Woodside Medical Centre

Updated 16 February 2017

Woodside Medical Centre is registered with the Care Quality Commission (CQC) as a partnership provider in Tile Hill, Coventry. The practice completed its merger with a co-located practice in December 2016 and has a growing practice list. At the time of our inspection, the practice had 10,485 patients. The practice provides GP services to 47 patients who live in care homes, and during term time provides GP services to a local college for young people with additional needs. The practice is a teaching and training practice and has four qualified GP trainers; two have recently undergone additional training to support medical students who start at the practice in January 2017.

The practice is open between 8.30am and 6.30pm Monday to Friday. Patients can book appointments in advance and through the practice on-line appointment system. The practice offers extended hours locally in Tile Hill via the Coventry and Rugby GP Alliance. These appointments are available every evening from 6.30pm to 9.30pm, Monday to Friday and on Saturday and Sunday mornings for all registered patients. The practice does not routinely provide an out-of-hours service to their own patients but patients are directed to NHS 111, the out of hours service when the practice is closed.

The practice staff work a variety of full and part time hours, staffing comprises of:

• Five GP partners (three male, two female.)

• A female salaried GP due to become a GP Partner

• Five GP registrars.

• A practice nurse lead

• Three practice nurses

• One Healthcare assistant

• One business manager

• One patient services manager

• One reception lead

• Eight receptionists

• Two medical secretaries

• One prescribing clerk

The practice holds a General Medical Services (GMS) contract with NHS England. This is a contract for the practice to deliver General Medical Services to the local community or communities. They also provide some Directed Enhanced Services, for example, they identify patients who are at high risk of avoidable unplanned admissions. The practice provides a number of services, for example long-term condition management including asthma, diabetes and high blood pressure. The practice offers NHS health checks and smoking cessation advice and support.

Updated 16 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Woodside Medical Centre on 11 January 2017. 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.
• 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.
• The practice used innovative and proactive methods to improve patient outcomes. For example, the GPs shared an online tool that was regularly updated when new evidence or local guidance was published. GPs reviewed information and commented and shared any learning points. Where relevant this information contributed to the practice’s agendas for team meetings.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Practice staff reviewed the needs of its local population to secure improvements to services where these were identified.
• 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 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. They had changed appointment availability by adjusting GP sessions on different days of the week to focus clinical activity appropriately and as a result, they found that the demand for routine appointments had significantly reduced.
• Patients said they found it easy to make an appointment with a 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.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Recruitment checks to include pre-employment health declarations and staff immunisation status.

• The practice to complete regular fire drills and to document attendees.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 February 2017

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.

• Performance rates for all of the diabetes related indicators were comparable or above local and national averages. For example, 86% of patients with diabetes had received a recent blood test to indicate their longer-term diabetic control was below the highest accepted level, compared with the Clinical Commissioning Group (CCG) average of 79% and national average of 78%.

• The percentage of patients with chronic obstructive pulmonary disease (COPD) who had had a review in the preceding 12 months was 96%; this was higher than the CCG average of 91%, and national average of 90%.

• 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 named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• The practice provided smoking cessation support and signposted patients to practice based and citywide education groups for long-term conditions. These included pharmacy outreach, respiratory and cardiac rehabilitation. This enabled patients to make informed lifestyle choices.

• The practice team regularly used resources to actively engage with other community teams and secondary care. This included National Institute for Health and Care Excellence (NICE) guidance, GP gateway, email, Advice and Guidance and informal telephone conversations and internally in the use of their app/tool to share best practice.

Updated 16 February 2017

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 who were at risk, for example, children and young people who had a high number of A&E attendances.

• The practice provided a family planning service.

• The practice’s uptake for the cervical screening programme was 81%, which was comparable with the CCG and national average of 81%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice had an effective system in place to follow up children who failed to attend for their immunisations. Children who did not attend for appointments were discussed in a weekly clinical meeting and followed-up as appropriate.

• The practice held a safeguarding register and recorded all outside agency requests for information via secure email to enable clear auditable data.

• The practice vaccination rate for pregnant women was 61%, almost double the national rate of 31.8%.

• In teenage pregnancy, patients could access the family nurse partnership scheme, where a nurse offers regular visits to parents throughout pregnancy up to the child's second birthday.

• The Tile Hill area was part of a pilot scheme of increased Health Visiting services and the practice meet with their designated health visitor each Friday. They exchanged any concerns and acted on any issues that they or the midwife may have picked up at a weekly integrated team meeting held between them and the social care and children’s centre members.

• The local practice area was supported by a children’s centre that provided help for families, breastfeeding mothers, and baby groups.

Updated 16 February 2017

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

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. This included arranging joint home visits, nurses providing the housebound influenza vaccinations and both practice and home based chronic disease reviews.

• Double appointments where offered for patients with complex needs and the practice liaised closely with community teams to meet their needs.

• The practice provided a named accountable GP for patients aged over 75 years with urgent appointments available the same day.

• GP services were provided for 47 patients in local care homes.

• Care plans were in place and agreed for those patients identified as being at high risk of admission / re-admission. The practice used the care plan process as an opportunity to raise levels of care in terms of helping the individual, the carers and broaching difficult topics such as resuscitation status. If a person specified a preference this was documented in their record and the patient retained a copy. Patients on a care plan were invited to use a designated phone line to contact the practice.

• The practice influenza vaccination rate was 66% for this group, above the national average of 58% and their vaccination policy extended to pneumococcal and shingles provision with a robust recall in place. The practice shingles vaccinations were currently at 15.5% for routine and 36.5% for catch up vaccinations.

• The practice had established a carers’ register, with 461 patients listed (4.4% of the practice list). and signposted carers to a weekly carers meeting in the practice building.

• The practice had a long established proactive approach to social isolation and provided a tea and talk service that had run for the past 15 years, made accessible by the local ring and ride service.

• The practice demonstrated awareness of the issues surrounding polypharmacy (patients on multiple medicines), and effects on quality of life and had a 100% record for polypharmacy reviews in the 12-month period.

• The practice accessed the city wide ‘Integrated Neighbourhood Team’ that identified the benefit of social prescribing in the older population and members of the multi-disciplinary team included physiotherapists, occupational therapists and community nurses.

Updated 16 February 2017

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, 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 set up lunchtime telephone appointments and increasingly engaged with people by email.

• 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. The practice appreciated the need to use all forms of media and two GPs had recently redeveloped the practice website to include Facebook access. The practice had awareness that where appointment access was an issue, patients sometimes sought advice treatment via A&E. The A&E attendance figures for the practice remained static in 2015/16 despite the increased number of patients arising from the practice merger. The practice remained in the bottom third in terms of attendance rates for the CCG but hoped that the further improvements they had made would have a positive impact.

• Patients had access to the service set up by the Coventry and Rugby GP Alliance for extended hours that allowed patient access to a GP from 6.30pm to 9.30pm Monday to Friday and on Saturday and Sunday mornings.

• NHS health checks were offered by letter for nurse led appointments. To date the practice had seen 17 % of patients attend.

• The practice area included higher than average unemployment rates within Tile Hill. The practice signposted patients to a weekly ‘Jobs Club’ held at the nearby church. The practice ethos was to support patients as much as possible when they were not working. Patients were encouraged to have a timely reintroduction to work to improve both their physical and psychological outcomes.

Updated 16 February 2017

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 showed for example, the percentage of patients with a diagnosed mental health condition who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months was 94%. This was higher than the CCG average (86%) and national average 89%.

• 80% of patients diagnosed with dementia had had their care reviewed in a face-to-face meeting in the last 12 months, which was comparable with the CCG average of 81% and the national average of, 84%.

• 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.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

• One of the practice partners had qualifications in substance misuse and acted as the prescriber for substitution therapy in opioid dependence. The practice liaised with the Community Drugs Team (CDT).

Updated 16 February 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 carers and those with a learning disability. This included registers of recorded domestic violence, child cause for concern, vulnerable adults and safeguarding.

• The practice provided carer support, signposting, information packs and held a carers’ register.

• There were 30 patients on the practice learning disability register and they were offered an annual health check.

• The practice offered longer appointments for patients with a learning disability.

• The practice offered a term time GP service for a local college, which provided educational support for young patients with additional needs. They organised regular medicine reviews and the practice held a folder that patients could use to point to body parts and pictograms for communication support.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. A GP service was provided for a women’s refuge and patients were able to register with an anonymous address. Many of these patients had complex needs and the staff accessed interpreters and liaised with other agencies to meet these needs.

• Patients of no fixed abode could register at the practice however; reception staff were unfamiliar with how they would document the patient onto their electronic systems.Reception staff said they would seek clarity from the GP partners.

• 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.

• The practice systematically identified patients who may have communication difficulties, to ensure they met their needs. and the practice complied with the requirements of the Accessible Information Standard.

• The practice had developed strong networks within the community such as the police and housing groups and used these to help identify vulnerable people.