young mums, young adults and ethnic minority groups. It encouraged social prescribing and acted as a hub to various support groups, for example, helping patients with depression, promoting recognition and management of minor ailments to young and new patients. These services improved patient self management (which helped reduce waiting times and improve access to healthcare).
  • The results showed good patient uptake, which in turn has provided positive feedback for the practice, especially in terms of patient trust in the practice.
  • To benefit the whole practice population and bespoke to the practice, a patient Health Champion programme was developed. This involved the practice training patients to volunteer and support other patients to improve individual understanding and control over their healthcare needs and led to improved patient satisfaction. The practice offered a seven week training course and had trained 56 Health Champions of which 27 had attained a level 2 qualification in Understanding Health Improvement. This model of care goes beyond clinical outcomes and aimed to support patients in a more holistic way, addressing wider health determinants.
  • The practice was proactive in obtaining patient feedback. This included feedback from regular ‘meet the manager’ events, their own surveys, Friends and Family Test (an average of 120 – 160 patient feedback per month), Patient Participation Group and Health Champions programme as well as the GP Patient Survey and NHS Choices. This enabled any issues, concerns or complaints to be raised, which were then systematically acted on. For example, improved patient access through online consultation.
  • The practice had developed a leadership programme in 2016 and commissioned a facilitator to work with the leadership and wider practice team.
  • The practice had good new facilities and was well equipped to treat patients and meet their needs. This included an area in reception where patients could self monitor their height, weight and blood pressure.
  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
  • The practice were accredited as a YOU’RE WELCOME’ pilot site. YOU’RE WELCOMEprovides a framework for delivering and planning young people’s health services and through participation, that young people will have a greater understanding of the services available. It aims to help practices improve access to health services for marginalised groups.
  • The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result, although details of the local NHS complaint advocacy organisation, NHS England and the Ombudsman were not consistently included in responses to patients.
  • We found that two indicators representing completion by the practice, childhood immunisations recommended for children up to 2 years of age, had been below the local and national average although the practice were actively taking action and could demonstrate significant improvement as of March 2017.

We saw several areas of outstanding practice including:

  • The practice were very proactive. They had developed a practice Health Champions programme which commenced in 2016 and aimed to benefit patients across all of the practice population groups. Health Champions were usually patients trained by the practice who then volunteer to support other patients to increase control over and improve the patients’ understanding of their health as well asthe services at the practice. Over 250 patients had benefitted from the service. The practice offered a seven week training course and had trained 56 Health Champions of which 27 had attained a level 2 qualification in Understanding Health Improvement.Once trained the patient Health Champion would: run a weekly stall in the waiting room area, support the practice in planning / running events, collect feedback from patients, signpost patients to local services, assist patients in the waiting area with using the self-arrival machines, Web GP IPads and using the surgery pod.

However there were areas of practice where the provider should make improvements:

  • Review the policies and procedures for complaints.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 6 February 2018

The practice is rated as good for providing safe services.

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

  • The practice used every opportunity to learn from internal and external incidents, to support improvement. Learning was based on a thorough analysis and investigation.

  • Information about safety was highly valued and was used to promote learning and improvement.

  • Risk management was comprehensive, well embedded and recognised as the responsibility of all staff.

  • There was evidence of regular equipment servicing / calibration. The practice carried out infection, prevention and control audits, the last one in September 2017.

  • Medicines were well managed although we identified minor areas for review in relation to uncollected prescriptions.

Effective

Outstanding

Updated 6 February 2018

The practice is rated as outstanding for providing effective services.

  • Two population groups were rated as outstanding for effective services; families, children and young people and people experiencing poor mental health (including people with dementia). This was because the practice had developed a patient Health Champion programme, had appointed a Community Health Advisor, co-produced health courses with patients and worked in partnership with local charities and the community to support people.The practice was also accredited as a You’re Welcome pilot site, which provides a framework for delivering and planning young people’s health services and through participation, that young people will have a greater understanding of the services available.

  • Our findings at inspection showed that there were systems to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence guidelines and other locally agreed guidelines.

  • We also saw evidence to confirm that the practice used these guidelines to positively influence and improve practice and outcomes for patients.

  • Data from the Quality and Outcomes Framework showed patient outcomes were comparable or above average compared to the national average. The practice had an effective action plan in place to address areas they needed to improve.

  • The practice used innovative and proactive methods to improve patient outcomes and working with other local providers to share best practice.

  • The practice ensured that patients with complex needs, including those with life-limiting progressive conditions, were supported to receive coordinated care in innovative and efficient ways.

Caring

Good

Updated 6 February 2018

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients had not rated the practice higher than others for several aspects of care but the practice had developed and implemented an effective action plan to address those areas.

  • Survey information we reviewed showed that patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • Information for patients about the services available was accessible.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 6 February 2018

The practice is rated as good for providing responsive services.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, replacement of the telephone system to improve issues with telephone access and monitoring, the addition of a white board in reception to highlight to patients when there were delays in clinics and appointment times.
  • A recent pilot using a messaging service to remind patients of their appointments or to cancel appointments if not needed, had reduced their non attendance rate from 35% to 21%.
  • Patients could access appointments and services in a way and at a time that suits them. The practice offered appointments until 8pm or on Saturdays, booking appointments online or by phone and the option of an online consultation.
  • The practice had good facilities and was well equipped to treat patients and meet their needs and had only moved into their modern, new premises earlier in the year.
  • The practice worked closely with other organisations and with the local community in planning services that met patients’ needs. For example, local schools, mosque, churches and voluntary organisations.

  • The individual needs and preferences of people with a life-limiting condition, including patients with a condition other than cancer and patients living with dementia, were central to their care and treatment. Care delivered was flexible and provided choice.
  • Information about how to complain was available and easy to understand although the complaint policy was not well publicised. The practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders. The practice manager held weekly ‘meet the manager’ events where patients could find out more about the practice, raise issues or concerns. These were in addition to meetings held with the PPG.

Well-led

Outstanding

Updated 6 February 2018

The practice is rated as outstanding for being well-led.

  • The practice gathered feedback from patients using new technology, and it had a very engaged patient participation group which influenced practice development. For example improving access challenges and waiting times for patients. The practice also had their own bespoke patient Health Champion programme which was developed to support patient health needs.

  • The practice had a clear vision with quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

  • High standards were promoted and owned by all practice staff and teams who worked together across all roles.

  • Governance and performance management arrangements had been proactively reviewed and took account of current models of best practice.

  • There was a high level of constructive engagement with staff and a high level of staff satisfaction. Staff told us that they felt empowered to make suggestions and recommendations for the practice.

Checks on specific services

People with long term conditions

Outstanding

Updated 6 February 2018

The practice is rated as good for the care of people with long-term conditions.

  • Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

  • Diabetes indicators showed the practice was comparable to or above the national average. For example, the percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) is 5 mmol/l or less (01/04/2015 to 31/03/2016) was 85% compared to the national average of 80%.

  • The practice had also provided Mindful Eating and Healthy Cooking six week nutrition workshops and a Ramadan diabetes workshop.

  • The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

  • There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

  • All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Outstanding

Updated 6 February 2018

The practice is rated as outstanding for the care of families, children and young people.

  • The practice had appointed a Community Health Advisor to work closely with mothers and children under 5 years. They had worked with approximately 250 patients since the initiative was implemented. This built trust in the practice, the services provided and was helping to improve attendance rates.

  • The practice held a DIY health course (co-produced with parents) on managing minor ailments. This was a 12 week course for parents with children under five years where parents explore how to navigate the health system to access support in the right place and at the right time. Topics were negotiated between local parents and a GP, weekly sessions were delivered and included common health concerns such as cold and flu, gastroenteritis, fever, feeding, skin conditions and ear pain.
  • The practice was also accredited as a YOU’RE WELCOME’ pilot site. YOU’RE WELCOMEprovides a framework for delivering and planning young people’s health services and through participation, that young people will have a greater understanding of the services available. It aims to help practices improve access to health services for marginalised groups. It helped staff to become more inclusive giving them the confidence to engage with young people.
  • We found that immunisation rates for standard childhood immunisations at the age of two were below the national average. To address this, the practice and network had developed an effective action plan and as of March 2017 had significantly improved this to meet their targets.
  • The practice held an under 5’s morning with Health Visitors and the toy house (a local charity) and provided a nutritionist session every two weeks with the Health Visitor clinics.
  • The practice also held asthma and eczema workshops for parents and children, enabled weekly sessions with MEND Mums (a local charity) providing nutrition and exercise for mothers who have children under two.
  • There were weekly discussions with the Health Visitors regarding perinatal mental health.
  • From the sample of documented examples we reviewed we found there were systems to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of accident and emergency (A&E) attendances.
  • Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
  • The practice provided support for premature babies and their families following discharge from hospital. For example, home visits and discussion at MDT meetings to consider additional support needs. Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
  • The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Older people

Good

Updated 6 February 2018

The practice is rated as good for the care of older people.

  • Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population.

  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

  • The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

  • The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

  • Where older patients had complex needs, the practice shared summary care records with local care services. For example community nurses and the wider multi-disciplinary team (MDT).

  • Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. For example healthy eating or the importance of influenza immunisation.

  • The practice also had patient Health Champions who led walking groups and provided healthy cooking and nutrition workshops.

Working age people (including those recently retired and students)

Good

Updated 6 February 2018

The practice is rated as good for the care of working age people (including those recently retired and students).

  • The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours and Saturday appointments. Patients could email the practice for general enquiries and also offered appointment reminders via text messaging.

  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

  • A gardening group was established for any patient interested in gardening and those recently retired and there was also a weekly walking and running group. The walking group regularly had six to ten walkers. The practice facilitated and enabled one to one employment support.

  • Feedback from the patient Health Champions was that the programme had improved well-being, confidence and knowledge of the support services available in the local community.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 6 February 2018

The practice is rated as outstanding for the care of people experiencing poor mental health (including people with dementia).

  • The practice carried out advance care planning for patients living with dementia.

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    The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example, by ensuring training for staff in dementia care and capacity assessment, having a dementia care lead in the practice, integrated care plans, use of the Social Prescribing project, practice meetings with the locality mental health nurse and psychiatrist, proactive and opportunistic mental health review checks, training patient Health Champions.

  • The practice provided Time to Change training which aimed to challenge mental health stigma and discrimination and offered patient Health Champion training to support patients with mental health needs.

  • There was a peer support group for patients experiencing mental health issues – this was run in partnership with a local charity, Depression Changes Minds.

  • Three staff at the practice had undertaken Mental Health First Aid training to support patients or staff.

  • A gardening group was available and led by a patient Health Champion.

  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 was 94% compared to the national average of 89%.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

  • Patients at risk of dementia were identified and offered an assessment.

  • The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

  • The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

  • Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

  • There were weekly discussions with the Health Visitors regarding perinatal mental health.

People whose circumstances may make them vulnerable

Good

Updated 6 February 2018

The practice is rated as good for the care of people who circumstances may make them vulnerable.

  • The practice held a register of patients living in vulnerable circumstances including, travellers and those with a learning disability. Homeless people could register at another local service in Tower Hamlets, although the practice provided support to help them do this.

  • End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

  • We saw a prominent presentation in reception put together by one of the patient Health Champions raising awareness of Domestic Violence. The practice also held in-house training sessions.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients and had information available for vulnerable patients about how to access various support groups and voluntary organisations and supported patients to access these. The practice held specific clinics for substance misuse and alcohol services.

  • Psychology services were based at the practice.

  • Online referrals and appointments in the practice were made to the Social Prescribing project which for example enabled patients to receive benefits, financial or employment support.

  • Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

  • The practice had advocacy services on four days each week as well as an interpreting service and availability of language line. A patient Advisor was available in reception during busy periods.

  • The practice offered longer appointments for patients with a learning disability and protected time for annual reviews.