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Inspection Summary


Overall summary & rating

Good

Updated 13 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Well Centre on 19 January 2017. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

  • The Well Centre is a unique GP practice, specifically looking after 11-20 year olds, it does not provide the normal care or range of service that could be found in another practice, for example there is no patient list, and the practice does not provide acute/emergency care.

  • There was an open and transparent approach to safety and an effective system 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 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.
  • 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.
  • The practice worked closely with other organisations such as local youth centers, local secondary schools, and the Child and Adolescent Mental Health Service (CAMHS) nurse, to provide counselling to the young population target group (11-20 year olds).
  • They received referrals from other GPs, schools, and hospitals which ensured that people living in vulnerable circumstances were able to receive medical care to suit their needs.

  • There was an active young people’s panel who had input into the practice service design, layout, use of space and decoration. As a result the environment of the practice was youth friendly. For example, they had a games console, board games, an interactive whiteboard for drawing/expressing feelings, large television on the wall, colouring paper, pens, music playing in the background, all of which helped in making the practice feel like a relaxed warm homely environment.

  • The practice was part of the diabetes transition project, which supported 40 young people with Type 1 Diabetes.The Well Centre did a pilot with Kings Health Partners, working with community youth workers and hospital teams to provide individualised support. As a result of this project they had reduced HbA1c (measurement of average blood sugar levels to by 1.5%)

  • The practice set up specialist workshops and lessons with youth workers and nurses. For example, an anxiety workshop was set up as they had identified this was a key theme for many young people attending The Well Centre. The workshops helped patients cope with depression and stress. Last year, January 2016 to December 2016, 129 young people attending The Well Centre had issues relating to anxiety. Other workshops were also set up, topics covered included; alcohol, diet, healthy eating, exercises, smoking, drugs and safe sex.

We saw an area of outstanding practice:

  • The practice provided emotional support to patients by sending youth workers out to local secondary schools, to promote young people’s health. Issues they discussed included healthy relationships, sexual health, substance misuse and stress management. Feedback forms were received from 30 students who were asked to score on a scale of 1 to 10 of how useful they found the session (with 10 being very useful), the average score for the practice was 8.8. The practice delivered drop-in counselling sessions to schools where young people could receive one-to-one youth work support.The sessions took place weekly in term time. From January 2016 to December 2016 a total of 50 drop-in sessions were provided with a total attendances of 558 young people.

The areas where the provider should make improvement are:

  • Review the business continuity plan to ensure staff contact details are available.

  • Continue to review the risk assessment in relation to the emergency procedures for the 11-20 year old population group, for example patients with diabetes.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 13 April 2017

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 13 April 2017

The practice is rated as good for providing effective services.

  • 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.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

  • From January 2016 to December 2016 a total of 122 young people accessed the psychiatric nurse for counselling support.

  • The practice had devised its own unique assessment template. Appropriate follow-ups for the outcomes of health assessments and checks were made, where abnormalities or risk factors were identified.

Caring

Good

Updated 13 April 2017

The practice is rated as good for providing caring services.

  • 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

Good

Updated 13 April 2017

The practice is rated as good for providing responsive services.

  • The practice was dedicated to young people, providing a service that enabled 11-20 year olds access to health advice, including counselling, sexual health and mental health.

  • 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.

  • Patients said they found it easy to make an appointment with a GP 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.

  • The practice sent youth workers out to local secondary schools, to promote young people’s health and the service the practice provided.

  • The practice set up a diabetes transition project with the aim of establishing a strategic role for youth work in supporting 14-21 year olds with Type1Diabetes.

  • The practice set up workshops, for example anxiety workshops as they had identified a number of patients with anxiety issues.

  • The environment of the practice was specially aimed at young people; they had a games console, interactive whiteboard for drawing/expressing feelings, music, and warm welcoming environment.

  • Three afternoons a week, Monday, Wednesday and Friday, young people were offered drop-in clinical consultations with GPs, youth workers and a mental health nurse. Small group work on health issues (run by youth workers) took place on days when there was no-drop-in session.

  • The practice had patient feedback cards and ran surveys monthly to improve patient’s needs.

  • The practice used text messages to send appointment reminders.

Well-led

Good

Updated 13 April 2017

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 lead GP 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 youth forum 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 13 April 2017

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

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

  • A diabetes transition Project was set up with the aim of establishing a strategic role for youth work in supporting 14-21 year olds with Type 1 Diabetes.

  • All patients could see a GP and all patients were given a structured “teen health check” to review to their health and medicines needs were being met. For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 13 April 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 Accident and Emergency (A&E) attendances.

  • 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.

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

  • We saw positive examples of joint working with youth workers and local schools.

  • In the last financial year The Well Centre supported over 500 young people, of which over 300 were attending for the first time.

  • The practice was piloting a family support service with the aim of improving mental health outcomes for young people.

Working age people (including those recently retired and students)

Good

Updated 13 April 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, 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 13 April 2017

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

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

  • 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.

  • 30% of their patients had a mental health concerns/diagnoses.

  • The practice was piloting a family support service with the aim of improving mental health outcomes for young people.

  • The practice set up anxiety workshops, as they recognised that this was a key theme for many young people attending The Well Centre. From January 2016 to December 2016, 129 young people had attended The Well Centre who had issues relating to anxiety.

  • From January 2016 to December 2016 a total of 122 young people accessed the psychiatric nurse for counselling support.

People whose circumstances may make them vulnerable

Good

Updated 13 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 homeless people, travellers and those with a learning disability.

  • The practice used alerts to categorise patients according to their circumstance

  • The practice offered longer appointments for patients with a learning disability. The practice had four patients on its learning disability register.

  • 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.

  • Translation services were available by telephone or face to face.

  • The Well Centre targeted the most vulnerable and hard to reach young people, including those that are NEET, (NEET is a young person who is not in education, employment or training) looked after or leaving care, and those involved in the YOS (youth offending service).