Well Street Surgery

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that staff involved people in decisions about their care and treatment and provided them with advice and support. Staff regularly reviewed people’s care and worked with other services to achieve this.

At our last assessment in January 2016, we rated this key question as Good. At this assessment, the rating remains Good.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people’s care and treatment were effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The practice had an Accessible Information Standard policy in place and offered double appointments for patients with a learning disability, mental health conditions or those requiring interpreter assistance. A digital alert system on patient profiles flagged individual vulnerabilities, communication needs and preferences when records were accessed, enabling staff to tailor assessments from the outset. The practice used CEG searches and prevalence data to proactively identify patients at risk of developing long-term conditions, and maintained a carers register of 329 patients who were offered flu vaccinations and signposted to the local carers centre. Staff could refer patients with broader social needs to the PCN social prescriber. Universal Care Plans were in place for patients approaching end of life, with DNACPR decisions documented. Feedback from the NHS Friends and Family Test (August 2024) showed 85% of patients rated the practice as good or very good. The Healthwatch Hackney Enter and View visit (October 2024) found that patients generally reported good quality of clinical care. During our inspection, patients we spoke with expressed satisfaction with how their needs were assessed and no concerns were raised.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The practice was a teaching and training practice hosting GP registrars. Weekly clinical meetings provided a forum for discussing clinical issues and sharing learning, with minutes seen during the inspection. Clinical staff used EMIS templates for care reviews, and our review of long-term condition records demonstrated care delivered in line with current NICE guidance. The practice pharmacist maintained an up-to-date MHRA safety alerts log on Microsoft Teams, and a prescribing lead was in place. Prescribing data reviewed as part of our assessment showed broad-spectrum antibiotic prescribing within normal statistical variation.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The practice held monthly multidisciplinary team meetings led by the palliative care lead, involving district nurses and community matrons, with clinical targets discussed and care coordinated for patients with complex needs. The practice also held monthly Mental Health meetings with the local Community Mental Health team, attended by a lead GP, to discuss complex patients and provide a direct interface with secondary care. The safeguarding lead held regular meetings with health visitors where concerns were shared. Referrals to secondary care were managed by a dedicated secretary with oversight from a named partner, and the practice worked within the Primary Care Network, sharing resources including a mental health nurse and Freedom to Speak Up guardian. The practice had engaged with PCN peer support meetings and the ICB QI lead as part of a structured workforce wellbeing quality improvement project, demonstrating collaborative working across practices to drive improvement. The Turkish clinic demonstrated collaborative working tailored to the needs of the local community.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and, where possible, reduce their future needs for care and support.

The practice offered NHS health checks conducted by healthcare assistants and nurses, with patients invited proactively. They also hosted the Together Better programme, a community engagement initiative offering weekly activities for patients including a coffee morning, walking group, chair yoga sessions and arts and crafts. The inspection team observed the coffee morning during the assessment. The triage system supported timely access, and enhanced access clinics were available on Tuesday evenings and the first Saturday of each month. Information about healthy living, support groups, screening programmes and community services was displayed in the reception areas. The practice used Clinical Effectiveness Group (CEG) searches and prevalence data to identify and monitor patients with or at risk of developing long-term conditions, with QOF lead overseeing recall.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Cervical screening coverage at the time of inspection was above the national average, at 80% for women aged 25 to 49 and 89% for women aged 50 to 64, supported by a recall system using automated messaging and telephone follow-up for non-responders. Childhood immunisation coverage was below the national target of 96% across all indicators (DTP 81%, MMR 71%, and the 1 to 5 year booster 52%). The practice serves a highly diverse, inner-city population in the 3rd decile of deprivation, and the below-target coverage reflected well-documented local factors, including cultural and community-level vaccine hesitancy and high population mobility, which are recognised across similar practices in the area and are not wholly within the practice's control. The practice had an active recall system in place and worked with community partners to promote uptake. Following the inspection, the provider produced a targeted childhood immunisation improvement plan, including community outreach and engagement with trusted local voices, which is reflected under Learning, Improvement and Innovation. Our review of long-term condition records, including for CKD, diabetes and hypothyroidism, demonstrated appropriate monitoring in line with national guidance. Partners had clinical oversight of test results, and our review of the global workflow confirmed acceptable management of laboratory results, with electronic prescriptions up to date. Clinical records were maintained on the EMIS system using templates for care reviews, and staff had completed information governance training.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff understood and applied legislation relating to consent. Clinical staff had completed Mental Capacity Act training, and clinicians demonstrated awareness of Gillick competency and Fraser guidelines when consulting with young people. A Duty of Candour policy was in place and accessible to all staff on the internal system. Patients who needed support with communication and decision-making could access interpreter services through Language Line, British Sign Language and telephone and in-person advocacy services for Bengali Sylheti speakers through the Community Advocacy Service, and Turkish-language advocacy through the weekly clinic provided by Derman.org.uk.