This practice is rated as Good overall. (Previous rating 25/10/2016 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Watling Medical Centre on 21 June 2018. This inspection was to confirm that the provider had carried out their plan to meet the legal requirements in relation to breaches in regulations that we identified in our previous inspection on 28 July 2016. At that time the service was rated as requires improvement for safe services, rated as good for providing effective, caring, responsive well led services; and rated overall as good. This report covers our findings in relation to those requirements and also in relation to additional improvements made since our last inspection.

At this inspection we found:

• The practice had taken action to address the Legionella risks identified at our last inspection (Legionella is a term for particular bacteria which can contaminate water systems in buildings).
• Protocols for monitoring patients on high risk medicines had not recently been reviewed.
• 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.
• 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.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• The provider had good facilities and was well equipped to treat patients and meet their needs. For example, automated doors had recently been introduced at its branch location.
• Clinical leadership, management and governance of the service assured the delivery of high-quality and person-centred care.

We saw one area of outstanding practice:

In March 2016, the practice introduced a health champion programme designed to motivate, empower and support patients to make healthier lifestyle choices and signpost them to relevant services/organisations. Feedback from clinicians has been positive; with many feeling that the health champions provide a valuable service within the practice which has reduced the number of patients seeking their advice on social issues. Since our last inspection in July 2016 the programme has:

• trained five volunteers

• enlisted one health champion to volunteer at the practice; signposting individuals to relevant services and supporting patients writing letters (for example to housing services).

• undertaken 127 patient contacts; signposting patients to services such as housing advice, financial support, employment advice, carers support and smoking cessation.

The areas where the provider should make improvements are:

• Ensure policies are reviewed and updated as required.
• Take action to improve how carers are identified.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Watling Medical Centre on 28 July 2016. Watling Medical Centre comprises a main location based in Burnt Oak, London Borough of Barnet and a branch location (approximately four kilometres away) based in Stanmore, London Borough of Harrow. Overall the practice is rated as good.

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

• Risks to patients were assessed and well managed with the exception of those relating to legionella and the safe storage of vaccines.
• There was an open and transparent approach to safety and an effective 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.
• 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 and 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. For example, a Wellbeing service had been introduced which navigated patients to the right local organisation for support.

• 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 several areas of outstanding practice. For example:

In 2014, the practice successfully applied for external funding to provide a Wellbeing Service to support patients’ social needs in Burnt Oak; an area of high social deprivation. The service employs a navigator to map services (including community and voluntary services) across the local area and navigate patients to the right local organisation for support.

The service also supports vulnerable groups such as the frail elderly and vulnerable young families in areas such as benefit maximisation support for carers; social isolation, bereavement support and employment support. A community fair event had also been organised to raise awareness of relevant services and individuals amongst vulnerable local families.

Since February 2014, all patients over 16 years of age who have registered with the practice are asked to complete a mental wellbeing assessment based on the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). A protocol is in place to ensure that scores are coded on the practice’s clinical systems and the nursing team are trained to implement support based on individual scores. Clinicians spoke positively about the impact of the service on reducing the amount of time spent dealing with social issues. For example:

Between February 2014 and January 2016 1,368 patients completed the WEMWBS assessment 20% of whom had been directly referred to the Well Being service. The remaining 80% were supported by the nursing team with general wellbeing advice during the new patient health check.

In addition, between February 2014 and January 2016, 241 patients were referred to voluntary sector organisations. Reasons for referral included childcare support, immigration support, support for carers, social isolation, and bereavement support.

In March 2016, the practice introduced a health champion programme designed to motivate, empower and support patients to make healthier lifestyle choices and signpost them to relevant services/organisations. The health champion programme is the first of its kind in Barnet and one of the first nationally which is a partnership with a community organisation.

Feedback from clinicians has been positive; with many feeling that the health champions provide a valuable service within the practice which has reduced the number of patients asking for their advice about social issues. Reception staff and clinicians routinely signpost patients to health champions for advice/support. To date the programme has achieved:

• Eight volunteers trained and received an Introduction to Health Improvement Award through the Royal Society for Public Health.

• Two health champions volunteering at the practice two hours per week; signposting individuals to relevant services and supporting patients writing letters (for example to housing services).

• One Stroke champion peer support worker supporting individuals and their families/carers who have suffered a stroke.

• One hundred and forty eight patient contacts. These patients have been signposted to services such as housing advice, financial support, employment advice, carers support and smoking cessation.

The areas where the provider must make improvements are:

• Introduce staff Legionella training and a monthly temperature monitoring regime, in accordance with the recommendations of its January 2016 Legionella risk assessment.

The areas where the provider should make improvement are:

• Review systems in place for identifying and supporting carers.
• Review systems in place for ensuring the safe storage of vaccines.
• Consider how the practice’s cervical screening uptake rate can be increased.
• Ensure that all non clinical staff receive annual basic life support training.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice