Archived: City Square Medical Group

Updated 11 July 2017

City Wellbeing Practice is a GP practice located on Cannon street road, London E1 2LX. It provides primary medical care to 6,500 patients in the Whitechapel area of east London on behalf of Tower Hamlets CCG. Services provided include minor surgery (injections only), phlebotomy and a range of nurse led clinics such as antenatal, diabetes and sexual health. The practice holds a general medical services contract (GMS) with NHS England (A GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities).

There are three GP partners (two female and one male) and one long term locum GP who is covering for one of the partners who is currently on maternity leave, each working seven clinical sessions per week. There is a part time female practice nurse, full time physician’s assistant, a part time health care assistant, practice manager and four reception/administration staff. The practice is a teaching practice for medical students.

The practices opening hours are;

• Monday 8:30am – 8pm
• Tuesday 8:30am – 7pm
• Wednesday 8:30am – 6:30pm
• Thursday 8:30am – 6:30pm
• Friday 8:30am – 6:30pm

Appointment times are;

• Monday 8:30am – 12:30pm 2:30pm – 8pm
• Tuesday 8:30am – 12:30pm 2:30pm – 7pm
• Wednesday 8:30am – 12:30pm 2:30pm – 6:30pm
• Thursday 9am – 12:30pm 2:30pm – 6pm
• Friday 9am – 12:30pm 2:30pm – 6pm

Extended hours are offered on Mondays from 6:30pm to 8pm, local hub appointments are also available on weekdays from 6:30pm to 8pm and at weekends from 8am to 8pm. In addition to pre bookable appointments that can be booked up to two weeks in advance, same day appointments, telephone consultations, online consultations are also available for people that need them on the day. Out of hour’s service are delivered by a different provider, which could be accessed by calling the surgery telephone number.

The practice is situated in an ethnically diverse inner city area with high levels of deprivation. There were a higher than average number of patients aged between 20 and 49 years with a lower number of older patients above 55 years old. 50% of the practice population are of Bangladeshi origin and there are high numbers of patients who do not speak English as a first language.

The life expectancy of male patients is 78 years, which is comparable than the national average of 79 years. The female life expectancy at the practice was 84 years, which is comparable national average of 83 years. Information published by Public Health England rates the level of deprivation within the practice population group as two on a scale of one to 10. Level one represents the highest levels of deprivation and level 10 the lowest.

Updated 11 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at City Wellbeing Practice on 19 November 2014. The overall rating for the practice was good. The full comprehensive report on the 19 November 2014 inspection can be found by selecting the ‘all reports’ link for City Wellbeing Practice on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 9 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 19 November 2014. There were concerns due to a lack of procedures for escalating and reviewing safeguarding concerns and not all staff had received safeguarding training.

Overall the practice is now rated as 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 had clearly defined and embedded systems to minimise risks to patient safety.
• 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.
• 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.
• Patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvement are:

• Review the methodology of their health & safety risk assessment and ensure that it is relevant to their building.

• Ensure improvements are made to address patient access to appointments as outlined in the patient survey.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 July 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.

• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less was 91% compared the CCG average of 82% and the national average of 78%.

• 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 system to recall patients for 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 11 July 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.

• Immunisation rates were comparable to national averages for all standard childhood immunisations.

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

• The practice provided support for premature babies and their families following discharge from hospital.

• Online consultations for ease of access for the younger population and appointments were available outside of school hours.

• 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 and for acute pregnancy complications.

Updated 11 July 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.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible, for example the practice has produced health promotion videos which were shown in the waiting area and available on their website.

Updated 11 July 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, extended opening hours and hub appointments.

• 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.

• Repeat prescriptions, online consultations and telephone consultations were also available.

• Patients aged 40–74 had access to appropriate health assessments and checks that were followed up where abnormalities or risk factors were identified.

Updated 11 July 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.

• 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.

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

• 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 11 July 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, travellers and those with a learning disability.

• 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.

• The practice held monthly safeguarding meetings with health visitors and school nurses.

• 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.