Archived: Meadowgreen Health Centre

Updated 9 December 2016

Background to Meadowgreen Health Centre

Meadowgreen Health Centre has two sites. The main branch is situated at School Lane Greenhill, Sheffield S8 7RL. This is located approximately five miles south of Sheffield City Centre. The practice branch site is situated at Lowedges, Sheffield, S8 7LL, which is approximately one mile to the south of the main site. The School Lane site is housed in a former school and is within a conservation area. Due to the age of the building there are some challenges in relation to disabled access. There is one consultation room on the first floor. All other consultation rooms are on the ground floor. Patients with mobility problems are seen in the ground floor rooms. The Lowedges site is housed in a 1970s purpose built premises. This is a single storey building which had some limitations in relation to space. Both sites are accessible by public transport and have car parking available.

There are currently 9,724 patients registered across both sites. The National General Practice Profile shows the majority of the patients are white British, with 2% mixed and 2% black ethnicity.

The practice provides Personal Medical Services (PMS) under a locally agreed contract with NHS England. They offer a range of enhanced services such as minor surgery and rotavirus and shingles immunisations.

The practice is a teaching and training practice, which means it offers training placements for medical students, newly qualified doctors, and more experienced doctors (registrars) wishing to specialise in general practice. One of the partners is an associate lecturer at a local University.

The practice has five GP partners, two female and three male and two salaried GPs who are both female. At the time of our inspection there were also two registrars, one male and one female working at the practice. The clinical team is completed by four female practice nurses and three female health care assistants (HCAs). Supporting the clinical team are two practice managers, two reception managers as well as a range of reception, secretarial and administrative staff.

The practice is classed as being within the fourth most deprived decile in England. People living in more deprived areas tend to have greater need for health services.

68% of the practice population has a long-standing health condition, compared to the local average of 56% and the national average of 54%.

23% of the practice population are aged over 65, compared to the local average of 16% and the national average of 17%.

The average life expectancy for patients at the practice is 79 years for men and 84 years for women, compared to 78 years and 82 years respectively for the CCG, and 79 years and 82 years nationally.

The practice is open between 8.15 am and 6.30pm Monday to Friday at the School Lane site and between 8.15am and 6.30pm Monday, Tuesday, Wednesday and Friday at the Lowedges site, and between 8.15am and 1pm on Thursday. Extended hours are offered between 7am and 8am on Monday at the School Lane site and between 7am and 8am at the Lowedges site.

Weekly clinics are held which include asthma, diabetes and childhood immunisations.

Out of hours cover is provided by the Sheffield GP collaborative, which is accessed by calling the surgery number or the NHS 111 service.

Updated 9 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Meadowgreen Health Centre on 9 November 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 were assessed and well managed.
• 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.
• Staff received induction programmes relevant to their role. Clinical staff had their hepatitis B immunity checked. Other newly recruited staff did not receive a health assessment or review of their immunisation status.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• We observed that conversations taking place at reception could be overheard by others in the waiting areas at both sites. Following the inspection the practice informed us they were looking at costings with a view to installing glass partitions at reception areas at both sites.
• 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.
• Patients said they found it easy to make an appointment with a GP or nurse. Telephone triage appointments were offered each day between 8.15am and 6.30pm. Same day appointments were available when clinically indicated.
• The practice had two sites. There were limitations in relation to space at both sites. The practice made good use of the facilities available to them. We saw a premises action plan had been developed to address shortfalls in relation to the decorative standard of both premises.
• There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.
• The practice had a strong ethos of teaching and training throughout all staff groups. One of the GPs was an associate lecturer at the University of Sheffield.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Provide all newly recruited staff with access to a pre-employment health assessment to include a review of their immunisation needs, in line with Public Health England (PHE) guidelines

• Continue to monitor confidentiality for patients speaking with reception staff at both sites and take steps to mitigate conversations being overhead whenever possible.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 December 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.

• 97% of patients had a diagnosis of heart failure which had been confirmed by echocardiogram (ECG) or specialist assessment within 15 months of entering onto the register, compared with 95% locally and nationally.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and 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 had access to support from a diabetic specialist nurse. Insulin initiation could be carried out at the practice, to avoid the need to attend hospital outpatient appointments. The health care assistant was able to provide foot checks for diabetic patients at the time of their review to avoid the need for patients to attend podiatry appointments.

• All patients with asthma who had attended hospital were contacted by the practice within 48 hours of discharge to review their health and medication needs.

• The practice made use of patient activation measures (PAMs) which encouraged patients to take ownership of their long term condition, and set individual objectives, in conjunction with clinical input.

Updated 9 December 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 accident and emergency (A&E) attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• Staff told us that children and young people were treated in an age-appropriate way and gave examples to demonstrate this.

• 88% of eligible women had completed a cervical screening test in the preceding five years which is higher than CCG and national averages of 88% and 81% respectively.

• Appointments were available outside of school hours. Despite some restrictions in relation to space within the premises, baby changing facilities were available, and a private room could be made available for those mothers wishing to breastfeed their baby.

• The practice held regular meetings with health visitors to discuss children and families with additional need. The midwife held an antenatal clinic in the practice, when they would also liaise informally with the GP and nursing staff.

Updated 9 December 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.

• Home visits were carried out by GPs, nurses and health care assistants when required.

• The practice had registered patients who resided in a nearby care home for older people. A named GP visited weekly to review the needs of the residents and provide responsive and proactive care to this group of people.

• The practice participated in the avoiding unplanned admissions scheme for those patients identified as most vulnerable. One of the GPs took the lead in this. Contact was made following discharge from hospital to review health needs. In addition routine contact was made on a four monthly basis if patients had not been seen elsewhere during that period.

Updated 9 December 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 acknowledged.  Appointments could be booked up to eight weeks in advance with GPs, and up to 12 weeks in advance for nurse appointments. In addition the practice offered telephone triage between 8.15 am and 6.30pm, with appointments being made available on the day when clinically necessary. Extended opening hours were offered on Monday between 7am and 8am at the School Lane site, and on Wednesday between 7am and 8am at Lowedges site. This enabled working patients to be seen before or after work when required.

• The practice was proactive in offering online services as well as a full range of health promotion and screening reflecting the needs of this age group. We saw that 1,653 patients (17% of the patient list) had registered for online access.

Updated 9 December 2016

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

• 90% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the preceding 12 months which was higher than the CCG and national averages of 85% and 84% respectively.

• 84% of patients with schizophrenia and other psychoses had a record of their alcohol consumption completed in the preceding 12 months which was lower than the CCG and national average of 89%.

• The practice hosted ‘Improving Access to Psychological Therapy’ (IAPT) services to support those patients experiencing mental health issues.

• The CSW supported patients experiencing mental health difficulties to engage with local support groups and voluntary agencies.

• The practice regularly worked with multidisciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia.

• 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.

Updated 9 December 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 palliative care patients, and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability or other enhanced need.

• The practice worked with other health care professionals, such as the mental health team, in the case management of vulnerable patients.

• The practice supported a local care home for neurologically disabled adults.

• The practice had access to a local authority employed ‘Community Support Worker’ (CSW). She worked closely with the practice to holistically assess the needs of more vulnerable patients. Support was given to enable them to access any benefits to which they were entitled. In addition support was given to enable this group of patients to access local groups and services to alleviate isolation and loneliness.

• 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 had identified 262 (3%) of their patient population as carers. Seasonal flu vaccination was offered, and information given about local support services such as a local carers charity.

• Alcohol and substance misuse support services were available locally.