Waterhouses Medical Practice

Updated 17 October 2017

Waterhouses Medical Practice is registered with the Care Quality Commission (CQC) as a partnership provider in North Staffordshire. The practice holds a Personal Medical Services (PMS) contract with NHS England but is going through a five year phased transition to a General Medical Services (GMS). A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract. A PMS contract is a locally agreed alternative to the standard General Medical Services (GMS) contract used when services are agreed locally with a practice which may include additional services beyond the standard contract. The practice is on the ground floor of the building and consists of a dispensing pharmacy, reception area, minor treatment room and consultation rooms. Administrative staff are located on the first floor. The practice has level access from the car park and is accessible for wheelchair users, there is a disabled toilet facility.

The practice area is one of low deprivation when compared with the national and local Clinical Commissioning Group (CCG) area. At the time of our inspection the practice had 3,204 patients. Demographically the population is predominantly white British with a practice age distribution comparable to the national and CCG area in all age groups. The percentage of patients with a long-standing health condition is 60% which is comparable with the local CCG average of 57% and national average of 54%. The practice is a training practice for GP registrars and medical students to gain experience and higher qualifications in general practice and family medicine.

The practice staffing comprises of:

• Two GP partners (one male and one female)

• A locum GP, who will become a partner at the practice in November 2017, and two locum advanced nurse practitioners are currently covering a GP vacancy.

• Three female practice nurses and a health care assistant.

• A clinical support assistant

• A practice manager

• An assistant practice manager

• Four dispensary staff

• Three members of administrative staff working a range of hours.

The practice is open between 8am and 1pm and 2pm and 6pm Monday to Friday except for Thursday afternoons when it is closed. The practice closes at 1pm - 2pm but their telephone lines continue to be manned by a duty receptionist. Appointments are from 9am to 11.30am every morning and 3pm to 6pm daily (except Thursday afternoon). Telephone consultations are available after 11.30am. Appointments can be pre-booked up to four weeks in advance and urgent appointments are available for those that need them. The practice has opted out of providing cover to patients in the out-of-hours period and Thursday afternoons. During this time services are provided by Staffordshire Doctors Urgent Care, patients access this service by calling NHS 111.

Updated 17 October 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection of Waterhouses Medical Practice on 21 June 2016. The practice was rated as inadequate for providing safe services and requires improvement for providing effective and well led services. We carried out a focused inspection in respect of safe care on 5 October 2016 to check that urgent action had been taken to comply with legal requirements. We undertook a further announced comprehensive inspection at Waterhouses Medical Practice on 19 April 2017. The overall rating for the practice was good with requires improvement in providing safe services. The reports for the three inspections can be found by selecting the ‘all reports’ link for Waterhouses Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 4 October 2017. It was to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in the regulation that we identified in our previous inspection on 19 April 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as Good.

Our key findings were as follows:

• Joint injections were carried out in clinical rooms with appropriate flooring to prevent and control the risk of infection.

• Syringes, dressings and dressing packs were in date and a system for checking them had been put in place.

• Medicines used in the treatment of joint injections were stored securely.

• Prescription stationary used in printers was stored securely.

• Satisfactory evidence of conduct in previous employment was documented for locum staff who worked at the practice.

• The safeguarding policy for vulnerable adults had been updated to reflect categories or definitions of the types of abuse for example, modern slavery.

• Systems to follow up children who failed to attend for hospital appointments had been implemented.

• Alerts had been added to the records of the parents of children with a child protection plan in place.

• A formal system to review nurse/patient consultation and prescribing records to ensure the competence and safety of nurses employed to work at the practice had been implemented. The practice had reviewed their processes for supporting nursing staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 May 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.

• One hundred per cent of patients with chronic obstructive pulmonary disease (COPD) had had a review undertaken including an assessment of breathlessness using a recognised scale in the preceding 12 months. This was higher than the CCG average of 89% and the national average of 90%.
• The percentage of patients with diabetes, on the register, whose last measured total cholesterol was within recommended limits was 87%. This was higher than the CCG average of 81% and the national average of 80%.
• 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 was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 24 May 2017

The practice is rated as good for the care of families, children and young people.

• There were systems and procedures in place to safeguard children from the risk of abuse. These arrangements reflected relevant legislation and local requirements.

• Immunisation rates were relatively high for all standard childhood immunisations.

• The practice worked with midwives and health visitors to support this population group. For example, in the provision of ante-natal, post-natal and child development clinics.

• Alerts were placed on patient records to make staff aware of children who had a child protection plan in place. However, alerts were not in place to inform staff of the parents of children with a child protection plan in place.

• On the day appointments were available for children.

• There was no system in place to follow up children who failed to attend for hospital appointments.

Updated 24 May 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. A clinical support assistant offered holistic support to frail, older patients and their carers. They also followed up older patients discharged from hospital and liaised with GPs and district nursing staff so that patients’ care plans were updated to reflect any extra needs.

• The practice identified older patients who needed 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.

Updated 24 May 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of this population group had been identified and the practice had adjusted the services it offered to respond to patients’ needs. Extended opening hours were no longer available at the practice although telephone consultations were available for working age people.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 24 May 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.

• One hundred per cent

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• One hundred per cent of patients with a diagnosed mental health condition had a comprehensive, agreed care plan documented in their record, in the preceding 12 months. This was higher than the CCG and national averages of 89%.

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

• A cognitive behavioural therapist and community psychiatric nurse provided weekly clinics at the practice for patients experiencing poor mental health.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

Updated 24 May 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.

• 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 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.