Archived: Whitehouse Centre GP Practice

Updated 10 October 2016

The Whitehouse Centre is a GP practice that is run by Locala Community Partnerships, which provides a diverse range of health services in the West Yorkshire area. The Whitehouse Centre provides services to those excluded from mainstream services. This is due to their immigration status as asylum seekers or refugees, homeless people and those experiencing social and psychological difficulties that make them particularly vulnerable and unable to access usual care pathways.

The practice currently occupies a converted house in the town centre of Huddersfield, adjacent to the train station and bus routes. There is car parking available on site. The premises are easily accessible with treatment rooms on the ground floor for those patients that cannot climb stairs. The reception area is small and privacy is difficult to maintain. However, a private room is available for patients that wish to use it.

GP primary care services are provided for 1,540 patients; 985 of whom are registered asylum seekers. The practice has seen a steep increase in patient turnover in the last 10 years as more patients are referred to them for care. The practice has registered 4,347 and deregistered 3,032 patients in the last decade.

There are two half time female GPs who work at the practice and they have the assistance of a volunteer retired male GP who offers one session each week. The GPs work with a highly experienced advanced nurse practitioner (full time) and two practice nurses (1.8 whole time equivalent), who are all female.

The practice is supported by a practice manager who shares their time between two Locala locations. Administrative staff and receptionists are a close working team who take turns to greet patients and undertake administrative functions.

The staff at Locala are all salaried colleagues within the business. There are no partners. During the inspection we were greeted by the Chief Executive and members of the senior manager team with responsibility for functions such as safety, recruitment and governance. Locala provides services under an Alternative Provider Medical Services (APMS) contract, commissioned by Greater Huddersfield Clinical Commissioning Group.

Updated 10 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Whitehouse Centre on 26 May 2016. Overall the practice is rated as outstanding. The practice provides services for patients who find it difficult to access mainstream services because of complex circumstances. Patients are mainly asylum seekers, homeless or living in emergency accommodation.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, developing effective and responsive shared care treatment pathways for patients receiving treatment for substance misuse.

• Feedback from patients about their care was consistently positive.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, in the anticipation of high levels of asylum seekers entering the district, the provider had developed a standard operating procedure. This was to ensure the safe dispersal of patients into mainstream services after an annual review, with safeguards to retain patients on the list if indicated.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients. For example, providing flexible appointment access for clearly identified and risk assessed patients who were unable to attend fixed appointment slots due to their complex psychological or physical difficulties.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

• The provider was aware of and complied with the requirements of the duty of candour.

We saw a number of areas of outstanding practice:

• New adult patients were screened for their exposure to trauma including post traumatic stress disorder (PTSD) and its impact on mental health. The clinical team had expertise in identifying victims of torture and had developed a clinical template to aid assessment and a suitable treatment plan.

• Clinical meetings were held on a daily basis, ensuring that all staff were kept informed of patients’ needs, clinical decision making and operational issues that might impact on patient care. This approach encouraged the sharing of expertise and promoted a strong sense of teamwork.

• The practice ethos was underpinned by compassion that extended to providing social assistance for the homeless, such as food parcels, clothing and discretionary funding to provide taxis for those that would otherwise be unable to access services.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 10 October 2016

The practice is rated as outstanding 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.

• Patients seeking treatment for substance misuse were supported through comprehensive and effective shared care arrangements with a lead GP and specialist workers.

• Longer appointments 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.

Updated 10 October 2016

The practice is rated as outstanding 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 A&E attendances.

• Immunisations were offered to new patients in line with World Health Organisation guidelines. Patients, including children, were also routinely screened for vitamin D deficiency and treated accordingly.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• There was a high recognition of the needs of young carers and children were actively discouraged from acting as interpreters for family members. We saw evidence of good working relationships with other health and social care professionals to support the needs of young carers.

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

Updated 10 October 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population. The patient population for this practice had less than ten older people, who were known to all the staff.

• The practice was responsive to the needs of these older people as they were at high risk of social isolation and lacked family support. For example, any missed appointments were followed up by a welfare check.

Updated 10 October 2016

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

• The majority of the patient population found obtaining and sustaining paid employment highly challenging, due to the nature of their complex health and social needs.

• Those patients who were in employment were actively supported by the practice.

• The practice had a policy of issuing short term fit notes, in order to regularly review patients and provide opportunistic care as needed.

• 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 10 October 2016

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

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

• Newly registered adult patients were screened for their exposure to trauma including post traumatic stress disorder (PTSD) and its impact on mental health.

• The clinical team had extensive expertise in identifying victims of torture and had developed a clinical template to aid assessment and diagnosis.

• The practice had a very small number of patients with dementia. However, all of these patients had an up to date care plan in place.

• The practice worked closely with patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• 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.

Updated 10 October 2016

The practice is rated as outstanding for the care of people who circumstances may make them vulnerable.

• 75% of the patient population were asylum seekers or refugees and the practice had extensive skills to identify and support the needs of this group.

• The practice held a number of registers to identify and support patients living in vulnerable circumstances. These included homeless people, ex-offenders, dangerous patients and those with a learning disability.

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

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice actively supported vulnerable patients in accessing various support groups and voluntary organisations.

• Staff used opportunistic encounters with extremely vulnerable patients, who were not already registered with GP services, and encouraged them to register for services to access appropriate care and support.

• 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. GPs and all nursing staff were trained to safeguarding level three.