28 May 2015
Hollinwood Medical Practice opened in January 2010 and is one of four GP practices in Greater Manchester run by Hope Citadel Healthcare CIC. Hope Citadel Healthcare CIC was set up with the aim of providing NHS services to those in under-doctored and deprived areas. They are a not-for-profit community interest company and offer whole person healthcare which they refer to as ‘focussed care’.
They have been commissioned by the Clinical Commissioning Group (CCG) under an Alternative Provider Medical Services (APMS) contract. This enables them to deliver services through a wide range of providers specifically tailored to the needs of the local population. The practice work with their in-house counsellors, community nursing team and other external organisations such as the local council, social care and community matrons to help with health and social care issues within the community.
The practice is open on Monday and Thursday from 8am until 7pm, on Tuesday and Wednesday from 8am until 8pm and on Friday from 8am until 6pm. On a Saturday they are open from 1pm until 5pm. They have increased the length of each appointment from 10 minutes to 13 minutes which patients have reported as positive..
When the practice opened in 2010 they had a zero list size which has grown to in excess of 3,000. The service is located in a considerably deprived area with a very diverse population. In August 2014 they moved to new purpose built premises and have encouraged more people in the community to access services. The practice should continue to review the access for patients so that the existing service is not diluted by the increase in the patient population
Patients have access to two male and two female salaried GPs, two nurses, a health care assistant, two counsellors and a focussed care co-ordinator (all female) who work part time. A part time practice manager, three part time administration staff and two full time reception staff manage the day to day running of the service. The practice helps to train GPs by accepting Foundation Year doctors and medical students. They do not currently have a trainee in position but a trainee is expected in August 2015.
There is a board of directors and a non executive board of trustees (all voluntary) who manage and support the staff over the four practices.
The CQC intelligent monitoring placed the practice in band 6. The intelligent monitoring tool draws on existing national data sources and includes indicators covering a range of GP practice activity and patient experience including the Quality Outcomes Framework (QOF) and the National Patient Survey. Based on the indicators, each GP practice has been categorised into one of six priority bands, with band six representing the best performance band. This banding is not a judgement on the quality of care being given by the GP practice; this only comes after a CQC inspection has taken place.
The practices have opted out of providing out-of-hours services to their own patients. Advice on how to access out of hours services is clearly displayed on the practice website and over the telephone when the surgery is closed.
28 May 2015
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Hollinwood Medical Practice on 5 March 2015. Overall the practice is rated as outstanding.
Specifically, we found the practice to be outstanding for providing caring, responsive, effective and well led services. They were outstanding for providing services to most of the population groups, specifically those who were vulnerable. We also found that safe services were good.
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. 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.
- Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided in many innovative ways to help patients understand the care available to them.
- The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).
- The practice had good facilities and multi-skilled staff and was well equipped to treat patients and meet their needs.
- Information about how to complain was available and patients who found had difficulties understanding, were encouraged to complain verbally and supported in the process.
- The practice had a clear vision which had quality and safety as its top priority. A business plan was in place, was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.
We saw several areas of outstanding practice including:
- The practice had increased the flexibility and length of time of their appointments to 13 minutes instead of ten and could demonstrate the impact of this by reduced use of the accident and emergency services and positive results from clinical audits.
- The practice had a very good skill mix which included a nurse prescriber, counsellors and rehabilitation workers and was able to provide social and medical care for a focussed range of patients. They were able to demonstrate the positive impacts for this group of patients.
- The practice attended the primary schools in the area three times a year, drug and alcohol rehabilitation units and hostels to promote better health. If underlying health issues were identified patients (if they did not have a GP) were offered the opportunity to register with the practice. If they were known to the practice they were encouraged to attend for an appointment.
- The practice organised social activities such as car boot sales, open days, “come and eat cake” days and food parcels for patients in need. They were also planning parenting classes, boogie babies and a choir. They did this to build relationships with the patient population, increase awareness of what the practice offered and reduce inappropriate attendance at other services such as walk in centres or accident and emergency departments.
- Through their care and treatment of chronic obstructive pulmonary disorder (COPD) the practice had identified areas within the county where COPD was higher and people required treatment. They had shared this information with the CCG and were working to reduce the effects of this condition throughout the community.
- All staff undertook annual 360 degree feedback and appraisals that identified learning needs, from which action plans were documented. 360 Degree Feedback is a system or process in which employees receive confidential, anonymous feedback from the people who work around them. Our interviews with staff confirmed that the practice was proactive in providing training and funding for relevant courses.
- Verbal complaints were encouraged to assist people with reading or writing difficulties and staff recorded these in full.
There were some areas where improvements should be considered.
Importantly the provider should:
- Introduce a system of management responsibility for each day’s workload to ensure that nothing is missed at the end of each day.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
28 May 2015
The practice is rated as outstanding for the care of people with long-term conditions. GPs and Nurses had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All patients had a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. The practice were able to evidence that prevalence gaps were closing through their active screening and case finding. Some staff members with specific interests received additional training.
28 May 2015
The practice is rated as outstanding for the care of families, children and young people. There were a large number of children with complex needs on the practice list cared for under Direct Enhanced Services (DES). This meant they had a named GP and increased access. Care plans were in place for a large majority of complex families and the practice worked closely with the Children and Adolescent Mental Health Services (CAMHS), community paediatricians and secondary and tertiary care. One of the GPs had a special interest in paediatrics and families with complex needs. Staff were given contraceptive and implant training and helped educate patients to reduce unwanted pregnancies. Health advice and education was provided in local primary schools three times a year. The practice had a multidisciplinary team approach for the care of the many families within the community where complex social issues affected their physical and mental health and were able to evidence positive outcomes.
28 May 2015
The practice is rated as outstanding for the care of older people. Nationally reported data showed that outcomes for patients were high for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services. The practice offered planned and unplanned home visits and rapid access appointments. Clinical staff were educated and mindful about polypharmacy issues including possible interactions, compliance issues and national guidelines. They worked closely with pharmacies, encouraging dosette boxes where required to reduce error. (Polypharmacy is the use of multiple medicines in the elderly). Christmas parties and hampers were arranged by the staff at the practice for the local supportive housing and the practice worked in partnership with the University of the Third Age which gives over 65s the opportunity for learning and activity. They also worked closely with Age Concern and social care services. These activities encouraged relationships and decreased isolation in older people.
28 May 2015
The practice is rated as outstanding 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 worked with Christians Against Poverty (CAP) to provide support with debt and money matters and focussed care workers assisted families with housing issues and the completion of documentation. Patients with difficulty reading and/or writing were encouraged to provide feedback, complaints and comments verbally and these were all logged and dealt with. The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
28 May 2015
The practice is rated as outstanding for the care of people experiencing poor mental health (including people with dementia). A high number of people experiencing poor mental health had received input from the practice. Patients with mental health problems had care plans and access to drug and alcohol services within the practice. A Benzodiazepine reduction clinician worked with patients to reduce their addictions. The practice offered counselling and CBT services and had good links with mental health services and crisis teams. Staff were trained to recognise mental health presentations and enable access. A resource list had been developed to support mental health work, including living life to the full. Audio and visual resources had also been made available. The practice had undertaken a dementia audit which had highlighted patients coded incorrectly. All dementia patients within the practice list had now been identified and were offered and receiving services available to them such as referrals to memory clinics for assessment and care.
28 May 2015
The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable. They held registers of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. A focussed care service carried out assessment of the needs of whole family units, reviewing the impact of health, social and welfare issues affecting one or more of them. Patients on the focussed care caseload had intense intervention from multi disciplinary workers employed by the practice and, when support could be reduced or stopped, they were discharged back to the normal practice caseload. Data was consistently audited and reviewed to show the benefits of the service and we saw extreme positive outcomes for a high number of patients. Asylum seekers, homeless and travellers had all been accepted onto the patient list and the practice was pro-active in encouraging these patients to the practice and educating them in the services available rather than A&E. They did this by working with probation services, the local probation hostel and safe houses for women in violent relationships. They encouraged vulnerable people into activities within the community such as choirs, churches and voluntary sectors. They provided assistance and support with paperwork for appeals and financial issues and access to food banks.