The Health Centre Practice

Updated 2 August 2017

The Health Centre Practice is a well-established GP practice that has operated in the area for many years. It serves approximately 11,500 registered patients and has a general medical services contract with NHS Cambridgeshire and Peterborough CCG. The service is located in Royston in premises that were purpose built over forty years ago. The building was extended by the partners in 2000 and also has a dispensary.

According to information taken from Public Health England, the patient population for this service has a lower than average number of patients aged 10-29 years compared to the national average and a higher than national average number of patients aged 25-44 and 60-74. Its population is in the least deprived decile with very low unemployment rates and many working age patients who commute to work.

The practice team consisted of seven GP partners, four practice nurses (one of whom is able to prescribe medicines) and four healthcare assistants with training in phlebotomy. A team of three dispensing assistants, 13 receptionists and four administrative staff support them along with a practice manager. The practice is also involved in the training of GPs and can also take medical students.

The opening times for the main surgery are Monday to Fridays from 8.30am to 6.30pm. Extended hours appointments are available from 6.30pm to 8pm on Mondays and 7am until 8am on Tuesday to Thursdays. An out of hour’s service is provided locally through the NHS 111 service.

Updated 2 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Health Centre Practice on 5 December 2016. The overall rating for the practice was ‘good’, with ‘requires improvement’ for providing well led services. The full comprehensive report on the 5 December 2016 inspection can be found by selecting the ‘all reports’ link for The Health Centre Practice on our website at www.cqc.org.uk.

We undertook an announced focused inspection on 11July 2017 to check that the practice had followed their action plan and to confirm they now met legal requirements in relation to the breaches in regulation that we identified in our previous inspection on 5 December 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice remains rated as good.

Our key findings were as follows:

• Patients with caring responsibilities were proactively identified so that appropriate support could be offered to them. After our previous inspection the provider had reviewed the numbers of carers and reiterated carers’ guidance and information via a carers information board and screen in the waiting room. A member of staff also had responsibility for providing information to carers and signposting them to organisations who were able to provide advice and support. The practice had 212 patients (1.8%) registered as carers, compared to 59 at the last inspection in December 2016.
• We reviewed the process for monitoring patients on high risk medicines and found that there was an effective procedure in place to ensure these patients received appropriate monitoring.
• At the December 2016 inspection we found that in the year prior only five out of 37 patients with a learning disability had attended for an annual health review. At our July 2017 inspection this number had remained low with seven out of 33 patients having undergone a health review in the past year. The practice advised us that a new nurse-led review procedure was due to be implemented imminently.
• There was a system in place to monitor progress with planned staff training to ensure that key training was kept up to date. The practice kept records of the registration and revalidation status of professional staff. The GPs and nurses were supported to address their professional development needs for revalidation.
• Blank prescriptions were kept secure at all times and tracked through the practice for their use.
• Any medicines incidents or ‘near misses’ were recorded and shared with the wider practice team to share any learning.
• There was an effective system for dealing with patient safety alerts, including alerts and updates from the Medicines and Healthcare Products Regulatory Agency.
• There were records to demonstrate the actions taken in response to infection control audits. However, the practice did not maintain effective cleaning schedules.
• Effective recruitment procedures were in place. The practice had successfully recruited a new clinician since our last inspection.

The areas where the provider should make improvement are:

• Review the systems used to complete annual health checks for patients with a learning disability.
• Maintain effective records that support the cleaning procedures in the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 February 2017

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

• Nursing staff had lead roles in chronic disease management to prevent the need for patients to travel further for advice and ongoing support. Patients who were unwell or at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators was similar to the national average. The practice had scored 94% which was 3% higher than the CCG average and 4% higher than national average.

• Longer appointments and home visits were available when needed. This included home visits to complete blood tests and provide vaccinations such as the flu vaccination.

• 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 24 February 2017

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 were at risk, for example, children and young people who had a high number of A&E attendances.

• Immunisation rates were above national average rates 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 employed young people to work as receptionists and provided drop in sessions at the local senior school for young people who may prefer not to attend the practice.

• The practice’s uptake for the cervical screening programme was 79%, which was higher than the CCG average of 72% and the national average of 74%.

• 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, health visitors and school nurses.

Updated 24 February 2017

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 patients who lived in the surrounding villages were provided with appointments at times that were convenient for the weekly local bus service.

• All requests for visits were triaged by the patients’ own GP or duty GP, on the day of the request.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were equal to or above national average scores. For example results from the Quality and Outcomes Framework showed scores for patients with heart failure were 100%. This was 3% higher than the CCG average and 2% higher than the national average.

• A member of staff had voluntarily taken responsibility for helping patients and their carers access statutory social and voluntary care services.

• Longer appointments were available for patients with complex needs or those who needed additional time to discuss their needs.

Updated 24 February 2017

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. This included early morning clinics.

• 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. This included an online email system to ask their GP advice on health issues where a face to face consultation was not necessary.

• GPs provided direct support to their registered students to help them manage stress related issues.

Updated 24 February 2017

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

• 87% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is similar to CCG average and 3% above the national average.

• Performance for mental health related indicators was similar to the national average. The practice had scored 91% which was 2% below CCG average and 1% below the national average score.

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

• The practice carried out advance care planning for patients with dementia.

• The practice were pro-active in providing care and support to all of their registered patients. If they were unable to meet their needs they supported patients to access specialist services, 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 and provided them with continuity of care through support by the patients’ own GP.

Updated 24 February 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 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 other health care professionals in the case management of vulnerable patients.

• The practice operated individual GP lists which enabled pro-active intervention due to knowledge of family networks and local intelligence

• Patients and families with end of life care needs were supported by their own family GP to ensure their own needs and choices were met.

• 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. The safeguarding lead was also the lead GP for safeguarding in North Hertfordshire and there were strong links with local specialist services such as places of safety for abused women and rape crisis teams.

• The practice had identified a low number of patients with caring responsibilities. A member of staff had taken responsibility for providing information to carers and signposting them to organisations who were able to provide advice and support.

• A low number of annual health checks had been completed for patients with a learning disability.