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Dr Ngozi Uduku Good Also known as Woodlands Health centre

Inspection Summary


Overall summary & rating

Good

Updated 19 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Ngozi Uduku (Woodlands Health Centre) on 28 July 2016. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patient responses regarding getting a routine appointment and with a GP of their choice was mixed. However, patients told us there was continuity of care and urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

  • Review the cleaning arrangements for the practice.
  • Review how carers are identified and recorded on the clinical system to ensure information, advice and support is made available to them.
  • Continue to review the telephone and appointments system to ensure patients can access the surgery and get appointments in a timely manner.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 19 October 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events.
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 19 October 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were in line with national average.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for all staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 19 October 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey was comparable with CCG and national averages for several aspects of care. For example, 86% of patients said the last GP they spoke to was good at treating them with care and concern (CCG average 83%; national average 86% and 90% of patients said the GP was good at listening to them (CCG average 87%; national average 89%).
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. This was echoed in the National GP Patient Survey where 78% of patients said the last GP they saw was good at involving them in decisions about their care (CCG average 79%; national average 82%).
  • Information for patients about the services available was easy to understand and accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 19 October 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. For example, the practice had formed a federation with 11 GP practices in Lewisham (a federation is a group of practices and primary care teams working together, sharing responsibility for developing and delivering high quality, patient focussed services for their local communities).
  • Patient responses on the day of the inspection regarding getting a routine appointment or with their preferred GP was mixed. This was echoed in the National GP Patient Survey where 42% said they usually get to see or speak to their preferred GP (CCG average 50%; national average 59%) and 72% were able to get an appointment to see or speak to someone the last time they tried (CCG average 82%; national average 85%).
  • Patients told us there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 19 October 2016

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

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.
  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.
  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 19 October 2016

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

  • The practice nurse had a lead role in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • All these patients had a named GP and 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.
  • Performance for diabetes related indicators was comparable to the national average. For example, the percentage of patients with diabetes, on the register, in whom the last HbA1c was 64 mmol/mol or less in the preceding 12 months was 79% (national average 78%).
  • The principal GP had recently co-founded the group Healthy Habits, formed to engage African Caribbean’s in improving and managing their health outcomes. Recent events included seminars on obesity, cardiovascular disease and diabetes.
  • The practice worked closely with patients receiving end of life care and had instigated a system of calling each patient on a weekly basis to ask how they were, if they had any concerns, needed a GP visit or medication. The practice told us this had been received well by patients, family and McMillian team and district nurses. All patients on the EOLC register had an alert on the clinical system to offer same-day appointments.
  • The practice utilised the Coordinate My Care (CMC) personalised urgent care plan developed to give people an opportunity to express their wishes and preferences on how and there they are treated and cared for.

Families, children and young people

Good

Updated 19 October 2016

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

  • There were systems in place 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 A&E attendances.
  • The percentage of patients with asthma, on the register, who had an asthma review in the preceding 12 months was comparable to the national average (practice 88%, national 75%).
  • The practice’s uptake for the cervical screening programme was 85%, which was comparable with the national average of 82%.
  • There were dedicated sexual health and family planning clinics.
  • Appointments were available outside of school hours and the premises were suitable for children and babies. Same-day appointments were available for children.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 19 October 2016

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

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.
  • All patients over 75 had a named GP.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. The practice undertook a weekly ‘ward round’ at a nearby residential home.
  • The practice had increased its influenza and pneumonia vaccine uptake for the over 65s from 59% in 2014/2015 to 75% in 2015/2016 following a focussed campaign which included an increased number of vaccine sessions (Saturday morning, late evening and open access sessions), letter and telephone reminders and home visits for their vulnerable housebound patients.

Working age people (including those recently retired and students)

Good

Updated 19 October 2016

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

  • The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
  • The practice offered a ‘Commuter’s Clinic’ on Monday from 7pm to 9pm, Tuesday from 7am to 8am and 6.30pm to 7.30pm and the last Saturday of each month from 7am to 10am for working patients who could not attend during normal opening hours.
  • Telephone consultations were available.

People experiencing poor mental health (including people with dementia)

Good

Updated 19 October 2016

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

  • Performance for mental health related indicators was comparable with the national average. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 93% (national average 88%) and the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months was 93% (national average 90%).
  • The percentage of patients diagnosed with dementia who care has been reviewed in face-to-face review in the preceding 12 months was 97% (national average 84%).
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia and carried out advance care.
  • The practice managed patients housed in four nearby mental health care homes. Multi-disciplinary ‘ward rounds’ were undertaken on a monthly basis.
  • The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
  • Staff had a good understanding of how to support patients with mental health needs and dementia and one of the GPs had a special interest in the management of dementia.
  • Some of the non-clinical staff had undertaken dementia training.

People whose circumstances may make them vulnerable

Good

Updated 19 October 2016

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

  • The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients and informed vulnerable patients about how to access various support groups and voluntary organisations.
  • Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff 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 website had the functionality to translate to other languages and change the font size, contrast and colour to assist patients with visual impairment.