Archived: The Stroudley Walk Health Centre

Updated 16 November 2017

Stroudley Walk Health Centre operates from 38 Stroudley Walk, London, E3 3EW. The practice provides NHS primary medical services through a Primary Medical Services contract to just over 4,000 patients in the Tower Hamlets Area. The practice is part of the Tower Hamlets Clinical Commissioning Group (CCG). It comprises of two full time male GPs, a part time female GP (a combined total of 25 sessions), two practice nurses (one of which was an independent nurse prescriber), three healthcare assistants, a practice manager, reception manager and a small team of administrative staff. The practice is a training practice. At the time of inspection there were no medical student, foundation year or GP registrar placements.

The practice has level access from the road and has a ground floor only. There are good bus and rail links close to the practice and some parking spaces for disabled people close by. It has a waiting room in front of the main reception desk.

The practice has no branch surgeries but is part of the MEEBBB Health network of five practices in the CCG. It has a high proportion of patients who are non-English speaking or whose first language is not English and a higher than average younger population but a lower than average older population.

The practice had a higher than average percentage of patients between the 20 - 39 year age group but a lower than average percentage of patients between the 45 -85 or over age group.

The practice is in an area with a high deprivation weighting. The Indices of Multiple Deprivation score is two. The lower the Indices of Multiple Deprivation decile, the more deprived an area is.

The practice is registered with the CQC to provide the regulated activities Diagnostic and screening procedures, Family planning, Maternity and midwifery services, Surgical procedures and Treatment of disease, disorder or injury.

The practice reception and surgery opening hours were:

Monday, Wednesday, Thursday, Friday: 8am – 7pm

Tuesday: 8am – 6.30pm

The second Monday of each month the practice is closed for an hour for training between 1-2pm.

Saturday and Sunday: Closed

The practice website stated that GP appointments were available from 8.00am until 6.50pm Monday, Wednesday, Thursday and Friday. Tuesday 8.00am to 5.30pm.

Extended appointments can be made on any day when the practice is open.

If the practice is closed there is a number patients can call to obtain the Out of Hours service contact details. This is also on the practice leaflet and website.

The practice was previously inspected in November 2014. All domains were rated as good and this inspection was to ensure that the practice were maintaining standards. At that inspection there were a small number of areas identified that the provider needed to improve and we found these had been addressed.

Updated 16 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stroudley Walk Health Centre on 10 October 2017. Overall the practice is rated as good.

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

• Staff were aware of current evidence based guidance.
• Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• There were good staff recruitment processes although not all staff had a documented induction or had received an appraisal.
• Results from the most recent national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment in relation to nurses but there was a negative variation for GP consultations.
• The practice had clearly defined and embedded systems to minimise risks to patient safety although we found two patients on high risk drugs (for example warfarin and lithium) that had a longer than recommended gap between monitoring. Patient Group Directions (PGDs) used by the nurse needed to be updated.
• The practice had arrangements in place to manage medical emergencies but we found that although checks were made and recorded against emergency equipment, the adult defibrillator pads had passed their expiry date and no child pads were available. There were no emergency drugs carried in the doctors emergency bag but no risk assessment had been carried out to identify whether this was appropriate.
• Information about services and how to complain was available although details of the local NHS complaint advocacy organisation, NHS England and the Ombudsman were not consistently included in responses. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day and the option to use a new online service (WebGP), to communicate with a GP.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events although the threshold for reporting an incident was high and included only poor practice.
• The practice premises were clean, maintained and equipped to treat patients and meet their needs. There were plans in place for new practice premises in 2018.
• 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
• The practice had a quality improvement programme although most audits were one cycle.
• We found that the vaccine fridge temperature was monitored but occasionally this went above the maximum recommended limit but with no explanation or check for how long this lasted.

The areas where the provider should make improvement are:

• Review the threshold for significant event reporting in line with best practice guidance.

• Review the monitoring of patients on high risk drugs and availability of emergency equipment and medicines. Update the relevant PGDs.

• Review the results of the GP Patient Survey for GP consultations and consider if further improvement can be made to outcomes in those areas.

• Review the monitoring and recording of the vaccine fridge temperature to ensure products are stored in line with the manufacturer’s guidance at all times.

• Review complaint responses to ensure details of local NHS complaints advocacy, NHS England and the Ombudsman are always referenced.

• Review the staff appraisal system so that all staff whether or not part time have the opportunity for annual appraisal.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 November 2017

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.

• The practice was comparable to other practices in relation to their diabetes indicators.

• 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.

Updated 16 November 2017

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

• 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.

• Immunisation rates were relatively high for all standard childhood immunisations.

• 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 by providing home visits and discussion of needs at multi-disciplinary meetings.

  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.

• The practice was also planning to become part of the YOU'RE WELCOME pilot. YOU’RE WELCOME 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. It aims to help improve access to health services for marginalised groups. It helps staff to become more inclusive giving them the confidence to engage with young people.

Updated 16 November 2017

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.

• All patients had a named GP.

• 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, the community nurses or the mental health team and held multi-disciplinary meetings to discuss complex care needs, including with a local consultant for older people.

• 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, prevention of falls and referral to relevant community services.

Updated 16 November 2017

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 Monday to Friday but is closed at weekends. Patients can also use a local NHS walk in centre.

• 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 had also increased their uptake of online services and had recently commenced WebGP, an option for online consultation with a GP which the practice aims to respond to within 24 hours.

Updated 16 November 2017

The practice is rated as good 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, an assessment of the risk of a fall, an annual care plan and comprehensive medication review.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs although we found that two patients who were prescribed Lithium and had a longer than recommended gap between monitoring.

• The practice was comparable to or better than other practices nationally for their mental health indicators.

• 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.

Updated 16 November 2017

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 homeless people, travellers and those with a learning disability.

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

• 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.

• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• 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.