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Archived: MEEBBB Health CIC (St Pauls Way Medical Centre) Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 31 March 2015

Letter from the Chief Inspector of General Practice

MEEBBB (Mile End East and Bromley by Bow) Health CIC (St Pauls Way Medical Centre) provides GP primary medical services to approximately 10,500 patients living in the London Borough of Tower Hamlets. The practice is a Community Interest Company run by representatives from four other local GP practices.

We carried out an announced comprehensive inspection on 26 November 2014. The inspection took place over one day and was undertaken by a lead inspector, a second CQC inspector and two GP Specialist Advisors. We looked at care records, spoke with patients, members of the patient participation group (PPG) and staff including the management team.

Overall the practice is rated as outstanding.

Specifically, we found the practice to be outstanding for providing effective, responsive services and for being well led. It was rated Good for providing safe and caring services.

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

  • The service is safe. Systems including incident reporting protocols, safeguarding measures and infection control procedures were in place to keep patients safe.

  • The service is effective. Staff were appropriately qualified to deliver effective care and treatment in line with NICE guidance and they shared best practice with external consultants and other GP practices.

  • The practice is caring. Patients said that staff were welcoming, caring and treated them with dignity and respect and the GP’s involved them in decisions about their treatment and care.

  • The practice is responsive to people’s needs. 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 (PPG).
  • The practice is well-led. The practice had a clear vision and strategy to go beyond clinical outcomes and support patients in a holistic sense taking into account and addressing wider issues such as housing, education and other social issues and health determinants. 

All the population groups including older people; people with long term conditions; mothers, babies, children and young people; the working age populations and those recently retired; people in vulnerable circumstances and people experiencing poor mental health received care that was safe, effective, caring, responsive and well-led.

We saw several areas of outstanding practice including:

  • Improvements in care for patients who use services are made as a result of ongoing monitoring and clinical audit programme. Completed audit cycles had been undertaken and audits had been shared and extended to the GP practices within the network. The practice had also engaged with external consultants in relation to audits undertaken.

  • A systematic approach is taken to working with others in the health and social care economy to improve care outcomes and tackle inequalities. The practice participates in a Social Prescribing project jointly funded by funded by MEEBBB Health CIC and Tower Hamlets CCG in which they refer patients to wider support services, activities and programmes within the borough. The practice regularly engages with Public Health England and the community drug therapies team and provides weekly Benefits Advisor sessions for patients. The practice undertakes a number of health promotion activities both in house and out in the community to enable patients and members of the public to increase control over, and to improve, their health. The practice promoted healthy eating by holding workshops every six months at a local café and signposted patients to various services according to which health changes they want to make.

  • The practice had analysed the Joint Strategic Needs Assessment data and the priorities of the Clinical Commissioning Group (CCG) and local authority in the planning of its services to meet the needs of the local population. These included extended hours for appointments, diabetes clinics and substance misuse services. The practice opening hours were 8am – 8pm Monday to Friday and 9am -5pm on Saturdays.

  • There is a strong commitment to developing skills, competence and knowledge of staff through an in practice weekly mentoring an annual learning programme. The practice allocated protected time for clinicians each week for mentoring. Mentoring sessions included discussions on referrals, results and prescribing and provided an opportunity for personal development and career progression.

  • There are consistently high levels of constructive staff engagement and a high level of staff satisfaction. Staff are proud of the practice and contribute to the practice’s vision to go beyond clinical outcomes and support patients in a holistic way.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider should:

  • Carry out a fire risk assessment to ensure patients and staff are protected from the risks associated with fire in the premises.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 31 March 2015

The practice is rated as good for providing safe services.

Procedures were in place to ensure incidents were reported, analysed and learning shared. Safety alerts received from the NHS central alert system were distributed to the appropriate staff and acted upon. Medicines were managed safely and staff were trained to deal with medical emergencies.

Safeguarding procedures were in place to protect children and vulnerable adults from harm. Staff were knowledgeable on safeguarding both children and vulnerable adults and knew who to report to with any concerns. There was a nominated GP safeguarding lead and there were patient registers for vulnerable adults and children.

We observed the premises to be clean and tidy. We saw there were cleaning schedules in place and cleaning records were kept. Patients we spoke with told us they always found the practice clean and had no concerns about cleanliness or infection control.

Systems were in place to monitor risk. Where risks had been identified control measures were in place to minimise them. Equipment used by the practice had undergone regular safety checks.

Appropriate pre-employment checks had been carried out on staff before they started working for the practice to ensure they were of suitable character.

The practice had a fire safety policy, fire protection equipment was serviced annually, nominated staff were trained as fire marshals, fire alarm checks and fire drills had been practiced regularly. However the practice had not carried out a fire risk assessment to identify actions required to maintain fire safety.

Effective

Outstanding

Updated 31 March 2015

The practice is rated as outstanding for providing effective services.

Staff referred to guidance from NICE and used it routinely. People’s needs were assessed and care was planned and delivered in line with current legislation.

Practice performance data for diabetic patients and flu immunisations were above the Clinical Commissioning Group (CCG) averages. The practice had scored 97 % in their QOF performance in the previous year and used QOF to drive practice performance.

The practice had undertaken clinical audits in line with CCG recommendations. Some actions for improvement had been identified as a result of the audits and audit cycles were completed to check that performance had improved. Audits had been shared and extended to the GP practices within the network. The practice had also engaged with external consultants in relation to audits undertaken.

Staff were appropriately qualified to deliver effective care and treatment. The practice worked with other services/health care professionals to manage patients with complex needs and offered a wide range of services to promote good health. The practice participated in a Social Prescribing project, regularly engaged with Public Health England and undertook a number of health promotion activities both in house and out in the community to enable patients and members of the public to increase control over, and to improve, their health.

Caring

Good

Updated 31 March 2015

The practice is rated as good for providing caring services.

The results of the national patient survey 2014 showed that the practice scored below the CCG average for the percentage of patients who described their overall experience of the practice to be ‘good.’ However the results of the practices’ internal patient satisfaction survey showed that 21% of patients said that the practice was either ‘very good’ or ‘excellent’ and 54 % said that the practice was ‘good.’ We received 47 completed Care Quality Commission patient comment cards and the vast majority of these stated that the service was ‘good’, ‘very good’ or ‘excellent.’

Feedback from patients during the inspection was mostly positive about the services they received. Patients told us that staff were caring and treated them with dignity and respect and this was reflected in the CQC comment cards. We also observed this during the inspection and saw that patient confidentiality was maintained.

Responsive

Outstanding

Updated 31 March 2015

The practice is rated as outstanding for providing responsive services.

The Clinical Lead and the Network Lead/Contract Manager had analysed the Joint Strategic Needs Assessment data and the priorities of the Clinical Commissioning Group (CCG) and local authority. The practice had planned services to meet the needs of the local population. These included extended hours for appointments, diabetes clinics and substance misuse services. The practice opening hours were 8am-8pm Monday to Friday and 9am-5pm on Saturdays.

The practice had recognised the needs of different groups in the planning of its services. For example, bi-lingual staff were recruited to the practice that were able to speak Bengali and patients also had access to a Health Advocacy and Interpreting Service to help them with their communication needs. The practice premises and facilities were accessible for patients with disabilities.

The practice had implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from the Patient Participation Group (PPG) and had a system in place for handling concerns and complaints. Patients’ complaints had been acknowledged and resolved in a timely manner.

Well-led

Outstanding

Updated 31 March 2015

The practice is rated as outstanding for being well-led. The practice had a clear vision and strategy to go beyond clinical outcomes and support patients in a holistic sense taking into account and addressing wider issues such as housing, education and other social issues and health determinants. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff. Staff were able to articulate the vision of the practice and worked as a team to achieve this.

Governance arrangements were in place including policies and procedures to govern activity and defined roles for staff and lines of accountability. Policies and procedures were proactively reviewed and took account of current models of best practice within the GP network. The practice chaired the GP Network meetings which provided peer to peer support, challenge and training for staff from five GP practices.

The practice carried out proactive succession planning and developed internal staff members with the potential to fill key leadership roles within the practice. Clinical staff had weekly protected time for mentoring. Mentoring sessions included discussions on referrals, results and prescribing and provided an opportunity for personal development and career progression.

Regular staff meetings were held and staff received training and support to carry out their job roles effectively, including annual appraisal.

There was a high level of constructive engagement with staff and a high level of staff satisfaction. The practice gathered feedback from patients using new technology, and it had a very active patient participation group (PPG).

Checks on specific services

People with long term conditions

Outstanding

Updated 31 March 2015

The practice was rated Outstanding for the domains of effective, responsive and well-led. The evidence which led to these ratings apply to everyone using the practice, including this population group, which has led to the Outstanding rating for the People with Long Term Conditions population group. The practice provided clinics for patients with diabetes, asthma, hypertension and chronic obstructive pulmonary disease (COPD). The practice nurses led clinics for long term conditions and care plans were developed for all patients with long term conditions. All patients with long term conditions also had a named GP and annual reviews were carried out to check that their health and medication needs were being met in line with best practice. There was a proactive call recall system in place to provide preventative and continuing care for patients. For those people with the most complex needs, the practice nurses worked with relevant health and care professionals to deliver a multidisciplinary package of care. The practice had achieved 100 % of its QOF targets for the asthma, COPD and hypertension QOF indicators for the previous year and 90 % of its QOF target for the diabetes indicator.

Families, children and young people

Outstanding

Updated 31 March 2015

The practice was rated Outstanding for the domains of effective, responsive and well-led. The evidence which led to these ratings apply to everyone using the practice, including this population group, which has led to the Outstanding rating for the Families, children and young people population group. 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. Multidisciplinary team meetings were held with GPs, health visitors, social workers and children’s centre staff to discuss and monitor vulnerable children under the age of 5 years of age. Regular internal meetings were held to discuss vulnerable children under the age of 16 and those on the child protection register. The lead GP attended locality child safeguarding leads meetings and a system was in place to alert staff if a child was on a child protection plan. The practice provided a range of services for families, babies, children and young people including weekly child health clinics supported by health visitors, baby immunisations, ante-natal and post-natal care and child development checks. Practice appointments were available outside of school hours and the premises were suitable for children and babies.

Older people

Outstanding

Updated 31 March 2015

The practice was rated Outstanding for the domains of effective, responsive and well-led. The evidence which led to these ratings apply to everyone using the practice, including this population group, which has led to the Outstanding rating for the Older People population group. Patients over the age of 75 years of age were provided with a named GP and care plans were developed for these patients. Care and treatment was planned with appropriate reviews to meet the identified needs of patients. There was a proactive call and recall system in place to provide preventative and continuing care for patients. The practice’s performance for seasonal flu targets for patients over the age of 65 years of age was 83% which was above the national average of 73%. The practice was responsive to the needs of older people and allocated two appointments each day for home visits to patients who were housebound with a dedicated GP providing this service. Routine planned visits were also provided for patients with complex needs. There were clinical and administrative leads for integrated care, dementia and adult safeguarding. There were appropriate and effective end of life care arrangements in place.

Working age people (including those recently retired and students)

Outstanding

Updated 31 March 2015

The practice was rated Outstanding for the domains of effective, responsive and well-led. The evidence which led to these ratings apply to everyone using the practice, including this population group, which has led to the Outstanding rating for the Working age people (including those recently retired and students) population group. The practice provided easy access to this population group. For example appointments were available early mornings, late evenings and Saturdays for those who were working or in education. In addition the practice offered online appointment booking for this group.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 31 March 2015

The practice was rated Outstanding for the domains of effective, responsive and well-led. The evidence which led to these ratings apply to everyone using the practice, including this population group, which has led to the Outstanding rating for the People experiencing poor mental health (including people with dementia) population group. Proactive call recall systems were in place for mental health reviews and physical health checks for patients. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. Practice meetings were held with the locality consultant psychiatrist and mental health nurse to discuss the care and treatment of patients. Care plans were developed and patients were provided with a named GP. The practice has a dementia lead GP and staff had received training in dementia care, the mental capacity act and capacity assessments. The practice carried out advance care planning for patients with dementia.

People whose circumstances may make them vulnerable

Outstanding

Updated 31 March 2015

The practice was rated Outstanding for the domains of effective, responsive and well-led. The evidence which led to these ratings apply to everyone using the practice, including this population group, which has led to the Outstanding rating for the People whose circumstances may make them vulnerable population group.The practice held a register of patients living in vulnerable circumstances including those with a learning disability. It had carried out annual health checks and offered longer appointments for people with a learning disability. The practice has a high proportion of patients registered from a Bangladeshi ethnic background who did not speak English as a first language. Bi-lingual staff had been recruited to the practice, including the Patient Advisor, who could speak Bengali. Other languages spoken by patients were catered for by the practice through the use of Language Line and a Bilingual Health Advocacy and Interpreting Service. The practice had a lead GP for substance misuse. Weekly substance misuse and alcohol clinics were provided for patients and the practice worked closely with the community drugs therapy team to provide this service. As part of the practice’s engagement with a social prescribing project within the borough, a Benefits Advisor provided sessions at the practice for patients requiring financial, employment and housing advice. Staff knew how to recognise signs of abuse in vulnerable adults and children and there was a lead GP for safeguarding. 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.