Archived: Dr Anthony Christopher Also known as Heath Town Health Centre

Updated 5 May 2016

Dr Anthony Christopher is located near the city of Wolverhampton in the West Midlands and operates from a single location. There are approximately 2445 patients registered at the practice. The practice has a larger than local average number of patients between the ages of four to 18 and 25 to 40 years. The percentage of patients between the ages of 65 and 85 plus is significantly lower than the practice average across England 7.1% compared to 26.5%. There is a significantly higher than national average representation of income deprivation affecting children and older people. The practice population is culturally diverse with approximately 77% of patients from Asian, African or East European backgrounds.

The practice is situated behind other properties within premises that used to also be occupied by other health professionals. The practice is now the only service that occupies the building. There is a lift situated at road level providing access to the practice for patients who use a wheelchair, patients with mobility problems and parents with pushchairs. The practice can also be accessed from the road by a flight of stairs.

The practice clinical team consists of a single male full time GP. The GP is supported by a practice manager and four receptionist/administration staff who work either full or part time hours. The GP told us that attempts to retain the services of a practice nurse had not been successful.

The practice is open between 8.30am and 6.30pm Monday, Tuesday, Thursday, Friday and Wednesday 8.30am to 1pm. Appointments are from 9am to 1pm Monday to Friday and afternoon appointments Monday, Tuesday, Thursday and Friday 2.50pm to 5.50pm. Extended surgery hours are available from 6pm to 7pm on Monday and Tuesday. The practice does not provide an out-of-hours service to its patients but has alternative arrangements for patients to be seen when the practice is closed. Patients are directed to the out of hours services, Primecare. Patients are also given details about the NHS 111 service and the local Walk-in Centres.

The practice has a contract to provide General Medical Services (GMS) for patients. This is a contract for the practice to deliver general medical services to the local community. It provides Directed Enhanced Services, such as the childhood vaccination and immunisation scheme and minor surgery. The practice provides a number of clinics for example long-term condition management including asthma, diabetes and high blood pressure.

Updated 5 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Christopher practice on Wednesday 13 January 2016. Overall the practice is rated as inadequate.

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

• Staff understood their responsibilities to raise concerns and to report incidents and near misses, however the practice did not have a formal system in place for recording and monitoring significant events, incidents and accidents.
• The practice did not have a programme of continuous clinical and internal audit in order to monitor quality and make improvements.
• There was insufficient monitoring of performance to demonstrate people received effective care and treatment.
• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
• Urgent appointments were available on the day they were requested. Patients said that they sometimes had to wait a long time to be seen at their appointment but accepted this as they were more than happy with the level of care provided by the GP.
• The practice had limited formal governance arrangements in place.
• There was a clear leadership structure and staff felt supported by the management. The practice did not proactively seek feedback from patients to ensure patients were involved in the delivery of the service.

The areas where the provider must make improvements are:

• Implement effective systems for the management of risks to patients and others against inappropriate or unsafe care. This should include arrangements for recording, analysing and acting upon significant events and improving the monitoring and recording of staff training.
• Ensure that staff who undertake the role of a chaperone have a Disclosure and Barring (DBS) check or an appropriate risk assessment carried out to demonstrate why a DBS check is not in place and how patients are protected from the risk of abuse during an examination.
• Implement robust governance arrangements to ensure appropriate systems are in place for assessing and monitoring the quality of services provided. This should include undertaking audits of practice, including completed clinical audit cycles.
• Implement systems for the management and monitoring of performance to demonstrate people received effective care and treatment. This should include patients with long term conditions such as diabetes and asthma and patients with dementia.

The areas where the provider should make improvement are:

• Consider repeating the risk assessment for legionella as recommended in the report and ensure a copy of the outcome and a policy is available at the practice to provide guidance for staff.

• Have a system in place to record, investigate and demonstrate the outcome of written and verbal complaints received.
• Ensure all staff receive training in the protection of vulnerable adults.
• Ensure that fire drill training/practice sessions take place for all staff.

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The practice will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration. Special measures will give people who use the practice the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 May 2016

The practice is rated as inadequate for the care of people with long-term conditions. The practice is rated as inadequate for the domains of safe, effective and well led and rated as requires improvement in responsive and caring. The concerns that led to these ratings apply to everybody using this practice including this population group. Performance for diabetes assessment and care 54.7% was much lower compared to the local average of 82.3% and the national average of 89.2%. Longer appointments and home visits were available when needed. The GP offered some suggestions as to the reasons for the low level of performance one of which was due to the transient population. The GP worked with relevant health care professionals to support the needs of patients with the most complex needs on an individual basis or by telephone.

Updated 5 May 2016

The practice is rated as inadequate for the care of families, children and young people. The practice is rated as inadequate for the domains of safe, effective and well led and rated as requires improvement in responsive and caring. The concerns that led to these ratings apply to everybody using this practice including this population group. 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. Immunisation rates were relatively high for all standard childhood immunisations. Data showed that 48.78% of patients on the practice asthma register had had an asthma review in the last 12 months this was significantly below the national average. The GP presented similar reasons for this level of performance as with the diabetes data but had not reviewed this information to see whether improvements could be made. 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. Appointments were available outside of school hours and the premises were suitable for children and babies. The practice’s uptake for the cervical screening programme was 77.72%, which was comparable to the national average of 81.83%.

Updated 5 May 2016

The practice is rated as inadequate for the care of older people. The practice is rated as inadequate for the domains of safe, effective and well led and rated as requires improvement in responsive and caring. The concerns that led to these ratings apply to everybody using this practice including this population group. The practice had fewer older patients at the practice when compared to other local practices. Care and treatment of older people reflected current evidence-based practice, and older people had care plans where necessary. The practice offered home visits and urgent appointments for those older patients with enhanced needs. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. Performance for the number of patients aged 65 and older who had received a seasonal flu vaccination was comparable to the national average. (76.23% as compared to the national average of 73.24%).

Updated 5 May 2016

The practice is rated as inadequate for the care of working-age people (including those recently retired and students). The practice is rated as inadequate for the domains of safe, effective and well led and rated as requires improvement in responsive and caring. The concerns that led to these ratings apply to everybody using this practice including this population group. The age profile of patients at the practice is mainly those of working age, students and the recently retired and the practice had adjusted its services to ensure these were accessible, flexible and offered continuity of care to this group of patients. The practice offered extended opening hours for appointments two evenings per week. However patients did not have access to book appointments or order repeat prescriptions online because the practice did not have a website. Health promotion advice was offered and health promotion material was available to patients in the waiting area. Patients were supported to access local healthy lifestyle programmes.​

Updated 5 May 2016

The practice is rated as inadequate for the care of people experiencing poor mental health (including people with dementia). The practice is rated as inadequate for the domains of safe, effective and well led and rated as requires improvement in responsive and caring. The concerns that led to these ratings apply to everybody using this practice including this population group. The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. The data showed that 100% of patients on the practice register who experienced poor mental health had been offered an annual health check. Although higher than the national average, 84.01% the practice had an exception rate of 40%. The dementia diagnosis rate for 2014/2015 was much lower than the national average (28.57% as compared to the national average of 84.01%).

Updated 5 May 2016

The practice is rated as inadequate for the care of people whose circumstances may make them vulnerable. The practice is rated as inadequate for the domains of safe, effective and well led and rated as requires improvement in responsive and caring. The concerns that led to these ratings apply to everybody using this practice including this population group. The practice had a register for patients with a learning disability and all had received an annual review. The practice was not aware of any patients living in vulnerable circumstances including homeless people or travellers. The practice was aware of the need to allow people with no fixed address to register or be seen at the practice. It had told 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 and how to access various support groups and voluntary organisations. However staff had not received training in safeguarding vulnerable adults to support them in the identification of possible signs of abuse and the procedures they should follow to act on their concerns.​