Woodgrange Medical Practice

Updated 3 February 2017

The Woodgrange Medical Practice is situated within NHS Newham Clinical Commissioning Group (CCG) in a converted bank; it has three floors all with lift access. The practice provides services to approximately 12,700 patients under a Personal Medical Services (PMS) contract. The practice provides a full range of enhanced services including diabetes, minor surgery and contraception (including coil fitting and implants). It is registered with the Care Quality Commission to carry on the regulated activities of maternity and midwifery services, family planning services, treatment of disease, disorder or injury, surgical procedures, and diagnostic and screening procedures.

The staff team at the practice includes three male GP partners (working eight, six and four sessions per week), five salaried GPs (four female, one on maternity leave, two working four sessions and one working five sessions per week). There is also one male GP working seven sessions per week, and one female GP working three sessions per week. The practice provides teaching for medical students and training for qualified GP registrars and has two female GP registrars (both working eight sessions per week) and one female student GP (not undertaking sessions). There are two female nurse practitioners working 31 and 30 hours per week, two female practice nurses working 37.5 hours per week, two locum practice nurses (working flexible hours as needed), three female health care assistants (two working 30 hours and one locum working flexible hours as needed). The practice manager works 36 hours per week and a team of reception and administrative staff all work a mixture of part time hours.

The practice core opening hours are between 8:00am and 6:45pm every weekday. GP appointments are from 8:30am to 12.00pm and 3.00pm to 6.30pm, and nurse appointments from 8.00am to 12.00pm and 1.30pm to 6.30pm every weekday. The practice offers on-site extended hours when GP, nurse and healthcare assistant appointments are pre-bookable on Saturdays from 8.30am to 12.30pm. Additional off-site extended hours are every weekday until 9.30pm through a network of local practices. Patients telephoning when the practice is closed are transferred to the local GP Co-op out-of-hours service provider. Appointments include pre-bookable appointments, home visits, telephone consultations and urgent appointments for patients who need them.

Information published by Public Health England rates the level of deprivation within the practice population group as three on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. The area has a higher percentage than national average of people whose working status is unemployed (13% compared to 5% nationally), and a lower percentage of people over 65 years of age 5% compared to 17% nationally). The average male and female life expectancy for the practice is 77 years for males (compared to 77 years within the Clinical Commissioning Group and 79 years nationally), and 83 years for females (compared to 82 years within the Clinical Commissioning Group and 83 years nationally). Data held at the practice showed 80% of the patients on list is are from an ethnic minority with 70% Asian-Indian subcontinental, 5% Caribbean, 15% identifying as “other” predominantly Eastern European and South American, and a 10% refugee population predominantly Somalian, Ethiopian, Sudanese and Rwandan.

Updated 3 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Woodgrange Medical Practice on 19 May 2016 Overall the practice is rated as outstanding.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

• Risks to patients were assessed and well managed with the exception of minor weaknesses in systems to ensure the safety of electrical equipment and contents of a medicines refrigerator.
• The practice used innovative and proactive methods to improve patient outcomes, it worked with other local providers to share best practice. 
• Feedback from patients about their care was consistently positive and data showed that the practice was performing highly when compared to practices nationally.
• 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. For example by substantially increasing GP sessions in response to a patients survey and providing daily GP cover in the reception area, re-organising the reception area, signage and queuing system to improve patients privacy and safety.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs and 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 a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw several areas of outstanding practice:

• GPs had led and delivered improved outcomes and care for patients including across the local Clinical Commissioning Group (CCG) and over wide range of clinical areas including chronic obstructive pulmonary disease (COPD), mental health, dermatology, women’s health, diabetes and asthma. The practice also ran a weekly citizens advice bureau clinics for its patients that was provided by professional welfare benefit advisers.
• The practice nurse ran various health based community groups to encourage patient’s general health, exercise and social interaction and had extended provision to other local practices. The nurse had also extended her work internationally to Kenya and attributed the success of these projects in part to the support received directly from the practice.
• ​G Ps showed leadership and took responsibility at an organisational level to improve local child protection arrangements. For example, both a partner GP and registrar made detailed records of child protection reporting system failures that had resulted in a lack of or delayed response from allied health and social care professionals to protect children. GPs initiated internal significant events protocols and sustained escalation of concerns until they reached persons responsible for the system. The practices ongoing commitment triggered an analysis of the system to improve child protection arrangements in the local  area.

However there were areas of practice where the provider should make improvements:

• Review or embed systems electrical equipment safety and medicines refrigerator checks.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 February 2017

The practice is rated as outstanding for the care of people with long-term conditions.

• The practice was a finalist in “The General Practice Awards” 2014 for its care of people with long term conditions, and specifically for its care of patients with diabetes. Locally held data showed the practice was currently the highest performer for diabetes care within a local group of practices. Exception reporting was 8% compared to 7% in the CCG and 11% nationally.
• The specialist nurse held diabetes triage reviews over the telephone with advance time slots available for working age people to manage their care over the telephone or secure appointment at a convenient time if needed.
• The practice identified and led areas for improvement and subsequently developed new local care pathways or redesigned pathways that delivered improvements for patients with asthma, chronic obstructive pulmonary disease (COPD), diabetes, and eczema.
• Performance for diabetes related indicators for the percentage of patients on the diabetes register with a record of a foot examination and risk classification within the preceding 12 months was 99% compared with the national average of 88%.
• The percentage of patients with hypertension having regular blood pressure tests was 86% compared to the CCG and national averages of 84%. Exception reporting for hypertension care was 2% compared to 3% in the CCG and 4% nationally.
• The practice had a wide range of services available on site including a COPD clinic and a diabetes clinic.
• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority and longer appointments and home visits were available when needed.
• Patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• One of the partner GPs was a specialist in dermatology, they offered clinics in practices across the CCG and were available to clinical staff in house on an immediate basis to help assess and treat patient’s skin conditions. Data showed high rates of patient satisfaction, substantial reductions in patients being referred to secondary care and faster treatment. 
• A GP partner had written to patients with diabetes and asthma to personally invite and encourage them have a flu vaccine and explained he and one of the other GPs had already received the vaccine from the practice nurse.
• The practice held regular in-house educational sessions where expert speakers were invited to promote healthcare awareness and neighbouring practices were also invited to attend. Subjects covered in 2015 – 2016 included Chronic Conditions.

Updated 3 February 2017

The practice is rated as outstanding for the care of families, children and young people.

• The practice identified areas for improvement and subsequently developed new care pathways or redesigned pathways that delivered improvements for patients with polycystic ovarian disease and heavy menstrual bleeding that were rolled out across the CCG. Reported improvements included more positive user experience, reduction in hospital referrals, improved patient experience and confidence in the clinician.
• Childhood immunisation rates were above local and national averages. For example, for those given to under two year olds ranged from 82% to 99% (CCG ranged from 82% to 94%), and five year olds from 92% to 97% (CCG ranged from 82% to 95%). 
• The practice had identified it had a relatively high population of working age women and offered a full range of contraceptive services delivered by female clinicians such as implants and coils.
• The practice nurse ran various community health promotion clubs and attributed the progress and expansion of her local and international work in part to the practice. Local initiatives included a “Health Club” exercise class mainly for Muslim women who felt more comfortable attending a women only class and a “Baby Toddler Group” in response to Newham’s high rate of children under three years old and families living in cramped conditions.
• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• The practice’s uptake for the cervical screening programme was 81%, which the same as CCG average of 81% and similar to the national average of 82%. Exception reporting was below average at 4% compared to 11% in the CCG and 6% nationally.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives and health visitors. Midwife clinics were held weekly and the practice promoted local weekly drop  in mother, child and baby health clinics for children up to five years old.
• B aby check appointments at the practice were 30 minutes per appointment in response to patients feedback to ensure time for health promotion, mental health or safeguarding concerns, explaining the importance of immunisation, and the use of the health visitor for advice.
• Practice GPs showed leadership and took responsibility at an organisational level to improve local child protection arrangements. For example, a partner GP and registrar made detailed records of child protection reporting system failures that had resulted in a lack of or delayed response from allied health and social care professionals to protect children. GPs initiated internal significant events protocols and sustained escalation of concerns until they reached persons responsible for the system. The practices ongoing commitment triggered an analysis of the system to improve child protection arrangements in the local  area.

Updated 3 February 2017

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The percentage of patients with rheumatoid arthritis, on the register, who had had a face-to-face annual review in the preceding 12 months was 91% which is the same as 91% within the CCG and 91% nationally.

• The practice nurse ran a “Holiday at Home” group for older people to meet at the church, reminisce, share stories, read the newspaper and do some light exercises together. Approximately eight older people registered at the practice attend this every week. We saw evidence of beneficial health outcomes such as weight and blood sugar for this group of patients.
• For older patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 3 February 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• Data showed the practice was consistently exceeding health checks targets for health for 40 – 75 year old patients.
• The specialist nurse held diabetes triage reviews over the telephone with advance time slots available for working age people to manage their care over the telephone or secure appointment at a convenient time if needed.
• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• The practice had a wide range of services available on site including minor surgery.

Updated 3 February 2017

The practice is rated as outstanding for the care of people experiencing poor mental health (including people with dementia).

• One hundred per cent of patients diagnosed with dementia had their care reviewed in a face to face meeting compared to the CCG average of 87% and the national average of 84%. Exception reporting for dementia care was 7% compared to 11% within the CCG and 8% nationally.

• Performance for mental health related indicators was 100% compared to the CCG average at 87% and the national average of 93%. Exception reporting for mental health was 9% compared to 7% within the CCG and 11% nationally.
• The practice had identified 116 patients on its register with a mental health condition requiring an annual health check and 89 of these patients (77%) had received the check.
• The practice held quarterly meetings with the local psychiatrist and community mental health team in attendance in the case management of patients experiencing poor mental health, including those with dementia.
• The practice held bi-monthly clinics for people with mental health problems.
• One of provided regular local newspaper articles on mental health to provide answers raise awareness and encourage access to mental health care services within the local community.
• With support from the local Mental Health Trust, the practice had arranged for psychological therapy sessions to be held at the practice for the last 3 years. D ata between 2013 - 2016 showed patients  rates for attendance and entering into treatment had increased by 50% over the period and the rate of patients not arriving for their appointment had decreased by 30%.
• The Minister of State for Care and Support had written to a GP partner in 2015 in recognition of his leadership and work to improve mental health crisis care in Newham including by working jointly with a mental health charity and other health partners as well as government departmental officials.

Updated 3 February 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability and 41 of these patients (85%) had received an annual health check.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.
• The practice had a wide range of services available on site including substance misuse prescribing.
• The practice ran a weekly citizens advice bureau clinic for its patients t hat was provided by professional welfare benefit advisers .
• The practice held regular in-house educational sessions where expert speakers were invited to promote healthcare awareness and neighbouring practices were also invited to attend. Subjects covered in 2015 – 2016 included FGM (Female Genital Mutilation), Domestic and Sexual Violence, and Safeguarding Adults and Children.