The Wellington Health Centre

Updated 24 October 2017

The Wellington Health Centre provides primary medical services through a Personal Medical Services (PMS) contract to around 6,700 patients in the St Johns Wood, Primrose Hill and Maida Vale areas of North West London. The patient population includes a cross-section of socio-economic and ethnic groups, mostly ‘White’, ‘White/British’ or ‘Asian’. The two most common languages spoken by patients are English and Arabic. There is a spread of age groups served by the practice. There are above average numbers in the 25-44 age groups.

The practice team is made up of a three GP partners, three salaried GPs, three locum GPs, the business partner/practice manager, assistant practice manager, a practice nurse and locum nurse, a practice secretary, a data administrator and five reception staff (including one trained phlebotomist). Six of the GPs are female and three male and they provide 41 GP sessions per week.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are from 8.30am to 11.30am and 2pm to 5.30pm Monday, Tuesday and Friday; 8.30am to 12.00 noon and 2pm to 5.30pm Wednesday; and 8.30am to 11.30am and 2.30pm to 5.30pm Thursday. Patients are also able to access late evening (6.30pm to 8pm) GP and nurse appointments Monday to Friday and on Saturday and Sunday (8am to 8pm) at ‘hub surgeries’ within Westminster. In addition to pre-bookable appointments that can be booked up to six weeks in advance, urgent appointments are also available for patients that needed them. The practice has recently introduced a walk-in service on three days in the week between 10.30am and 11.30am with three doctors on duty. Patients can also seek telephone advice from a nurse or doctor by ringing the surgery between 12.30pm and 2.30pm.

The practice has out-of-hours (OOH) arrangements in place with an external provider. Patients are also advised that they can call the 111 service for healthcare advice.

In December 2016 the practice partnership took on from another provider the Little Venice Medical Centre operating a General Medical Service (GMS) contract. Plans are being drawn up for co-location at a new, fit for purpose site between the two current locations. It was expected that this would help to bring stability and certainty to both patients and staff.

Updated 24 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Wellington Medical Centre on 2 December 2014. The overall rating for the practice was good, however the rating for providing safe services was requires improvement. The full comprehensive report on the December 2014 inspection can be found by selecting the ‘all reports’ link for The Wellington Medical Centre on our website at www.cqc.org.uk.

This inspection was undertaken to check the provider had taken the action we said they must and should take and was an announced comprehensive inspection on 17 August 2017. Overall the practice is still rated as good and the rating for providing safe services has improved from requires improvement to good.

Our key findings were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice now had clearly defined and embedded systems to minimise risks to patient safety. It had taken the action we said it must and should take at our December 2014 inspection in relation to medicines management. However, we identified some shortcomings in the arrangements checking ancillary emergency equipment and prescription security.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. The practice had taken the action we said it must take at our December 2014 inspection to ensure staff training records were fully completed.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The majority of patients we spoke with said they found it easy to make an appointment with a named GP but some said there was not always continuity of care. Urgent appointments were available the same day.
• The practice had adequate facilities and equipment to treat patients and meet their needs. However, there was no emergency pull cord in the disabled toilet.
• 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Ensure prescriptions left in printers are appropriately secured.
• Ensure recorded checks of emergency equipment include ancillary emergency equipment such as oxygen masks, suction pumps and pulse oximeters.
• Carry out checks of emergency exit routes to ensure they remain accessible and install an emergency pull cord in the patients’ toilet.
• Continue with efforts to improve uptake of childhood immunisations in relation to national targets.
• Review the system for the identification of carers to ensure all carers have been identified and provided with support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 October 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• QOF performance for diabetes related indicators was similar to CCG and national averages: 86% compared to 80% and 90% respectively. The needs of new diabetic patients were reviewed and referred to appropriate education programme, a dietician and eye screening.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• All these patients had a named GP and there was a computerised system to recall patients for a structured annual review to check their health and medicines needs were being met. Reviews were also conducted opportunistically during consultations.
• 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.

Updated 24 October 2017

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

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.
• The practice was involved in a scheme to provide a general paediatric opinion on un-complicated cases of childhood illness on a rotating basis. Meetings were held monthly in conjunction with neighbouring practices.
• Immunisation uptake rates for the standard childhood immunisations were below national targets based on the latest published data. The practice recognised improving immunisation performance was a challenge and followed up with families in an attempt to increase uptake.
• Children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• The practice had emergency processes for acutely ill children and young people.

Updated 24 October 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Where older patients had complex needs, the practice shared summary care records with local care services.
• The practice offered respite care for carers and the practice’s patient participation group had a support group for elderly patients who could provide support at home if needed.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 24 October 2017

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

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, the practice provided a selection of appointments times and styles to cater for working people and students including a recently introduced walk-in service on three days in the week.
• There was an on-site care navigator who facilitated access to health promotion services such as exercise on prescription.
• The practice offered well person checks to discuss lifestyle and advise patients on ways to minimise health risk factors.
• An on-site counsellor provided support to patients in this group for mental health problems.
• 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.

Updated 24 October 2017

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

• The practice carried out advance care planning for patients living with dementia.
• 94% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was higher than the national average.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• Performance for mental health related indicators was just higher than the CCG but lower than the national averages: 86% compared to 85% and 93% respectively.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice held six monthly mental health reviews on patients with serious and complex mental health problems attended by a consultant adult psychiatrist and a psychogeriatrician (a psychiatrist concerned with behavioural and emotional disorders among the elderly) where patients on the practice mental health register were discussed.
• The practice hosted a weekly session where a healthcare professional from the local Community Mental Health Team (CMHT) saw referred patients to advise on treatment, signpost or refer on to secondary care where appropriate.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 24 October 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 and those with a learning disability. The practice regularly discussed cases of concern at weekly practice meetings and reviewed the vulnerable patient list annually.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.