We carried out an announced comprehensive inspection at Tilbury Health Centre (College Health Tilbury and Chadwell Group) on 9 April 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for all population groups.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• The practice had implemented QOF action plans when they gained the contract for the practice. Unverified data from 2018-2019 showed that there was an improvement in patient outcomes.
• We found that the clinical system settings restricted safeguarding pop up alerts for some staff. However, when we reviewed staff who did not have access, they had full access to safeguarding information.
• The practice had a system to monitor test results however we there were some abnormal test results that had not been viewed for four days. The practice had reviewed and actioned all the outstanding test results by the end of the day and told us they would implement changes to strengthen their system.
• The practice monitored cold chain appropriately, however we found three fridges were over stocked and did not allow sufficient space around the vaccine packages for air to circulate. Since the inspection the practice had removed storage containers in all three fridges to ensure the air was able to circulate.
• The practice had identified 199 patients as carers which amounted to 1.8% of their practice list.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice had a dedicated learning disability co-ordinator and team who were passionate and responsive to patient’s needs. They had developed communication aids which were designed to make it easier for patients to understand the information they were being given.
• Patients in care homes were visited weekly to ensure their needs were met and to reduce admission into hospital.
• Pop-up clinics had been organised by the practice at the local church review patients who would did not usually engage directly with the practice. The practice held other events such as carers events and healthy heart events to encourage patients to monitor their health.
• The practice had implemented a multi-modal consultation system.
• Patients we spoke with shared concerns regarding the telephone access. The practice was aware of their patient satisfaction and had implemented changes to overcome the concerns.
• There were high levels of staff satisfaction. Staff were proud of the organisation as a place to work and spoke highly of the culture. Staff at all levels are actively encouraged to raise concerns via the ‘speak up’ slots.
• There was a clear proactive approach to seeking out and embedding new ways of providing care and treatment. For example, through the implementation of their multi-modal consultations.
• The practice carried out regular clinical meetings to ensure clinicians were up to date with current evidence-based practice. All clinicians, including allied health professionals, received regular peer reviews using the Royal College of General Practitioners tool kit to audit clinical notes, ensure clinicians were working within current guidelines and highlight areas of improvements.
• There was a focus on continuous learning and improvement at all levels of the organisation. Staff were encouraged to share responsibilities and develop their roles.

The areas where the provider should make improvements are:

• Strengthen processes to monitor pathology results.
• Continue to monitor and improve childhood immunisation achievements.
• Improve systems to store vaccinations in line with national guidance.
• Continue to monitor and improve patient access.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care