We carried out an announced comprehensive inspection at Wordsworth Health Centre on 24 November 2016. The overall rating for the practice was good overall and outstanding in well-led. However, the rating for the practice providing caring services was requires improvement as we found areas where the practice should improve that mostly related to caring services. The full comprehensive report on the 24 November 2016 inspection can be found by selecting the ‘all reports’ link for Wordsworth Health Centre on our website at www.cqc.org.uk.

This inspection was an announced desk-based review carried out on 5 April 2018 to confirm that the practice had improved in areas identified in our previous inspection. This report covers our findings in relation to those areas.

Overall the practice remains rated as good.

Our key findings were as follows:

• GP Patient Survey data for patient’s access had worsened since our previous inspection and was significantly below average. We noted recent and significant changes the practice had made such as increasing GP sessions from 31 to 51 per week, employing two part-time nurses, freeing up a clinical pharmacist at specific times to deal with prescription issues, doubling telephone lines capacity from six to twelve, implementing a call queueing and overflow system which after a certain amount of rings diverts to an available person, increasing related telephone staffing at answering and managerial levels, promoting patient’s online access, and educating patient’s for self-referral to other services. We noted outcomes of these improvements may not yet have been reflected in the most recent practice GP patient survey results, as this data was collected 1 January to 31 March 2017.
• The most recent GP Patient Survey results for caring services published July 2017 were mixed. The practice attributed much of this to access and workload issues causing pressures to both staff and patients which it had taken action to improve. The practice undertook its own survey that showed marked improvement to patient’s experiences of GP appointments, and a number of improvement initiatives for caring services including for homeless people, breastfeeding mothers, and to host chair based exercises and social networking.

At our previous inspection on 24 November 2016, we rated the practice as requires improvement for providing caring services due to its below average GP Patient survey satisfaction scores which were also low for patient access.

At this inspection 5 April 2018 the practice GP Patient survey satisfaction scores continued to be below or significantly below average. However the practice had taken significant action to improve the satisfaction scores.

There were areas where the provider should make improvements:

• Review and improve national GP patient satisfaction survey results to ensure improvement outcomes are reflected in patient’s experiences of the service, and are embedded and sustainable.

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 at Wordsworth Health Centre on 24 November 2016. At the practice’s previous inspection in June 2015, it was rated as requires improvement for safe, caring and responsive services, resulting in an overall rating of requires improvement. At this inspection, we noted that action had been taken to address our concerns and rated the practice overall as good.

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

• The practice had recently reorganised its clinical leadership team and we noted a common focus on improving quality of care and patient experiences. Leaders had an inspiring shared purpose and strove to deliver and motivate staff to succeed.

• The practice had a clear vision which had quality and safety as top priorities. The strategy to deliver this vision was regularly reviewed and discussed with staff.

• 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.

• The practice used innovative and proactive methods to improve patient outcomes. For example, a trained nurse consultant provided in house psychological therapy and we noted that patient outcomes for mental health were above local and national averages. This was also the case for other conditions such as asthma, cancer and diabetes.

• Face to face and comment card feedback was generally positive regarding the standard of care received.

• The practice made changes to the way it delivered services as a consequence of patient feedback. For example, it had acted on low patient satisfaction scores regarding phone and appointments access by increasing phone line capacity and by publicising on line services, so as to reduce demand on phone lines.

• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result.

• Staff told us they were proud of the organisation as a place to work and spoke highly of the culture. We noted strong collaboration and support across all staff.

• Practice management and governance arrangements facilitated the delivery of high-quality and person-centred care.

We saw an example of outstanding practice:

The practice provided an in house Cognitive Behaviour Therapy (CBT) service led by a trained CBT nurse consultant. CBT is a psychological therapy which looks at how a patient thinks about a situation and how this affects the way they act or ‘behave’ which in turn will affect how they think and feel. When we asked the practice for evidence of impact, we were shown patient records which highlighted benefits after relatively short courses of CBT. A patient who had undergone CBT spoke about how the therapy had improved their mental and physical well-being and when we discussed the service with a local consultant psychiatrist, they spoke positively about the practice’s low referral rates when compared to other practices in the area and attributed this to the CBT service.

However there were was an area of practice where the provider should make improvements:

• Continue to monitor national GP patient satisfaction scores on appointments access and on how clinicians’ involve patients in decisions about their care.

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 at Wordsworth Health Centre on 3 June 2015. Overall the practice is rated as requires improvement.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed, with the exception of those relating to the safe storage of vaccines.

• Data showed patient outcomes were above average for the locality. Four clinical audits had been started in the last 12 months; two of which were completed two cycle clinical audits.
• 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 readily available although the complaints policy did not specify a standard timeframe for investigating complaints.

• Urgent appointments were usually available on the day they were requested but we noted negative feedback regarding patients’ overall experience of making an appointment.

The areas where the provider must make improvements are:

• Introduce a protocol to ensure that vaccines are safely managed and stored; and ensure that staff are aware of their responsibilities in relation to it.

In addition the provider should:

• Review its complaints policy to ensure there is clarity on the timeframe for responding to patient’s complaints.
• Review its appointments system to ensure it is responsive to patient need.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

We conducted an inspection of this practice in September 2014. We identified breaches of regulation regarding fire safety, emergency medicines, aspects of vaccines storage, pre-employment checks and infection prevention and control. At this inspection we noted that the provider had taken action to address our concerns.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Wordsworth Health Centre, also known as The Graham Practice, is a general practice (GP) surgery that operates from a single premises located in Manor Park in the London borough of Newham. The equivalent of five full-time GPs work at the practice which has approximately 11,800 registered patients. Other healthcare professionals at the practice include practice nurses, health care assistants and a nurse consultant in cognitive behavioural therapy (CBT).

Census data shows an increasing population and a higher than average proportion of Black and minority ethnic residents in Newham. The proportion of people below 40 years of age is above the England average while the proportion of people above 40 years of age is below the England average. Newham is the second most deprived out of 326 local authorities. Drug misuse, recorded diabetes, incidence of TB and acute sexually transmitted infections are significantly worse than the England average. Life expectancy for males in Newham is below the England average. The number of early deaths due to cardiovascular disease is significantly worse than the England average.

As part of our inspection we asked other organisations, including NHS England, Newham Clinical Commissioning Group and Healthwatch Newham to share what they knew about the service with us. We also spoke to patients and invited them to leave their feedback for us on comments cards. We carried out an announced visit to the practice which lasted 1.25 days.

Patients we spoke with had confidence and trust in the treatment they received from the practice. They felt they were treated with care and respect by clinical staff and most reception staff. However they found it very difficult to see their GP and experienced the practice’s GP telephone triage and consultation service as unresponsive to their needs. This was an area for improvement.

We found patients received services that were safe and well-led in many respects. The was a strong emphasis on clinical governance, which is a system for promoting excellence in the clinical care provided to patients, and there were systems in place to learn from significant events and from patient feedback, including complaints. Clinical and non-clinical staff were engaged and motivated to provide the best possible care to patients.

However, the practice was in breach of some regulations related to safety including:

• Fire safety
• Medicines management
• Cleanliness and infection control
• Requirements relating to workers

Other areas for improvement included:

• Patient information about the chaperone service.
• Feedback to patients about progress on the action plan from the 2013-2014 practice survey.
• Action plans for mitigating risk to the sustainability and effective operation of the practice.

We found patients received services that were effective and caring. The practice checked regularly that it was providing treatment and care in line with recognised best practice by completing clinical audit cycles. Staff received professional development to support them to deliver treatment and care to an appropriate standard. Patients felt involved in decisions about their care and consent procedures were in place to ensure patients understood the implications of their decisions.

We looked at services for:

• Older people
• People with long-term conditions
• Mothers, babies , children and young people
• The working-age population and those recently retired
• People in vulnerable circumstances who may have poor access to primary care
• People experiencing poor mental health

We found these population groups received care that was well-led, safe, effective and caring. Improvements were required to ensure the service was responsive and that all population groups could access the service.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.