Fullwell Cross Medical Centre Inspection report

1 Tomswood Hill Essex IG6 2HG Date of inspection visit: 02 May 2018 Tel: 08444127231 Date of publication: This is auto-populated when the www.fullwellcrosscentre.co.uk report is published

This report describes our judgement of the quality of care at this service. It is based on a combination of what we found when we inspected, information from our ongoing monitoring of data about services and information given to us from the provider, patients, the public and other organisations.

Ratings

Overall rating for this location Good –––

Are services safe? Good –––

Are services well-led? Good –––

1 Fullwell Cross Medical Centre Inspection report This is auto-populated when the report is published Overall summary

This practice is rated as Good overall. (Previous inspection • Staff involved and treated patients with compassion, December 2016 – Good) kindness, dignity and respect. • The practice changed how patients could access the The key questions are rated as: practice by telephone to make booking appointments Are services safe? – Good easier. • There was a strong focus on continuous learning and Are services well-led? - Good improvement at all levels of the organisation. We carried out an announced focused inspection at • The practice had an active patient participation group Fullwell Cross Medical Centre on 2 May 2018. We undertook (PPG) which supported the practice in identifying and this inspection in response to concerns identified and implementing improvements to the overall patient brought to the attention of the commission. This was a experience. focused inspection which looked at the Safe and Well-led The areas where the provider should make improvements key questions. are: At this inspection we found: • Ensure the implementation and review dates are clearly • The practice had clear systems to manage risk so that recorded on all practice policies and procedures. safety incidents were less likely to happen. When Professor Steve Field CBE FRCP FFPH FRCGP incidents did happen, the practice learned from them and improved their processes. Chief Inspector of General Practice • 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.

2 Fullwell Cross Medical Centre Inspection report This is auto-populated when the report is published Overall summary

Population group ratings

Older people Good –––

People with long-term conditions Good –––

Families, children and young people Good –––

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

People whose circumstances may make them vulnerable Good –––

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

Our inspection team

Our inspection team was led by a CQC lead inspector. The team included a GP specialist adviser and a CQC Inspection Manager.

Background to Fullwell Cross Medical Centre

Fullwell Cross Medical Centre has been based in the The practice has 13,400 registered patients with an age current two-storey purpose-built premises since 1974. It distribution similar to the national average. The surgery is is located at 1 Tomswood Hill, Ilford, Essex IG6 2HG, based in an area with a deprivation score of 6 out of 10 within a predominantly residential area of Barkingside in (with 1 being the most deprived and 10 being the least the borough of Redbridge. Redbridge Clinical deprived). Commissioning Group (CCG) are responsible for The practice is a teaching and training practice providing commissioning health services for the locality. placements for two GP registrars per year. (A GP registrar The premises includes 10 consulting/treatment rooms, a is a qualified doctor training to become a GP). large reception and waiting area, administration offices Medical services are provided by four male and two and a large meeting room. All rooms used for patient care female GP partners (5.25 wte) and two GP registrars are based on the ground floor. providing a total of 31 GP appointment sessions per The practice is registered with the CQC as a partnership. week. Nursing services are provided by two part time The senior partner has been with the practice for 32 years practice nurses; one full time health care assistant (HCA); and the newest partner joined 11 years ago. one Elderly Care HCA. The practice also had one New to Nursing Nurse who provided four sessions per week. Services are delivered under a Personal Medical Services Administrative services are provided by a Practice (PMS) contract. (PMS contracts are local agreements Manager, an Assistant Practice Manager and between NHS and a GP practice. They offer local administrative and reception staff. flexibility compared to the nationally negotiated General Medical Services (GMS) contracts by offering variation in The surgery is open between 8am and 6.30pm Monday to the range of services which may be provided by the Friday. Extended hours are provided on a Monday and practice, the financial arrangements for those services Tuesday from 6.30pm until 8pm. The telephone lines are and the provider structure). open between 8am and 6.30pm. The surgery is closed at weekends.

3 Fullwell Cross Medical Centre Inspection report This is auto-populated when the report is published Overall summary

The practice is registered to provide the regulated activities of family planning; maternity and midwifery services; treatment of disease, disorder and injury; surgical procedures and diagnostic and screening procedures.

4 Fullwell Cross Medical Centre Inspection report This is auto-populated when the report is published Good –––

Are services safe?

We rated the practice as good for providing safe • The practice had systems for sharing information with services. staff and other agencies to enable them to deliver safe care and treatment. The practice engaged with other Safety systems and processes health providers to review communication methods to The practice had clear systems to keep people safe. improve the timeliness of corespondence. • Clinicians made timely referrals in line with protocols. • There was an effective system to manage infection prevention and control (IPC). Appropriate and safe use of medicines • All actions identified in the most recent IPC audit had The practice had reliable systems for appropriate and safe been completed. handling of medicines. Risks to patients • Patients’ health was monitored in relation to the use of There were adequate systems to assess, monitor and medicines and followed up on appropriately. Patients manage risks to patient safety. were involved in regular reviews of their medicines. • Patients were required to attend the practice if their • Arrangements were in place for planning and medicines were changed by another health provider. monitoring the number and mix of staff needed to meet This ensured the patients were aware of the changes. patients’ needs, including planning for holidays, sickness, busy periods and epidemics. Lessons learned and improvements made • There was an effective induction system for temporary The practice learned and made improvements when things staff tailored to their role. went wrong. • The practice was equipped to deal with medical emergencies and staff were suitably trained in • Staff understood their duty to raise concerns and report emergency procedures. incidents and near misses. Leaders and managers • Staff understood their responsibilities to manage supported them when they did so. emergencies on the premises and to recognise those in • There were adequate systems for reviewing and need of urgent medical attention. investigating when things went wrong. The practice learned and shared lessons, identified themes and took Information to deliver safe care and treatment action to improve safety in the practice. For example, Staff had the information they needed to deliver safe care following a significant event the practice held a full staff and treatment to patients. meeting to discuss the incident, produced a comprehensive action plan and shared the learning • The care records we saw showed that information both within the practice and with external organisations. needed to deliver safe care and treatment was available • The practice acted on and learned from external safety to staff. There was a documented approach to events as well as patient and medicine safety alerts. managing test results. • In response to an incident the practice implemented a Please refer to the Evidence Tables for further policy which ensured medicine changes instructed by information. other health providers. The policy ensured changes to prescribed medicines would only happen once the patient had been thoroughly informed of the amendments.

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We rated the practice and all of the population groups career development conversations. All staff received as good for providing a well-led service. regular annual appraisals in the last year. Staff were supported to meet the requirements of professional Leadership capacity and capability revalidation where necessary. Leaders had the capacity and skills to deliver high-quality, • Clinical staff were considered valued members of the sustainable care. practice team. They were given protected time for professional development and evaluation of their • Leaders were knowledgeable about issues and priorities clinical work. GPs were supported to utilise their relating to the quality and future of services. They specialist interests within the practice. Special interests understood the challenges and were addressing them. utilised by the practice include, joint injections, sports • Leaders at all levels were visible and approachable. medicine and family planning. They worked closely with staff and others to make sure • The practice manager was enrolled on an accredited they prioritised compassionate and inclusive leadership. Quality Improvement Programme. • The practice had effective processes to develop • There was a strong emphasis on the safety and leadership capacity and skills, including planning for the well-being of all staff. The practice introduced an future leadership of the practice. informal meeting each day where lunch was provided Vision and strategy by the leadership team. The practice had a clear vision and credible strategy to •There were positive relationships between staff and teams. deliver high quality, sustainable care. Governance arrangements • There was a clear vision and set of values. The practice There were clear responsibilities, roles and systems of had a realistic strategy and supporting business plans to accountability to support good governance and achieve priorities. The practice developed its vision, management. values and strategy jointly with patients, staff and external partners. • Structures, processes and systems to support good • Staff were aware of and understood the vision, values governance and management were clearly set out, and strategy and their role in achieving them. understood and effective. The governance and • The strategy was in line with health and social priorities management of partnerships, joint working across the region. The practice planned its services to arrangements and shared services promoted interactive meet the needs of the practice population. and co-ordinated person-centred care. • The practice monitored progress against delivery of the • Following a recent incident the practice had strategy. implemented additional measures to ensure patients were aware of changes to their treatment and Culture medicines if changed by different health providers, The practice had a culture of high-quality sustainable care. including hospitals and mental health trusts. • Staff were clear on their roles and accountabilities • Staff stated they felt respected, supported and valued. including in respect of safeguarding and infection They were proud to work in the practice. prevention and control, diabetes, mental health and • The practice focused on the needs of patients. prescribing. • Openness, honesty and transparency were • Practice leaders had established proper policies, demonstrated when responding to incidents and procedures and activities to ensure safety and assured complaints. The provider was aware of and had systems themselves that they were operating as intended. to ensure compliance with the requirements of the duty However, written policies and procedures did not of candour. include the date it was implemented and the date it • There were processes for providing all staff with the would need to be reviewed. The practice agreed to development they need. This included appraisal and implement this on the day of inspection. Managing risks, issues and performance

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There were clear and effective processes for managing • The practice used information technology systems to risks, issues and performance. monitor and improve the quality of care. • There was an effective, process to identify, understand, Engagement with patients, the public, staff and monitor and address current and future risks including external partners risks to patient safety. The practice involved patients, the public, staff and • The practice had processes to manage current and external partners to support high-quality sustainable future performance. Performance of employed clinical services. staff could be demonstrated through audit of their consultations, prescribing and referral decisions. • A full and diverse range of patients’, staff and external Practice leaders had oversight of national and local partners’ views and concerns were encouraged, heard safety alerts, incidents, and complaints. and acted on to shape services and culture. There was • The practice implemented service developments and an active patient participation group. where efficiency changes were made this was with input • The service was transparent, collaborative and open from clinicians to understand their impact on the quality with stakeholders about performance. of care. The practice implemented a system to reduce Continuous improvement and innovation the amount of time clinicians take to review correspondence from other services. This system saved There was evidence of systems and processes for learning, the practice approximately one day per week of GP time continuous improvement and innovation. which was used to provide more patient appointments. • There was a focus on continuous learning and Appropriate and accurate information improvement. • Staff knew about improvement methods and had the The practice acted on appropriate and accurate skills to use them. information. • The practice made use of internal and external reviews • Quality and operational information was used to ensure of incidents and complaints. Learning was shared and and improve performance. Performance information used to make improvements. was combined with the views of patients. Please refer to the Evidence Tables for further • The practice used performance information which was information. reported and monitored and management and staff were held to account. • The information used to monitor performance and the delivery of quality care was accurate and useful. There were plans to address any identified weaknesses.

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