Archived: SSAFA Care CIC Health and Walk In Centre Also known as SSAFA Care CIC

Updated 30 June 2017

SSAFA Care CIC Health and Walk In Centre is located in the city centre of Leicester within the Merlyn Vaz Health and Social Care Centre which is purpose built and is shared with three other GP practices, a pharmacy and other local health services such as midwifery and mental health services. The health centre has staff and patient car parking available including disabled parking spaces.

The GP practice provides primary medical services to approximately 4,926 registered patients. SSAFA are an armed forces charity and provide lifelong support to armed forces personnel and their families. SSAFA Care Community Interest Company (CIC) (the provider) formed in 2008 to deliver NHS healthcare and began providing primary medical services in Leicester in January 2009. The walk in centre began providing services in 2009, initially on a five year contract and is commissioned to provide a GP led minor illness and minor injury service. The integrated registered GP practice and walk in service contract is currently part of a procurement process. The new contract will be a continuation of this service and will include an additional GP practice.

It is located within the area covered by NHS Leicester City Clinical Commissioning Group (LCCCG). It is registered with the Care Quality Commission to provide the regulated activities of; the treatment of disease, disorder and injury; diagnostic and screening procedures; family planning; maternity and midwifery services and surgical procedures.

The practice has a higher than average distribution of registered patients between the ages of 25-44 years of age and a significantly lower distribution of patients aged over 44 years of age compared to local and national averages. 38% of the patient population have a long standing health condition compared to the local average of 50% and the national average of 53%.

At the time of our inspection the practice employed one lead GP (male) and three locum GPs (two male, one female) who provide locum services on long-term basis. All other nursing staff including three advanced nurse practitioners, one nurse practitioner and two practice nurses are locum staff, most of whom work at the practice regularly. The practice employed a team of seven reception and administration staff and two health care assistants on a permanent basis. The clinical team and non-clinical staff are supported by a group practice manager.

The GP practice is open from 8am until 6.30pm, Monday to Friday. The walk in centre is open from 8am until 8pm seven days per week for anyone entitled to NHS services, whether registered with the practice, another GP practice or not NHS registered at all. They also provide services to overseas visitors. During April 2015 to April 2016, the walk in centre saw 19,600. During a six month period from September 2016 to February 2017, the walk in centre saw 12,233 patients.

The practice provides on-line services for patients such as to book routine appointments and ordering repeat prescriptions.

The practice has an Alternative Provider Medical Services contract (APMS). An APMS contract is provided under directions of the Secretary of State for Health and can be used to commission primary medical services from GP practices as well as other types of service providers.

The practice has opted out of providing the out-of-hours service. This service is provided by the out-of-hours service accessed via the NHS 111 service. Advice on how to access this service is clearly displayed on the practice website, in the practice leaflet and over the telephone when the practice and walk in centre is closed.

Updated 30 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at SSAFA Care CIC Health and Walk In Centre on 21 March 2017. Overall the practice is rated as inadequate.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, reviews and investigations were not thorough enough. Not all members of staff were involved in regular significant event meetings.
• Patients were at risk of harm because systems and processes to keep them safe were ineffective. For example, the processes in place to review and monitor patients prescribed high-risk medicines was inconsistent and reviews were not always completed in accordance with best practice guidance.
• Patient care records in relation to some home visits carried out were not found to be accurate and did not represent the actual care and treatment of patients. Clinical staff were unable to confirm whether some visits had taken place.
• Although some clinical audits had been carried out, not all audits were used to drive improvements to patient outcomes.
• There was a system in place within Leicester, Leicestershire and Rutland CCGs for all urgent care services including some emergency services whereby these providers had access to twice daily calls to discuss and monitor patient demand and capacity. These providers worked together in cases of high demand on services and put emergency plans into place to ensure effective use of these services within LLR.
• There was one key performance indicator in place between the local CCG and the walk in centre which was to ensure 90% of patients to be seen within 30 minutes of arrival. The practice continually achieved this KPI throughout the past 12 months, we saw evidence to show that the achievement for January-March 2017 was 97% compared to October-December 2016 when the practice achieved 98%.
• Results from the national GP patient survey showed patients felt they were treated with compassion, dignity and respect. The practice was above average for its satisfaction scores on consultations with GPs and nurses.
• Information about services and how to complain was available and easy to understand. However, the practice did not have a system in place for all staff including non-clinical staff to learn from complaints through discussion at regular meetings or via direct feedback.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had a number of policies and procedures in place to govern activity.

The areas where the provider must make improvements are:

• Review governance and clinical oversight arrangements including systems for assessing and monitoring risks and the quality of the service provision such as implementing a system of effective clinical audits and re-audits to improve patient outcomes.

• Review process in place to ensure the safeguarding register is up to date and accurate and monitored regularly.

• Ensure systems and processes are in place to ensure patients prescribed high-risk medicines are monitored appropriately ensuring all required reviews are carried out.

• Ensure that an accurate, complete and contemporaneous record is maintained for every patient.

• Review processes for reporting, recording, acting on and monitoring significant events, incidents, near misses and complaints. Ensuring actions taken and lessons learned are shared with the wider team and actions are documented with timely review dates.

In addition the provider should:

• Review methods of communication and meeting structures to ensure all practice staff clinical and non-clinical are provided with the opportunity to be involved in discussions about the practice.

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 June 2017

The practice was rated as inadequate for being safe, effective and for being well-led and good for being caring and responsive. The issues identified as being inadequate overall affected all patients including this population group. The practice is rated as inadequate 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.

• Performance for diabetes related indicators was 76% which was lower than the CCG average of 86% and the national average of 90%. (exception reporting rate was 14% which was higher than the CCG average of 8% and the national average of 12%).

• The lead GP had a specialist interest in the diabetes management and held a regular dedicated diabetes clinic for patients including pre-diabetic patients.

• 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 multi-disciplinary package of care.

Updated 30 June 2017

The practice was rated as requires improvement for being safe, effective and for being well-led and good for being caring and responsive. The issues identified as being inadequate overall affected all patients including this population group. The practice is rated as inadequate 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 accident and emergency (A&E) attendances.

• Childhood immunisations were carried out in line with the national childhood vaccination programme. Uptake rates for the vaccines given were comparable to CCG/national averages. For example, rates for the vaccines given to five year olds ranged from 82% to 94%.

  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 and for acute pregnancy complications.

Updated 30 June 2017

The practice was rated as inadequate for being safe, effective and for being well-led and good for being caring and responsive. The issues identified as being inadequate overall affected all patients including this population group. The practice is rated as inadequate 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.

Updated 30 June 2017

The practice was rated as inadequate for being safe, effective and for being well-led and good for being caring and responsive. The issues identified as being inadequate overall affected all patients including this population group. The practice is rated as inadequate 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, we were told that patients who were registered with the practice could be seen in the walk in service if they presented at the practice and requested an on the day routine or urgent appointment.

• 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 30 June 2017

The practice was rated as inadequate for being safe, effective and for being well-led and good for being caring and responsive. The issues identified as being inadequate overall affected all patients including this population group. The practice is rated as inadequate 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.

• Performance for mental health related indicators was 100% which was the maximum amount of points available compared to the CCG average of 93% and the national average of 93%. (exception reporting rate was 12% which was similar to the CCG average of 11% and the national average of 11%).

• 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 30 June 2017

The practice was rated as inadequate for being safe, effective and for being well-led and good for being caring and responsive. The issues identified as being inadequate overall affected all patients including this population group. The practice is rated as inadequate 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.

• 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.