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Inspection Summary


Overall summary & rating

Good

Updated 10 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Woolstone Medical Centre on 4 August 2016 and 1 September 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. However, fire extinguishers at the practice had not been serviced.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. However, the practice did not keep a centralised record that all relevant training had been completed.
  • 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.
  • The provider was aware of and complied with the requirements of the duty of candour.

We saw the following areas of outstanding practice:

  • The practice had received feedback from patients with poor mental health and learning disabilities that they felt that a patient waiting room could feel congested and leave them feeling nervous. As a result the practice had :

  • Designed and introduced a quiet room adjacent to the wating room next to the reception area. This allowed patients to wait in a quiet and secluded area. The practice staff had received training from the Rethink mental health charity, and they had used this training when designing the room.

  • Across the road from the practice was a care home for patients with complex learning disabilities. As well as the quiet room, the practice had put in place a system whereby patients could be called from by the doctor directly from the home, preventing them from having to wait for their appointment. The practice had received positive feedback from patients with poor mental health, vulnerable patients and carers in relation to these changes.

  • The practice provided details of specific training with which staff had been provided to better provide services to patients, including autism and dementia awareness.

  • One member of the reception team had been trained in grief counselling and was a point of contact for these patients.

The areas where the provider should make improvement are:

  • The practice should arrange for fire extinguishers in the practice to be serviced on an annual basis.

  • The practice should consider keeping a local record of all relevant training completed by staff in the practice.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 10 November 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events.

  • Lessons were shared to make sure action was taken to improve safety in the practice.

  • When things went wrong patients received reasonable support, truthful information, 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 in place to keep patients safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 10 November 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement.

  • Through improved read coding the demetia diagnosis rate had been increased 25% in 2014 and 50% (equivalent to 26 patients) in 2015.

  • Staff had the skills, knowledge and experience 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.

Caring

Good

Updated 10 November 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed 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 saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Outstanding

Updated 10 November 2016

The practice is rated as outstanding for providing responsive services.

  • Practice staff 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, including involvement in pilot projects.

  • After feedback the practice had developed systems to assist patients with learning disabilities and poor mental health who were waiting to be seen by a doctor. The practice had also provided training for staff.

  • 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 easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 10 November 2016

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

  • The practice 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 it.

  • 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 provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken

  • 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.

Checks on specific services

People with long term conditions

Good

Updated 10 November 2016

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.

  • Performance for diabetes related indicators was similar to the national average. The practice had scored 87% for diabetes related indicators in the last QOF, similar to the national average of 89%.

  • The practice had implemented the year of care programme for patients with long term conditions, and reported improved outcomes from having done so. For example, in patients with hypertension, the percentage of patients whose blood pressure was below 140/80 had increased from 73% to 82%.

  • 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.

Families, children and young people

Good

Updated 10 November 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.

  • 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 80% and the national average of 82%.

  • Following a reduction in the provision of family planning clinics in the local area, the practice had increased its capacity to provide family planning advice in the surgery by 45%.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

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

Older people

Good

Updated 10 November 2016

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.

  • The practice was involved in the Lewisham Frailty Pilot scheme which helped identify patients for the admissions avoidance programme.

  • Patients over 75 had named GPs.

Working age people (including those recently retired and students)

Good

Updated 10 November 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.

  • 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 10 November 2016

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

  • Performance for mental health related indicators was similar to the national average. The practice had scored 87% for mental health related indicators in the last QOF, which was similar to the national average of 93%.

  • The practice had designed and introduced a quiet room adjacent to the waiting room next to the reception area. This allowed patients to wait in a quiet and secluded area. The practice staff had received training from the Rethink mental health charity, and they had used this training when designing the room.

  • 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.

People whose circumstances may make them vulnerable

Good

Updated 10 November 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, 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.

  • There was a care home for patients with complex learning disabilities near the practice. The practice had built a quiet room where these patients could wait before consultations. They had also put in place a system whereby patients could be called from by the doctor directly from the home, preventing them from having to wait for their appointment.

  • The practice provided details of specific training with which staff had been provided to better provide services to patients, including autism awareness.

  • One member of the reception team had been specifically trained in grief counselling and was a point of contact for these patients.

  • 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.