Archived: Grove Hill Medical Centre

Updated 17 May 2017

Grove Hill Medical Centre provides a range of primary medical services from its premises at Kilbride Court, Grove Hill, Hemel Hempstead, Hertfordshire, HP2 6AD.

The practice serves a population of approximately 4,833. The area served is slightly less deprived compared to England as a whole. The practice population is mostly white British with some Central and Eastern European communities. The practice serves an above average population of those aged from 0 to 9 years, 30 to 44 years and 55 to 69 years. There is a lower than average population of those aged from 15 to 29 years, 45 to 54 years and 70 years and over.

The clinical team includes one male and two female GP partners, one practice nurse and one healthcare assistant. The team is supported by a practice manager and nine other administration, secretarial and reception staff. The practice provides services under a General Medical Services (GMS) contract (a nationally agreed contract with NHS England).

The practice is staffed with the doors and phone lines open from 9am to 12.30pm and 1.30pm to 6pm Monday to Friday. Between 12.30pm and 1.30pm daily except Wednesdays the doors are closed and phones switched to voicemail and patients directed to emergency numbers if required. On Wednesdays there is no lunchtime closure and there is extended opening from 7am. Appointments are available from 9am to midday and 4pm to 6pm daily, with slight variations depending on the doctor and the nature of the appointment.

An out of hours service for when the practice is closed is provided by Herts Urgent Care.

Updated 17 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Grove Hill Medical Centre on 31 August 2016. The overall rating for the practice was good. However, we identified breaches of legal requirements. Improvements were needed to systems, processes and procedures to ensure the practice provided well-led services. Consequently the practice was rated as requires improvement for being well-led. The full comprehensive report from the 31 August 2016 inspection can be found by selecting the ‘all reports’ link for Grove Hill Medical Centre on our website at www.cqc.org.uk.

After the comprehensive inspection, the practice wrote to us and submitted an action plan outlining the actions they would take to meet legal requirements in relation to;

• Regulation 17 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014

- good governance.

The areas identified as requiring improvement during our inspection in August 2016 were as follows:

• Ensure that a Legionella risk assessment is completed and that any issues identified are resolved and that water temperature checks are completed correctly.
• Ensure that infection control audits are fully completed and that the issues identified and actions in place to resolve them are clear.
• Ensure sufficient quality assurance processes are in place, including implementing a structured programme of repeat cycle clinical audit.
• Ensure there is a formal and coordinated practice wide process in place for how staff access guidelines from NICE and use this information to deliver care and treatment.
• Ensure that at all times sufficient processes are in place and adhered to for the management and review of results received from secondary care services.

In addition, we told the provider they should:

• Ensure that all staff employed are supported by completing the essential training relevant to their roles, including safeguarding adults training.
• Take steps to ensure that hot water temperatures at the practice are kept within the required levels.
• Ensure that at least one piece of photographic proof of identification is included in the personnel file of each member of staff.
• Ensure that checks on all emergency equipment are documented and that the Resuscitation Council guidelines displayed at the practice are up to date.
• Continue to identify and support carers in its patient population by providing annual health reviews.
• Ensure that, where practicable and appropriate, all reasonable adjustments are made for patients with a disability in line with the Equality Act (2010).

We carried out an announced focused inspection on 5 April 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches of regulation that we identified in our previous inspection on 31 August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our key finding on this focused inspection was that the practice had made improvements since our previous inspection and were now meeting the regulation that had previously been breached.

The practice is now rated as good for providing well-led services.

On this inspection we found:

• Clinical audit demonstrated quality improvement.
• Appropriate Legionella and water temperature management processes were in place. (Legionella is a term for a particular bacterium which can contaminate water systems in buildings).
• The latest infection control audit was fully completed and the issues identified and any actions in place to resolve them were clearly detailed.
• A coordinated practice wide process was in place to ensure that staff had access to National Institute for Health and Care Excellence (NICE) guidelines and used this information to deliver care and treatment that met people’s needs.
• Sufficient processes were in place and adhered to for the management and review of results received from secondary care services.

Additionally where we previously told the practice they should make improvements our key findings were as follows:

• All staff had completed adult safeguarding training.
• Personnel files contained appropriate photographic proof of identification.
• A documented log of the weekly checks on the defibrillator was available and well completed.
• Up to date Resuscitation Council guidelines were displayed at the practice and staff were aware of any changes from the previous version.
• Sufficient arrangements were in place to identify carers in the practice’s patient population and offer them an annual health review.
• A portable hearing loop was provided.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 November 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.
• 88% of patients on the asthma register had their care reviewed in the last 12 months. This was above the CCG average of 76% and the national average of 75%.
• Performance for diabetes related indicators was above the CCG and national averages. The practice achieved 98% of the points available compared to the CCG average of 91% and the national average of 89%.
• All newly diagnosed patients with diabetes were managed in line with an agreed pathway.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured six monthly review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GPs worked with relevant health and care professionals to deliver a multi-disciplinary package of care.

Updated 28 November 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 may be at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were comparable to other practices in the local area for all standard childhood immunisations.
• 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 practice’s uptake for the cervical screening programme was 81% which was comparable to the CCG average of 83% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• There were six week post-natal checks for mothers and eight week checks for their children.
• A range of contraceptive and family planning services were available.

Updated 28 November 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.
• The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs.
• Older people had access to targeted immunisations such as the flu vaccination. The practice had 585 patients aged over 65 years. Of those 383 (65%) had received the flu vaccination at the practice in the 2015/2016 year.
• There were named GPs for each of the care homes in the practice’s local area. The GPs visited as and when required to ensure continuity of care for those patients with scheduled visits every six months to complete health reviews for those patients.  

Updated 28 November 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 identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• The practice offered online services such as appointment booking and repeat prescriptions as well as a full range of health promotion and screening that reflects the needs for this age group.
• There was some additional out of working hours access to meet the needs of working age patients. There was extended opening every Wednesday until 7.30pm. 

Updated 28 November 2016

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

• 92% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was above the CCG and national average of 85%.
• Performance for mental health related indicators was better than the CCG and national averages. The practice achieved 100% of the points available compared to the CCG average of 96% and the national average of 93%.
• 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• The practice referred patients as required to mental health trust well-being workers based elsewhere.
• There was a GP lead for dementia.

Updated 28 November 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 those with a learning disability. There were 14 patients on the practice’s learning disability register at the time of our inspection and all had received a health review in the past 12 months (the practice completed the reviews every six months).
• The practice offered longer appointments for patients with a learning disability and there was a GP lead for these patients.
• 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.
• Additional information was available for patients who were identified as carers and there was a nominated staff lead for these patients.
• The practice had identified 66 patients on the practice list as carers. This was approximately 1.4% of the practice’s patient list.