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Dr Wafik Moustafa Good Also known as Acton Town Medical Centre

Inspection Summary


Overall summary & rating

Good

Updated 11 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Acton Town Medical Centre on 5 December 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 a system in place for reporting and recording significant events. 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 clearly defined and embedded systems to minimise risks to patient safety.
  • Staff were aware of current evidence based guidance. Staff were appropriately trained and qualified and had the skills and knowledge to deliver effective care and treatment.
  • Results from the national GP patient survey were mixed. The practice consistently scored below average for the quality of consultations with clinical staff and for patient involvement in decision making. The receptionists were rated very highly for being helpful.
  • Information about services and how to complain was available. 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 routine appointments available within 48 hours.
  • 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 sought feedback from staff and patients, which it acted on.

The areas where the provider should make improvement are:

  • The practice should improve the management and control of diabetes among the practice population.
  • The practice should record the monitoring checks it routinely carries out in relation to the emergency oxygen and defibrillator.
  • The practice should ensure that the locum pack contains the key information that locum staff who are unfamiliar with the practice may need.
  • The practice generally scored well on the national patient survey. However, it tended to score below average on questions about patient involvement in decision making. The practice should investigate this aspect of its service further with a view to improving the patient experience.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 11 April 2017

The practice is rated as good for providing safe services.

  • There was an effective system for reporting significant events and action was taken to improve safety in the practice. When things went wrong patients received reasonable support, a clear explanation 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 to minimise risks to patient safety.
  • Staff demonstrated that they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.
  • The practice had arrangements to respond to emergencies and major incidents.

Effective

Good

Updated 11 April 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average for most indicators.
  • However, practice performance for certain key diabetes indicators was below average.
  • Staff were aware of current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills and knowledge 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.
  • The practice provided a range of health promotion services.

Caring

Good

Updated 11 April 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed that the practice tended to achieve patient ratings comparable to other practices in the local area.
  • The patients who participated in the inspection commented positively on the quality of care they had received and the kindness and professionalism of the staff.
  • Information for patients about the services was available in a range of formats.
  • The practice was aware of the needs of carers and was taking action to identify carers on the patient list and provide them with information and support.

Responsive

Good

Updated 11 April 2017

The practice is rated as good for providing responsive services.

  • The practice understood its population profile and had used this understanding to meet the needs of its population. For example, the practice facilitated good communication through the use of interpreting services.
  • The service was accessible to patients. 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.
  • Information about how to complain was available and a recent example showed the practice responded quickly to issues raised. Learning from complaints was shared with the patients concerned and the staff team.

Well-led

Good

Updated 11 April 2017

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

  • The practice had a vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about their responsibilities.
  • There was a clear leadership structure and staff felt supported by management. The practice had policies and procedures to govern activity and held regular governance meetings.
  • An overarching governance framework supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • Staff had received inductions, annual performance reviews and attended staff meetings and training opportunities.
  • The provider was aware of the requirements of the duty of candour and had applied this in the case of a recent example we reviewed.
  • The principal GP, and senior staff encouraged a culture of openness and honesty. Safety incidents were reported and shared and action taken to prevent recurrence.
  • The practice sought feedback from staff and patients and we saw examples where feedback had been acted on. The practice engaged with the patient participation group and welcomed patients' suggestions.
  • There was a focus on continuous learning and improvement at all levels. Staff had protected time for training.
Checks on specific services

People with long term conditions

Good

Updated 11 April 2017

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

  • The practice had identified patients with long term conditions and offered these patients a structured annual review to check that their health and medication needs were being met.
  • The practice had comparable results for most indicators of chronic disease management as measured by the Quality and Outcomes Framework (QOF) compared to other practices.
  • However, performance on diabetes was markedly below average. For example in 2015/16, 60% of diabetic patients had blood sugar levels that were adequately controlled compared to the CCG and the English averages of 78%. The practice was taking action to improve.
  • The practice participated in local schemes to reduce the risk of unplanned hospital admission. One of the GP partners attended regular multidisciplinary meetings where patients' cases were reviewed and their care plans updated to reflect any changes.  
  • The practice followed up patients with long term conditions following discharge from hospital and ensured that any care plan was updated to reflect any additional needs.
  • There were emergency processes for patients with long term conditions who experienced a sudden deterioration in health.

Families, children and young people

Good

Updated 11 April 2017

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

  • The principal GP was the safeguarding lead for the practice. There were systems in place to identify and follow up children at risk of abuse.
  • The practice prioritised young children and babies for urgent or same-day appointments. The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.
  • In 2015/16, 72% of practice patients with asthma had an asthma review in the preceding 12 months compared to the national average of 76%.
  • The practice provided child immunisations. Immunisation rates were above or close to the 90% targets for standard childhood immunisations. The practice liaised with the health visitors to follow up children who did not attend for immunisation.
  • Appointments were available outside school hours including on Saturday morning.

Older people

Good

Updated 11 April 2017

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

  • The practice offered 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 or longer appointments for those with enhanced needs.
  • The practice identified older patients requiring palliative care or at high risk of unplanned hospital admission. The practice regularly met with the district nurses and other professionals to review these patients' needs.
  • The practice provided an on-site phlebotomy service which reduced the need for patients to travel for health appointments. The practice organised community transport for patients without alternative means of transport to attend hospital or other health appointments. 
  • The practice identified and provided support to carers, for example offering regular health checks.
  • Older patients were provided with health promotional advice and support to help them to maintain their health and independence. For example, the practice offered eligible older patients the flu, shingles and pneumococcal vaccinations.
  • Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

Working age people (including those recently retired and students)

Good

Updated 11 April 2017

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

  • The needs of this group had been identified and the practice had adjusted the services it offered to ensure these were accessible.
  • Appointments at the practice were available until 6pm four days a week and from 9am to 12 noon on Saturday morning. Telephone consultations were also available daily. There was an online booking and electronic prescription service. The practice sent text reminders to patients who had signed up for these when appointments and reviews were due.
  • The practice offered health promotion and screening services appropriate for this group, for example NHS health checks to adults aged 40-74. The practice had identified obesity as an area for action and provided educational advice and support and referrals to specialist bariatric services. 
  • The practice cervical screening coverage rate was 80% compared to the CCG average of 79% and the national average of 81%.

People experiencing poor mental health (including people with dementia)

Good

Updated 11 April 2017

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

  • In 2015/16, all six patients diagnosed with dementia had their care reviewed in a face to face meeting within the last 12 months.
  • Patients identified as at risk of dementia were assessed and referred to the local memory clinic. Patients with dementia were offered regular reviews at the practice.
  • The practice carried out advance care planning with patients living with dementia and their carers.
  • 89% (16 of 18) patients diagnosed with psychosis had a comprehensive, agreed care plan documented in the record, within the last 12 months. The national average of 89%.
  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
  • 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 were familiar with the locally agreed NHS mental health crisis 'pathway'.
  • Patients with long term mental health problems were able to meet with the psychiatric nurse at the practice for regular follow-up.
  • The practice had information available for patients experiencing poor mental health about how they could access counselling services, various support groups and voluntary organisations.

People whose circumstances may make them vulnerable

Good

Updated 11 April 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 those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability and other complex needs. All practice patients with a learning disability had attended for a health check and review within the last 12 months.
  • The practice worked with other health care professionals for example health visitors, in the management of vulnerable patients.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations. For example, it had referred patients at risk of becoming homeless to the local branch of a national homeless charity.
  • Staff interviewed knew how to recognise signs of abuse in vulnerable adults and children. 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.
  • The practice recognised the needs of carers. The practice had a designated 'carer champion', staff had received awareness training and the practice provided carers with information about the support available to them.