The Hythe Medical Centre

Updated 15 July 2016

The Hythe Medical Centre is located in Staines. The main site is housed in a porta cabin which is located near a the community centre. The practice have been in ongoing discussions with the clinical commissioning group (CCG) and other local practices to try to relocate to a permanent building. The branch site is located in the Staines Health Centre which is a purpose built property. The building is sublet from a private landlord by NHS Estates. At the time of our inspection there were approximately 4,400 patients on the practice list.

The age profile of the practice population is comparable to the national average although the practice has a slightly lower number than average of younger male patients birth to 24 years and slightly higher number than average of female patients birth to four years and patients over 65 years. It also has a lower than average percentage of patients with long standing health conditions. The practice has a lower than national average number of patients affected by deprivation.

The practice is owned by a single GP who works with two salaried GPs. There were two male and one female GPs. There are also three nurses, a practice manager and deputy practice manager, reception and administration staff.

The practice is open between 8.30am and 6pm Monday, Tuesday, Thursday and Friday. On Wednesday the practice closes early and is open from 8.30am to 1pm. Calls were answered by an external service between the hours of 8am to 8.30am, 6pm to 6:30pm and Wednesday afternoons between 1pm to 6.30pm where a GP from the practice is on call. Extended hours surgeries are offered 6.30pm to 8.15pm Tuesday and 7.30am to 8am Thursday mornings. Patients requiring a GP outside of normal hours are advised to call NHS 111 where they are redirected to an external out of hours service.

The practice has a General Medical Services contract and offers enhanced services for example; childhood immunisations, flu and pneumococcal immunisation schemes.

Services are provided from two locations:-

Hythe Medical Centre

Rochester Road

Staines

Middlesex

TW18 3HN

Staines Health Centre

Knowle Green

Staines-upon-Thames

Middlesex

TW18 1XD

We did not inspect the branch surgery during this inspection.

Updated 15 July 2016

Letter from the Chief Inspector of General Practice

Following an announced comprehensive inspection of The Hythe Medical Centre in December 2015 the practice was given an overall rating of requires improvement.

The practice was rated as requires improvement for providing safe and well-led services, and good for providing caring, effective and responsive services. In addition, all six population groups were rated as requires improvement. At our inspection we identified concerns relating to building and equipment safety checks, the provision of emergency equipment, recruitment and appraisal of staff. we also had concerns in respect of the recording, analysis, and sharing of learning from significant events.

After the comprehensive inspection, the practice wrote and provided an action plan to tell us what they would do in respect of our inspection report findings and to meet legal requirements. We undertook this focused inspection on 9 June 2016 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. Overall the practice is rated as good following this inspection.

Our previous inspection in December 2015 found the following areas where the practice must improve:

• Improve staff understanding and the subsequent recording of significant events and the communication of any learning points to appropriate staff.

• Ensure that oxygen is available to deal with medical emergencies.

• Ensure that building safety checks are completed, including electricity safety checks, legionella risk assessments and the routine testing of fire alarms and fire drills.

• Ensure that portable electrical safety testing is carried out and that clinical equipment is calibrated.

• Ensure that infection control audits are completed regularly and any subsequent concerns actioned.

• Ensure the annual appraisal process is robust and that all staff have annual appraisals.

• Ensure that recruitment checks are completed in line with practice policies.

• Implement a schedule of clinical audit to support improvement.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk

Our key findings across the areas we inspected for this focused inspection were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting, recording, investigating and sharing learning from significant events.
• Risks to patients were assessed and well managed including building and equipment safety checks and infection control audits.
• The practice had good facilities and was well equipped to treat patients and meet their needs including the management of patient confidentiality in the waiting area and provision of oxygen to deal with medical emergencies.
• There was a system in place for annual appraisals and all staff had an appraisal within the last twelve months.
• Recruitment checks for new staff were completed in line with practice policy.
• There was a clear schedule of clinical audit used to drive quality improvement.

As a result of this inspection, the areas where the provider should make improvement are:

• Review the results of the national GP survey and consider ways that the practices performance could be improved, specifically in areas where the survey results are below average.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 July 2016

The practice is now rated as good for the care of people with long term conditions.

Our previous inspection in December 2015 rated this practice as requires improvement for the care of people with long term conditions, as the issues identified as requiring improvement for providing safe and well-led services affected all patients including this population group. The practice has made significant improvement and is now rated as good for providing safe and well-led services and overall.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Diabetic indicators were comparable to other practices, for example the percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was comparable with national average (practice 81%, national average 78 %).

• 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.

Updated 15 July 2016

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

Our previous inspection in December 2015 rated this practice as requires improvement for the care of families, children and young people, as the issues identified as requiring improvement for providing safe and well-led services affected all patients including this population group. The practice has made significant improvement and is now rated as good for providing safe and well-led services and overall.

• 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.
• The percentage of patients diagnosed with asthma, on the register, who had an asthma review in the last 12 months was 85% which was comparable with the national average 75%.
• 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.
• The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years was 80% which was comparable with the national average 81%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives and health visitors.

Updated 15 July 2016

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

Our previous inspection in December 2015 rated this practice as requires improvement for the care of older people, as the issues identified as requiring improvement for providing safe and well-led services affected all patients including this population group. The practice has made significant improvement and is now rated as good for providing safe and well-led services and overall.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. Longer appointments and appointments outside of surgery times were available when needed.

• The percentage of people aged 65 or over who received a seasonal flu vaccine was 72% which was comparable to the national average 73%.

Updated 15 July 2016

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

Our previous inspection in December 2015 rated this practice as requires improvement for the care of working age people, as the issues identified as requiring improvement for providing safe and well-led services affected all patients including this population group. The practice has made significant improvement and is now rated as good for providing safe and well-led services and overall.

• The needs of the working age population, those recently retired and 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 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 offers appointments between 7:30 and 8am on a Thursday morning and 6:30 to 8:15pm on a Tuesday evening for patients who find it difficult to attend during normal surgery hours.
• The practice also offers telephone appointments.

Updated 15 July 2016

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

Our previous inspection in December 2015 rated this practice as requires improvement for the care of people experiencing poor mental health, as the issues identified as requiring improvement for providing safe and well-led services affected all patients including this population group. The practice has made significant improvement and is now rated as good for providing safe and well-led services and overall.

• 85% of patients diagnosed with dementia who had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average (84%).
• The practice regularly worked with multi-disciplinary teams in the case management of people 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.
• 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 15 July 2016

The practice is now rated as good for the care of people whose circumstances may make them vulnerable.

Our previous inspection in December 2015 rated this practice as requires improvement for the care of people whose circumstances may make them vulnerable, as the issues identified as requiring improvement for providing safe and well-led services affected all patients including this population group. The practice has made significant improvement and is now rated as good for providing safe and well-led services and overall.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• 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.