Millbank Medical Centre

Updated 19 October 2016

Millbank Medical Centre provides primary medical services through a Personal Medical Services (PMS) contract within the London Borough of Westminster. The practice is part of NHS Central London (Westminster) Clinical Commissioning Group. The services are provided from a single location to around 7000 patients. The practice serves a wide ethnic, cultural, demographic and socio-economic mix and has higher than average numbers of patients in the 25-39 age groups. The practice serves a substantial Bangladeshi, Arabic, African and Southern Mediterranean population and in the last decade has seen a significant increase in patients from China and Eastern Europe.

At the time of our inspection, there were three permanent GPs (2.75 whole time equivalent - all female) employed at the practice who normally provide 22 clinical sessions per week. The practice is a teaching practice and there were three ST2 trainee GPs (two female and one male) and one ST3 trainee GP (male) assigned to the practice, providing 23 clinical sessions per week. The practice also employed a practice manager (0.96WTE), a practice nurse (0.4 WTE), a healthcare assistant (1 WTE), two practice secretaries (1 WTE), a senior receptionist (0.96 WTE) and four reception staff (2.57 WTE).

The practice is open between 8.00am and 6.00pm Monday to Friday. Appointments are available between these times. In addition to pre-bookable appointments that can be booked in advance, urgent appointments are also available for people that need them. There are also GP telephone appointments available morning and afternoon. These are used for problems which could be dealt with over the telephone, for example to discuss test results.

There are also arrangements to ensure patients received urgent medical assistance when the practice was closed. Out of hours services are provided by a local provider. Patients are provided with details of the number to call. The practice also provided patients with information on local practices they could attend or book an appointment if they needed to see a GP on Saturday or Sunday.

The practice is registered to carry on the following regulated activities:

Diagnostic and screening procedures

Maternity and midwifery services

Surgical procedures

Treatment of disease, disorder or injury

Updated 19 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Millbank Medical Centre on 26 May 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 who used services were assessed and well managed in most respects. There were some deficiencies in the documentation relating to the practice’s recruitment processes and, whilst there was an evacuation plan in place, no fire drills had been undertaken in the last six months.

• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• 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 complied with the requirements of the duty of candour.

The areas where the provider should make improvements are:

• Consider the introduction of a practice specific policy on safeguarding of vulnerable adults and arrange training in this area for any staff who have not received such training.
• Ensure all appropriate pre-employment identity and reference checks are documented in staff records.
• Ensure the completion of any outstanding staff appraisals.
• Review the system for the identification of carers to ensure all carers have been identified and provided with support.
• Continue to review measures to improve patient access to appointments.
• Advertise in the reception area that translation services are available.
• Arrange for weekly clinical meetings to be minuted to provide an audit trail of discussion and agreed decisions and actions. Consider making minutes of fortnightly practice team meetings more informative to identify more clearly agreed decisions and action.
• Consider displaying the practice’s mission statement to patients in waiting areas and on the practice’s website.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 October 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.
• QOF performance for diabetes related indicators was above the CCG and national average for 2014/15.
• Longer appointments and home visits were available when needed.
• All these patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 19 October 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.
• The practice’s uptake for the cervical screening programme was 74%, which was comparable to the CCG average of 74% but below 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 and health visitors. The practice worked with paediatric consultants at a local NHS acute trust to run a regular paediatric hub clinic attended by paediatricians, mental health workers, dieticians, health visitors, local GPs and school nurses.
• The practice was currently involved in a large paediatric asthma review project with medical students and paediatric registrars.

Updated 19 October 2016

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. All patients in this group had a care plan and a named GP.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Staff worked together and with other health and social care professionals to understand and meet the range and complexity of older patients’ needs and to assess and plan ongoing care and treatment.
• The practice worked closely with the CCG to improve the support for older people. It reviewed hospital admissions and A&E attendances as part of its locality audits.

Updated 19 October 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 reflected the needs for this age group.

Updated 19 October 2016

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

• 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is better than the national average.
• Performance for QOF mental health related indicators was above the CCG but below the national average.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those 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. The practice had been certified as ‘dementia friendly’ following external assessment, and all staff had received dementia awareness training.

Updated 19 October 2016

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 those with a learning disability.
• 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 informed vulnerable patients about how to access various support groups and voluntary organisations.
• GPs worked with a local substance misuse charity to support people reducing their dependence on medicines such as benzodiazepines.
• 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.