Archived: Mr William Williams Also known as Arrival Practice

Updated 1 June 2016

The Arrival Practice is the name under which the practice operated by Mr William Williams delivers services. The Arrival Practice is near the centre of Stockton based in Endurance House, Clarence Street,Stockton On Tees, Cleveland.   The practice is situated on the first floor of a purpose built medical centre which also has a pharmacy. There are parking spaces available for patients and staff. There are 1600 patients on the practice list of which 800 patients are asylum seekers, 700 having refugee status and 100 patients being mainstream patients. Following the closure of a nearby practice mainstream patients were given the option of registering with this previous specialist practice. The proportion of patients under the age of 18 years is 50.2% which is above the national average; the majority of patients were under 65 with only 0.6% over 65 years. The practice is in one in the most deprived areas of Stockton. People living in more deprived areas tend to have greater need for health services. Due to the nature of the patient population there is a large turnover of patients making continuity of care difficult and affecting QOF results. We were told that many patients move on to different areas or their applications to stay in the country have been unsuccessful. The practice is fully aware of the processes patients go through when seeking asylum and the affect this has on patient’s health. The practice aimed to provide trust and respect while working in partnership with their patients, supporting and guiding them to make appropriate decisions that will maintain their health and improve their wellbeing. The practice works closely with a range of services and organisations to meet the needs of their population groups.

There are two salaried GPs, both female, and one long term locum GP male. There are three practice nurses all female who all work part time. There is an overall manager, and a practice manager supported by reception, medicines management, and other administration staff. The practice is open from 8.30am to 6pm, Monday to Friday. Appointments are available during these times.

The practice does not provide extended hours. We saw that appointments can be booked by walking into the practice, online and by the telephone. However the majority of patients do not have access to the equipment required to book online appointments. The practice did not use a telephone triage system due to the language barriers and the majority of patients visiting the practice required a translator. Patients requiring a GP outside of normal working hours are advised to contact the GP out of hour’s service provided by Northern Doctors Urgent Care via the NHS 111 service. The practice has a General Medical Service (GMS) contract, previously having a specialist contract that was recently reviewed. Patients who do not speak English found using the 111 service difficult and often presented at A&E or the walk in centres.

There are good links to public transport. However the majority of the patients do not have the funds available to use public transport or have their own transport. The practice were able to send text confirmation of appointments and requests for them to contact the practice.

Updated 1 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Arrival Practice on 5 April 2016. Overall the practice is rated as good.

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.
• 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 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. There had been no complaints in the past year.
• Patients said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day. The practice routinely used interpreters as the majority of patients attending this practice were seeking asylum or refugees.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 June 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The proportion of patients on the diabetes register with a record of foot examinations in the preceding 12 months was 92% which is above the national average of 88%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check their health and medicine 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.

• All new patients were screened for infectious diseases and offered a full sexual health screening.

• The practice worked closely with the respiratory team offering a tuberculosis clinic in the practice twice a week to provide fast access to results and treatment.

• The practice makes available counselling services for patients and those undergoing screening.

Updated 1 June 2016

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

• 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. Immunisation rates were relatively high for all standard childhood immunisations. The practice had identified there were a large number of women presenting at A&E and walk in centres with their children. On discussions with patients it was identified that these women were often alone and unsupported and often unable to use the 111 service due to language barriers. All patients presenting at A&E were followed up by the GP and asylum seeker health visitor to address the needs of the patient to make informed choices.

• 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.

• All mothers of new-borns were sent a congratulations card by the practice. The purpose of this was twofold. Many of the mothers had no one to congratulate them in this country and the card also invited the mother and baby to their first joint appointment at ten days after the birth. The babies were then registered, and mother and baby checked.

• The practice were fully aware of Female genital mutilation (FGM), also known as female genital cutting and female circumcision, which is the ritual removal of some or all of the external female genitalia. All patients were asked if they had undergone cutting and the practice recorded this in the patients notes for support and informing future patient care. The practice also raised awareness with patients that FGM was not legal in this country. All children thought to be at risk were discussed with the practice safeguarding lead, referred to the asylum seeker health visitor and local authority safeguarding team.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• On registering with the practice all women were offered a sexual health screening, contraception advice and cervical smear.

• We saw positive examples of joint working with midwives, health visitors and school nurses in particular the dedicated health visitor for asylum seekers.

• The practice also raised with parents what was acceptable punishment of children in this country.

Updated 1 June 2016

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

• The practice has a small population of older people only 0.6% due to the nature of the practice population the majority were under the age of 35. However they were able to offer 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 urgent appointments for those with enhanced needs were available.

Updated 1 June 2016

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

• The majority of patients were not working due to their legal status in the country which does not allow them to work whilst they were seeking asylum. Only 21% of the practice population were in paid work or full-time education.

• The needs of the working age population, those recently retired and students were offered services to ensure 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 reflected the needs for this population group. The majority of the population did not have access to a computer however they had good access to a range of information in the practice.

Updated 1 June 2016

The practice is rated as good for the care of people experiencing poor mental health (there was only one person with dementia registered in the practice.) The majority of the patients registered suffered from conditions not listed or measured by QOF. Examples of these were the high proportion of anxiety, depression, survivor’s guilt, torture and post-traumatic stress.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. We saw the practice had recently managed to access further counselling services in the practice increasing the availability from one day per week to three days per week. This had helped reduce waiting times for counselling in the practice.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health. All patients were followed by the GP as soon as possible.

• Staff had a good understanding of how to support patients with mental health needs.

  The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in

  the record, in the preceding 12 months was 100% compared to national average of 88%.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months was a 100% compared to the national average of 89%.

Updated 1 June 2016

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

• The majority of the practice population were living in vulnerable circumstances including those seeking asylum, refugees and those with a learning disability.

The practice recognised that refugees and vulnerable migrants may be subjected to hostility, racism, social deprivation and marginalisation. The isolation, loneliness and missing of their family members and friends were common. Patients also suffered from low self-esteem and a loss of status. The practice regularly worked with other health care professionals in the case management of vulnerable patients. Examples of these were navigation workers who worked with asylum seekers and refugees to help them access services, make informed choices, improve their mental and physical health, access counselling services, make social contacts and generally feel more positive about themselves.

• The practice offered longer appointments for patients with learning disabilities. 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 displayed information and posters directing patients to where they would find services and support such as the food and clothing banks.