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