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Dr Creme and Partners Good Also known as Paddington Green Health Centre

Inspection Summary


Overall summary & rating

Good

Updated 18 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Purssell and Partners on 3 March 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. Staff had 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.
  • Patients said they found it easy to make an appointment with a named GP and that 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 one area of outstanding practice:

The practice had developed a successful partnership with a local community trust. This was part of the practice’s strategy to attend existing patient groups outside the practice – to go to the patients. The practice has supported the group financially and practically to offer training to its members to give them the confidence to speak about their experiences of patient care and to be part of helping to improve it. There were plans for the trust to work with practice staff to help them to be aware of the different needs of patients from ethnically diverse backgrounds

The areas where the provider should make improvement are:

  • Complete a written policy on safeguarding of vulnerable adults and arrange relevant formal training for all practice staff.
  • Consider the completion of practice DBS checks for GPs, rather than relying upon the ‘GP Performers List’ for confirmation of such checks.
  • When carrying out regular fire drills, identify in the evacuation reports who participated in the exercise and how long it took.
  • Ensure arrangements in hand for the completion of outstanding staff appraisals are concluded by the end of the current reporting year.
  • Advertise translation services are available.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 18 May 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 there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and 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. Although staff understood their responsibilities for safeguarding, there was no written policy on safeguarding of vulnerable adults and the majority of practice staff had not completed formal training in this area. However, the practice was awaiting a centrally developed policy and advice on training from the CCG

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  • The practice carried out pre-employment checks for all staff, although it relied on the ‘GP Performers List’ for confirmation of DBS checks. The completion of its own DBS checks for GPs would provide more up to date information and additional assurances.
  • Risks to patients were assessed and well managed. The practice had up to date fire risk assessments and carried out regular fire drills, although it would be helpful to the practice for ongoing monitoring and review to identify in the evacuation reports who participated in the exercise and how long it took.

Effective

Good

Updated 18 May 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed the majority of patient outcomes were at or above average for the locality and compared to the national average. The practice had taken action to address areas where there were less favourable ratings.
  • 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.
  • There was evidence of appraisals and personal development plans for all staff. Due to the impact of an influx of new patients to the practice, appraisals for the current year were outstanding for several staff. Arrangements were however, in hand for their completion by the end of the reporting year.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 18 May 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.

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Responsive

Good

Updated 18 May 2016

The practice is rated as good 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. For example, under a new local service from the CCG, the practice was organising an improved service with regular review, working with the local psychiatric primary care liaison nurse to provide a better quality of care plan, and also address physical health needs.
  • 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 offered an all-day emergency triage service.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. The practice had put particular focus on enhancing the surgery environment including art work and poetry. The practice was working with a living artist to place his work in the practice; staff and patients were involved in this project.
  • 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 18 May 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 this and had contributed to the practice’s recently developed mission statement.
  • 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 knowing about 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 (PPG) was active but the practice was seeking to broaden patient engagement by setting up a ‘virtual’ PPG.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 18 May 2016

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

  • The prevalence of patients with long term conditions such as Chronic obstructive pulmonary (COPD), diabetes, Chronic heart disease (CHD), and atrial fibrillation was above average for the CCG and reflected the social deprivation in the population locally.
  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. One of the practice nurses had respiratory expertise and undertook spirometry, asthma and COPD reviews.
  • There was a twice weekly anticoagulation clinic for the practice’s patients and also patients from neighbouring practices.
  • The practice performance for the majority of 2014/15 QOF indicators for long-term conditions was above average including diabetes related indicators.
  • Longer appointments and home visits were available when needed.
  • All these patients had a structured review at least annually with either the GP or nurse to check their health and medicines needs were being met. For those patients with the most complex needs, the practice worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 18 May 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. The practice worked with the local Multi-Agency Safeguarding Hub (MASH) to provide information in a timely way.
  • Immunisation rates were relatively high for all standard childhood immunisations.
  • 78% patients with asthma, on the register, have had an asthma review in the last 12 months that includes an assessment of asthma control. This was comparable with the national average of 75%.
  • The practice’s uptake for the cervical screening programme was 83%, which was comparable to the national average of 82%.
  • 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, and health visitors. The practice provided child health surveillance with immunisations, baby clinics and regular multidisciplinary team meetings weekly with health visitors. The practice had a system of GP telephone triage of all acute requests for urgent or same day appointments, giving an opportunity for timely telephone advice and the ability to organise same day face to face assessments.
  • The practice worked with local paediatricians to pilot and develop joint working. There was a monthly clinic at the practice for their patients, followed by a multidisciplinary team meeting. This subsequently evolved into the Connecting Care for Children initiative which had spread the model to CCGs in North West London.

Older people

Good

Updated 18 May 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 provides support to patients living in supported housing who have complex needs.
  • Regular 30 minute appointments are provided to elderly frail patients, in part to produce a more effective shared care plan with the patient, but also to deal with the multimorbidity problems of these patients and the fact that they need a more multidisciplinary intervention in order to stay well. These clinics may be held in the surgery or in the patient’s home according to need.
  • There are weekly reviews of older people in the practice’s multidisciplinary team meetings and monthly at ‘village’ meetings (wider multidisciplinary team working across the immediate locality).
  • The practice monitors admissions to hospital and ensures a review within 48 hours of discharge. They also make use of the local Rapid Response Nursing service to try and look after patients at home effectively and safely and if possible avoid hospital admission.
  • The practice provides on the day telephone access to a clinician to all patients between 8.00am and 6.30pm, focussing in particular on the older patient group.

Working age people (including those recently retired and students)

Good

Updated 18 May 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 reflected the needs for this age group.
  • There were two late evening surgeries weekly (6.30-8.30pm). The main surgeries started at 8.30am giving opportunities for early appointments for those who wished to attend before work. The practice also took regular telephone appointments.
  • The practice offered NHS Health checks to 40-75 year olds and had had a good uptake, reaching 378 people.
  • GP services were provided to the students from the Royal Academy of Music. The principal GP partner was an associate member of the British Association of Performing Arts Medicine and had expertise in diagnosing and treating performance related injuries. These patients were offered same day appointments and the practice worked regularly with the counsellor and teaching staff at the Academy to improve the service.

People experiencing poor mental health (including people with dementia)

Good

Updated 18 May 2016

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 had had their care reviewed in a face to face meeting in the last 12 months, which was below the national average of 84%. However QOF performance for mental health related indicators as a whole was above the CCG and the same as the national average.
  • The practice had in-house counsellors and hosted the Improving Access to Psychological Therapies (IAPT) team within the building, with whom they discussed patients in the MDT setting They also worked closely with the psychiatry team for those patients with behavioural problems
  • The practice carried out advance care planning for patients with dementia. Under a new local service from the CCG, the practice was organising an improved service with regular review, working with the local psychiatric primary care liaison nurse to provide a better quality of care plan, and also address physical health.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. There was 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. Staff had received dementia awareness and Mental Capacity Act training. The practice had identified 72 patients with dementia and referred them to the Memory Clinic for diagnosis as appropriate.
  • The practice had undergone a dementia awareness audit and would shortly be introducing improved signage and patient friendly décor as part of their action plan.

People whose circumstances may make them vulnerable

Good

Updated 18 May 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 longer appointments for patients with a learning disability and carried out annual health checks on them.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
  • Carers were identified and offered a connection to the local Carer’s’ Network, as well as influenza immunisation.
  • The practice worked with two local hostels, mental health and alcohol teams to identify and support homeless people. They also worked with outreach workers for a small number of patients with Drug and Alcohol issues. This included substitute opiate prescribing, seeing them with the outreach worker on a fortnightly basis.
  • 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.