Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection December 2014 – Outstanding)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Outstanding

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Outstanding

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive at Victoria Medical Centre on 14 December 2017 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• A proactive approach to anticipating and managing risks to people who use their services was embedded and was recognised as the responsibility of all staff.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• The continuing development of the staff’s skills, competence and knowledge was recognised as being integral to ensuring high-quality care. Staff were proactively supported and encouraged to acquire new skills, use their transferable skills, and share best practice.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• 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).
• Facilities and premises were innovative and met the needs of a range of people who used the service.
• The practice had a clear vision which had quality and safety as the top priorities. High standards were promoted and owned by all practice staff with evidence of team working across all roles.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• At our previous inspection in December 2014, we reported that the practice had identified specific needs of some of their population groups; the elderly were socially isolated, younger women were not being given pre-conception health promotion and advice. The practice had continued to give priority to measures introduced previously. There were a range of initiatives showing the practice’s continuing responsive approach to their patients including the Atlas programme for improving the well-being of men; and the continued circulation across GP practices and the local hospital and its use throughout Central London CCG practices of an award winning leaflet designed by the practice given to women to provide information about preparing for pregnancy.

The areas where the provider should make improvements are:

• Review satisfaction scores from the national GP Patient survey alongside the results from the practice’s annual patient survey in formulating an action plan to address issues identified particularly those associated with access to services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 4 December 2014. Overall the practice is rated as outstanding. Specifically, we found the practice to be outstanding for providing effective and responsive services and for being well-led. It was also rated as outstanding for providing care for older people and working age people (including those recently retired and students).

The practice was rated as good for providing safe and caring services. It was also rated as good for providing care for people with long term conditions; families, children and young people; people whose circumstances make them vulnerable and people experiencing poor mental health. Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• A proactive approach to anticipating and managing risks to people who use their services was embedded and was recognised as the responsibility of all staff.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
• 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). Information about how to complain was available and easy to understand.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had a clear vision which had quality and safety as the top priorities. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

We saw several areas of outstanding practice including:

The practice had worked with a Professor from the nearby university to trial an innovative approach to improving the wellbeing of working men in their population to decrease stress and distress by delivering high quality counselling and acupuncture to over 150 male patients over an 18 month period. This work was shortlisted for a BMJ award and is likely to influence local commissioning. Seventy eight percent of the 150 men reports improvement in their wellbeing following the course.

The practice sees more than 350 pregnant women a year and deliver very full antenatal services from an integrated team of GPs, practice nurses and health visitors. This team recognised that many women had not taken folate in early pregnancy and took action to address this and in the process produced a leaflet entitled “Thinking about getting pregnant but not right now. An A-Z of pre-pregnancy care”. This leaflet won a best practise award from the Primary Care Women’s Health Forum. 10,000 copies have been circulated across GP practices and the local hospital and is used throughout Central London CCG practices.

The practice has a PPG with 800-900 members and has a twitter account with around 100 followers. The practice acts on the feedback in a number of ways to improve services to patients. The Patient Participation Group (PPG), facilitated by the practice, arranged for patient learning sessions to be held. These were advertised in the newsletter and in the waiting area. Presentations had been made by guest speakers on coping with stress and managing diabetes. Exercise classes took place at the practice including over 60s sessions on Monday and Friday. A patient at the practice had recently started an evening ‘shape up’ group with the support of the practice. The aim of the group was to help patients manage their weight, improve their health and become more active. The practice had been designed with space for these events, which took place in a large room adjacent to the reception area.

The practice hosts and supports a monthly Memory Café for patients with dementia and their carers and family members. The practice has actively sought feedback from those attending and has been rewarded by very high patient satisfaction reports.

The practice has employed a “Link Worker” for the elderly. This individual identifies and where appropriate visits all over the age of 75 to offer support and information about health and social care support that is available locally and signposts patients to services to prevent falls and receive shingles and flu vaccination programmes.

The continuing development of staff skills and knowledge is recognised as integral to ensuring high quality care. Staff were proactively supported to acquire knowledge and share best practice. Weekly practice meetings included a learning element. Guest speakers and healthcare specialists were invited to talk about their area of expertise. An example of this was a talk by a local ‘youth gang’ outreach worker. The aim of this was to raise awareness of gang culture which existed in the area and how this may affect patients’ health.

The practice had worked with eternal providers to assess the interface between the public and their reception team, the first contact points for patients attending the practice. This project resulted in the practice producing patient group specific packs to help them access not only the practice but all local health services to try and improve the most appropriate use of those services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice