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Spitalfields Medical Centre - Health E1 Good

Inspection Summary


Overall summary & rating

Good

Updated 23 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Spitalfields Medical Centre – Health E1 on 16 June 2016. Overall the practice is rated as good.

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

  • The practice asked all new patients about their caring responsibilities, but no patients with caring responsibilities had been recorded.

  • The practice had carried out one complete two-cycle audit in the last two years. It also monitored 29 key performance indicators every month.

  • The practice used innovative and proactive methods to improve patient outcomes. For example the practice ran dual-diagnosis clinics to enable mental and physical health issues to be addressed within the same consultation.

  • There was an open and transparent approach to safety and a system in place for reporting and recording significant events.

  • 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.

  • Patients said they found it easy to make an appointment with a named GP or nurse practitioner and there was continuity of care, with urgent and routine appointments available the same day.

  • 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 areas where the provider should make improvement are:

  • To review how patients with caring responsibilities are identified and recorded on the patient record system to ensure information, advice and support is made available to all.

  • To introduce safeguarding training and updates for all staff at the appropriate level.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 23 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.

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

  • When things went wrong patients received reasonable support, truthful information, and an 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 23 November 2016

The practice is rated as good for providing effective services.

  • The practice had undertaken one completed two cycle audit within the last two years where the results had been used to improve patient outcomes. It also monitored 29 key performance indicators on a monthly basis. These included clinical performance in regard to chronic heart disease and diabetes.

  • 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.

  • 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 23 November 2016

The practice is rated as good for providing caring services.

  • The practice asked all new patients about their caring responsibilities but had not identified any patients with caring responsibilities.

  • 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.

  • Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. Staff visited the hostels where some patients lived to form working relationships with hostel staff.

Responsive

Good

Updated 23 November 2016

The practice is rated as good for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. It had established links with local charities such as a charity that helped homeless people find housing. The practice also made rooms available to other organisations to provide support and assistance to its patients, for example, oa charity that helped patients to access housing, legal advice and education.

  • The practice ran specialist nurse led dual diagnosis clinics enabling patients with mental health and substance misuse problems to be seen for all of their issues at the same time.

  • The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example the practice visited local homeless shelters and hostels to build better working relationships with the staff.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group (PPG). The .PPG had asked what the practice could do to stop patients playing loud music in the reception area as it upset some other patients. The practice had put up a notice in reception asking patients not to play loud music.

  • Patients could access appointments and services in a way and at a time that suited them. The practice had tailored its appointment system to suit the needs and life-style of its patients and gave longer appointments and held walk-in clinics every day.

  • Information about how to complain was available and easy to understand, and the practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 23 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 a governance framework which supported the delivery of the strategy and good quality care.

  • 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.

Checks on specific services

People with long term conditions

Good

Updated 23 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.

  • 87% of patients with diabetes, on the register, had a last blood pressure reading (measured in the preceding 12 months) of 150/90 mmHg or less, compared to a local average of 91% and a national average of 87%.

  • 82% of patients with diabetes, on the register, had had an influenza immunisation in the preceding 1 August to 31 March (local average 81% national average 78%).

  • 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 23 November 2016

The practice is rated as good for the care of families.

  • Children and young people were referred to other local GP services.

  • The practice’s uptake for the cervical screening programme was 82%, which was comparable to the CCG average of 73% and the national average of 82%.

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

Older people

Good

Updated 23 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.

  • It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • The practice carried out NHS health checks for patients aged 40–74.

  • When families had suffered bereavement, if there were contact details, the practice would send a letter expressing their condolences, and advising them how to access support services.

Working age people (including those recently retired and students)

Good

Updated 23 November 2016

The practice is rated as good for the care of working age people:

  • 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.

  • The practice provided a room for weekly clinics run by a social justice charity that advised patients about education, housing and legal advice.

People experiencing poor mental health (including people with dementia)

Good

Updated 23 November 2016

The practice is rated as good for the care of people experiencing poor mental health:

  • 90% of patients with schizophrenia, bipolar affective disorder and other psychoses had a record of their alcohol consumption in the preceding 12 months compared to a local average of 86% and a national average of 80%.

  • 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 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.

  • The practice provided treatment and support for patients experiencing poor mental health. This included nurse led clinics and access to specialist consultant psychiatrist run clinics held at the practice.

People whose circumstances may make them vulnerable

Good

Updated 23 November 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable:

  • The practice provided specialist care to adult homeless people.

  • 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.

  • 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.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. The practice ran nurse led dual diagnosis clinics enabling patients with mental health and substance misuse problems to be seen for all of their issues at the same time.