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The Willesden Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 13 April 2018

We carried out an announced comprehensive inspection at The Willesden Medical Centre on 27 October 2015. The overall rating for the practice was Good, with a rating of Requires Improvement in the Safe domain. The full comprehensive report on the Month Year inspection can be found by selecting the ‘all reports’ link for The Willesden Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced desk-based review carried out on 31 January 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 27 October 2015. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At this inspection, we found that the practice arrangements in relation to medicines management had improved. Consequently, the practice is now rated as good for providing safe services.

Our key findings were as follows:

  • The practice had implemented a system to monitor the expiry dates.

  • The practice had implemented a system to ensure that all fridge temperatures in the practice were checked; however, there were gaps in record books provided.

  • The practice had implemented a standard training record system which recorded all staff training.

  • The practice had reviewed arrangements for patients to access appointments. Patients could now book appointments via Patient Access, an online service where they could book appointments. They also offered extended hours twice a week and patients could also attend booked appointments at their local HUB service.

  • The practice used an interpreting service available to all patients who required it.

  • The practice had reviewed and updated their recruitment policy to include a checklist to ensure all recruitment checks adhered to the recruitment policy.

The areas where the provider should make improvements are:

  • Review the newly implemented system of fridge temperature checks to ensure there are no gaps in monitoring.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 13 April 2018

Effective

Good

Updated 18 March 2016

The practice is rated as good for providing effective services.

  • Data showed patient outcomes were at or above average for the locality.

  • 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. However, records of training did not identify all the training staff had undertaken or needed to complete

  • There was evidence of appraisals and personal development plans for all staff.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of people’s needs.

Inspection report


Caring

Good

Updated 18 March 2016

The practice is rated as good for providing caring services.

  • Data showed that patients rated the practice higher than others for several aspects of care.

  • 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 easy to understand and accessible.

  • We also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Inspection report


Responsive

Good

Updated 18 March 2016

The practice is rated as good for providing responsive services.

  • It 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.

  • Results from the GP survey showed that

  • 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 that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Inspection report


Well-led

Good

Updated 18 March 2016

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

  • It 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 this.

  • 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 partners encouraged a culture of openness and honesty. The practice had systems in place for knowing about notifiable safety incidents

  • 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.

Inspection report


Checks on specific services

People with long term conditions

Good

Updated 18 March 2016

The practice is rated as good for the care of people with long-term conditions. The practice utilised chronic disease monitoring templates to ensure the uniformity of health checks for patients with long term conditions. Alerts on the system highlighted outstanding health checks, GPs and admin staff generated recalls to patients. All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

Inspection report


Families, children and young people

Good

Updated 18 March 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. Immunisation rates were relatively high for all standard childhood immunisations. Non-attenders for immunisations were followed up by telephone. Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. We saw good examples of joint working with midwives and health visitors including weekly antenatal and child health clinics. Postnatal examinations for babies at six weeks had a dedicated afternoon clinic with longer appointments. Appointments were available outside of school hours and the premises were suitable for children and babies. The practice worked with the Children Adolescents Mental Health Service (CAMHS) and a local young people and adolescent centre for emotional support. The services could be signposted or referred to as needed.

Inspection report


Older people

Good

Updated 18 March 2016

The practice is rated as good for the care of older people. It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

The practice carried out proactive care planning with a named GP offering continuity of care to patients over the age of 65. They worked closely with a rapid response nursing team to avoid hospital admissions; GPs’ could refer patients to the team. Patients were usually seen and reviewed within four hours; management of patients was discussed with an Accident and Emergency Consultant. There was feedback to the GP either for on-going daily care, or the patients were either discharged back to the GP or admitted to hospital as required.  The practice used the BIRT2 tools to identify patients at risk. Patients categorised as being high risk were managed by the named GP who carried out medical reviews and, care plans were agreed with the patients in conjunction with carers where necessary. There was an Integrated Care Co-ordination Service (ICCS) to support vulnerable older patients and facilitate access to a range of services. The practice ICCS co-ordinator attended quarterly meetings, to discuss patients supported by the service.

Inspection report


Working age people (including those recently retired and students)

Good

Updated 18 March 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. Patients were able to access late evening commuter surgeries two evenings per week, as well as a Thursday morning walk-in clinic. Text messages are sent out to patients the day before booked appointments as a reminder. 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. This included on-site services such as minor surgery, counselling for patient convenience and accessibility, and health checks for eligible adults.

Inspection report


People experiencing poor mental health (including people with dementia)

Good

Updated 18 March 2016

The practice is rated as good for the care of people experiencing poor mental health including people with dementia. The practice regularly worked with multidisciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice followed the local memory services recommendations for dementia screening, they arranged extended appointments to meet with the patient and supportive family members. Eighty seven percent of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It 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 people with mental health needs and dementia. Patients could self-refer or be referred to an on-site improving access to psychological therapies (IAPT) clinic.

Inspection report


People whose circumstances may make them vulnerable

Good

Updated 18 March 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 homeless people, and those with a learning disability. The practice offered registration to homeless people and immediate access to appointments. There was a neighbouring practice that provided specialists services to homeless people, that they could be signposted to.

It offered longer appointments for people with a learning disability and carers, facilitated appointments for support workers and completed referrals into secondary care for dentistry.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people, at monthly and quarterly meetings. It had told 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 had recruited ICP nurses to complete care-plans for patients assessed as being most at risk.

Inspection report