Westbury Medical Centre

Updated 28 December 2016

Westbury Medical Centre provides GP primary care services to approximately 10,500 people living in Tottenham and Wood Green, London Borough of Haringey. The practice has a Personal Medical Services (PMS) contract for providing general practice services to the local population. Personal Medical Services (PMS) agreements are locally agreed contracts between NHS England and a GP practice. The practice is a teaching practice for medical students.

There are currently two male GP partners, both of whom are full time. There are two part time female salaried GPs. The practice provides a total of 30 GP sessions per week.

The clinical team is completed by two advanced nurse practitioners who work full time, two long term locum practice nurses who work part time and three health care assistants, two of whom are also trained as phlebotomists (Phlebotomists are specialist healthcare assistants who take blood samples from patients for testing in laboratories).

There is also a practice manager, five administrative and five reception staff. The practice is registered with the Care Quality Commission to provide the regulated activities of maternity and midwifery services, surgical procedures, treatment of disease, disorder or injury, diagnostic and screening procedures and family planning.

Information published by Public Health England rates the level of deprivation within the practice population group as two on a scale of one to ten. Level one represents the very highest levels of deprivation and level ten the lowest. This information also shows that Income Deprivation Affecting Older People (IDAOPI) is 38% and is higher than the CCG average of 32% and the national average of 16%. Income Deprivation Affecting Children (IDACI) is 35% (CCG average 29%, national average 20%).

The practice is located in a three storey former residential building. Consulting rooms are located on two floors. Patients unable to access the second floor are accommodated on the ground floor.

The practice opening hours are 8:00am to 6.30pm on Mondays, Thursdays and Fridays and 8:00am to 8:00pm on Tuesdays and Wednesdays. The practice is closed on Saturdays and Sundays. Telephones are answered between 8:00am and 6:30pm daily.

Patients can book appointments in person, on-line or by telephone. Patients can access a range of appointments with the GPs and nurses. Face to face appointments are available on the day and are also bookable up to four weeks in advance. Telephone consultations are offered where advice and prescriptions, if appropriate, can be issued and a telephone triage system is in operation where a patient’s condition is assessed and clinical advice given. Home visits are offered to patients whose condition means they cannot visit the practice.

The practice has opted to provide out of hours services (OOH) to patients and these were provided on the practice’s behalf by a nominated provider. The details of the how to access the OOH service are communicated in a recorded message accessed by calling the practice when it is closed and details can also be found on the practice website.

The practice provides a wide range of services including clinics for diabetes, weight control, asthma, contraception and child health care and also provides a travel vaccination clinic. The practice also provides health promotion services including a flu vaccination programme and cervical screening.

The practice had not previously been inspected.

Updated 28 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Westbury Medical Centre on 28 September 2016. Overall the practice is rated as Good.

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

• 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.
• Feedback from patients about their care was consistently positive.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. For instance, the practice had undertaken a detailed study of GP appointment demand and had put in place an action plan which had released over 400 GP appointments over a six month period and improved the range of appointment options available to patients who needed extra support. This learning had been shared with members of the local CCG.
• 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, the practice had worked with the patient group to present a series of patient education events.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• 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 one area of outstanding practice :

The practice had established a fitness and body conditioning club for patients with, or at risk of developing, long term health conditions and patients experiencing poor mental health. The club had an active membership of over 50 patients and we saw evidence of improved outcomes for patients including evidence of controlled weight loss, improved blood sugar levels and managed reductions in medicines taken. We looked at records of eleven patients who attended the weekly classes and saw that blood sugar levels had reduced by 10% for four patients with diabetes, three patients had managed to reduce or stop certain medicines and three had achieved their targets for weight loss.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 28 December 2016

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

• Patients diagnosed with chronic obstructive pulmonary disease (COPD) were provided with a ‘Hospital Admission Avoidance Pack’ and had been instructed in the correct use of its contents.
• The practice had established a fitness and body conditioning club to support patients with, or at risk of developing, long term health conditions and patients experiencing poor mental health. The club provided weekly fitness classes under the instruction of a qualified fitness instructor and had over 50 active members. The practice could demonstrate improved outcomes for patients including evidence of controlled weight loss, improved blood sugar levels and managed reductions in medicines taken.
• Nursing staff had lead roles in chronic disease management. Health care assistants had also been trained to undertake chronic disease management and this had improved the range of appointments available to patients.
• 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 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.

Updated 28 December 2016

The practice is rated as good 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.
• Parents or carers who wished to opt out of the primary immunisation programme were invited to attend a face-to-face meeting with a GP and patients who failed to attend for immunisations were contacted by letter, text message and telephone.
• 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 88%, which was higher than the CCG average of 80% and the national average of 82%.
• 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, health visitors and school nurses.

Updated 28 December 2016

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

• The practice had provided the ambulance service and accident and emergency department (A&E) at a local hospital with a special number to by-pass the practice telephone switchboard. Ambulance and A&E staff used this to alert the practice when contact with a patient indicated that the patient would benefit from a GP visit.
• GPs used a risk stratification tool designed to identify patients at highest risk of attending A&E or being admitted to hospital and had identified 2% of the practice population at most risk. The care of these patients was reviewed during weekly clinical meetings. The practice had a lower number of emergency admissions compared to local and national averages.
• Discharge letters for patients who had been in hospital were reviewed by a specialist administrator within one day of receipt and patients whose discharge notes indicated that follow up actions were required were prioritised and passed to GPs on the same day.
• Outcomes for conditions often associated with older people were better than local and national averages. For instance, 90% of patients diagnosed with hypertension had well controlled blood pressure compared to the CCG average of 81% and national average of 84%. The exception reporting rate for this domain was 3% (CCG average 5%, national average 4%).

Updated 28 December 2016

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

• 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.
• Appointments were available outside of normal working hours. The practice held two late evening clinics when appointments with GPs and nurses were available and provided walk-in appointments with Advanced Nurse Practitioners from 8:00am every weekday.
• Telephone and email consultations were available for patients who were unable to attend the practice.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs of this age group.

Updated 28 December 2016

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

• Performance for mental health related indicators was better than local and national averages. For example, 99% of patients with schizophrenia, bipolar affective disorder and other psychoses had an agreed documented care plan on the record (CCG average 88%, national average 88%). The exception reporting rate this indicator was 6% (CCG average 7%, national average 13%).
• 84% of patients diagnosed with dementia had had their care reviewed in a face-to-face review in the preceding 12 months (CCG average 86%, national average 84%). The exception reporting rate for this indicator was 0% (CCG average 6%, national average 8%).
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 28 December 2016

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

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• Patients whose living arrangements did not fit the traditional description of homelessness but who accommodation was insecure or chaotic could register using temporary addresses or using the practice address.
• 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.
• Care planning for patients with learning difficulties was undertaken using a nationally recognised tool.
• 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.