Archived: Westbury Road Medical Practice

Updated 1 February 2017

Westbury Road Medical Practice is a GP practice in the London Borough of Newham, to the east of London. The practice is part of the London Borough of Newham Clinical Commissioning Group (CCG) and provides primary medical services through a General Medical Services (GMS) contract with NHS England to around 4300 patients.

The practice is housed within a converted, formerly residential building situated in a residential area. The building is owned and managed by NHS property services. The practice is easily accessible by public transport. It doesn’t have a designated car park and parking on surrounding streets is generally for permit holders only. However there are public car parks within walking distance of the practice. There are plans in place to relocate the practice to a new purpose built building by December 2017.

The practice has an ethnically diverse patient population predominantly; Bangladeshi 62%, Pakistani 11%, Indian 6%, Afro-Caribbean 4%, British white/white other 3%. The practice locality is in the 3rd more deprived decile out of 10 on the deprivation scale. Newham residents have lower life expectancy and higher rates of premature mortality than other borough in London. The main causes of death in Newham are cardiovascular disease, cancer and respiratory disease and the levels of diabetes are among the highest in the country. Newham is the third most deprived local authority area in England.

Clinical services are provided by two male GP partners (seven sessions each) and two female locum GPs (two sessions each). Non-clinical services are provided by a practice manager, a female practice nurse, a female healthcare assistant and five administrative/reception staff.

The practice is a teaching practice. It teaches year two and year fourmedical students. The practice also recruits apprentices from Newham College.

The practice is open from 9am every week day except Wednesday when it closes in the morning and opens at 2.30pm. It closes at 2pm on Thursday, 6.30pm on Monday and Friday and 7pm on Tuesday and Wednesday. Consulting times are from 9am to 1pm and 4.30pm to 6.30pm every weekday except Wednesday when there is no morning clinic and Thursday when there is no afternoon clinic. Out of hours services are provided through the Newham GP Cooperative which can be contacted via a dedicated local number. When the practice is closed calls are automatically diverted to the out of hours service. Patients can also access services through the extended hours and additional capacity services which operate locally.

The practice is registered to carry out the following regulated activities: Diagnostic and screening procedures, Maternity and midwifery services, Treatment of disease, disorder or injury from 45 Westbury Road, London E7 8BU.

Westbury Road Medical Practice has not been inspected previously.

Updated 1 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Westbury Road Medical Practice on 14 November 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. However processes in place to ensure patients with Peripheral Arterial Disease were effectively monitored required review.
• 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.
• Patients 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.
• 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. However further attention to patient experiences as reflected in the results of the GP patient survey was necessary.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Carry out a thorough analysis of the significant events to identify any trends.

• Review registers and levels of exception reporting for Peripheral Arterial Disease to ensure patients receive safe care and treatment that met their needs.

• Assess, monitor and improve the quality of the service with particular regard to the experiences of people who use the service.

• Take further steps to encourage patients with caring responsibilities to identify themselves.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 1 February 2017

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

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

• Processes in place to ensure patients with long term conditions were effectively monitored required review, specifically in relation to Peripheral Arterial Disease.

• Quality and Outcomes Framework (QOF) performance in 2015/16 for diabetes related indicators was 94% which was in line with the CCG average of 86% and the national average of 90%.

• One of the GPs was a diabetic specialist and initiated insulin.

• Longer appointments and home visits were available when needed.

• 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.

• Patients were signposted to the appropriate agencies for lifestyle management including weight management, smoking cessation and alcohol misuse.

Updated 1 February 2017

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.

• 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.

• The practice’s uptake for the cervical screening programme was 80%, which was comparable to the CCG average of 81% and the national average of 82% (01/04/2014 to 31/03/2015).

• Appointments were available outside of school hours and the premises were suitable for children and babies. Same day consultations were available for children. They were given priority appointments or the evening clinics.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

• A breastfeeding room could be provided on request.

Updated 1 February 2017

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.

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

• High risk patients discharged from hospital were followed up to avoid further admissions. Medication and social needs were reviewed and discussed at multi disciplinary team meetings if necessary.

• End of life care plans were discussed where appropriate and multi disciplinary care plans were recorded in the clinical system which was accessible to all relevant health and social care parties.

Updated 1 February 2017

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.

 Late afternoon appointments were available on Tuesday and Wednesday evenings (until 7pm). Patients could also access late evenings and weekends appointments through the GP cooperative as part of the extended-hours service.

Updated 1 February 2017

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

• 73% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the CCG average of 77% and the national average of 78%.

• Quality and Outcomes Framework (QOF) performance in 2015/16 for mental health related indicators was 87% which was in line with the CCG average of 87% and the national average of 93%.

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

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

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• 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.

Updated 1 February 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.

• 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 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.