Archived: Horne Street Surgery

Updated 17 March 2016

Horne Street Surgery is situated less than a mile from Halifax town centre. It is housed in purpose built premises which is shared with another practice and walk in centre. The practice has a list size of 4035 patients. The vast majority (85%) of their patients are of Pakistani origin. The remaining patients are made up of small percentages of other South Asian, Eastern European, White British and African ethnicities. The practice provides Personal Medical Services (PMS) under a locally agreed contract with NHS England. They offer a range of enhanced services such as childhood vaccination and immunisations and extended hours access.

There are two GPs, both of whom are male. The practice is also staffed by two female practice nurses, one locum female nurse practitioner and one phlebotomist/smoking cessation advisor. The clinical team is supported by a practice manager, medical secretary and a team of administrative and reception staff.

The practice catchment area is classed as being in the most deprived percentage of practices in England. The age profile of the practice shows a significantly higher than average percentage of the 0-34 year age group, and a significantly lower than average percentage of patients aged 40 and over.

Horne Street Surgery is open between 8am and 6.30pm Monday to Friday, with extended hours on Tuesday until 7.30pm. Several clinics are held at the practice each week including contraceptive services, diabetes, asthma, smoking cessation and chld immunisation clinics.

Out of hours cover is provided by Local Care Direct and can be accessed by calling the surgery telephone number or by calling the NHS 111 service. Patients can also attend the adjacent walk-in centre which is open between 8am and 7pm on weekdays, and from 8am to 6pm on weekends.

Horne Street Surgery is registered with the CQC to provide diagnostic and screening procedures, maternity and midwifery services, treatment of disease, disorder or injury and surgical procedures.

Updated 17 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Horne Street Surgery on 2 February 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found access to the surgery by phone difficult, but appointments were ususally available with a named GP and most appointments were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour. Duty of Candour is a requirement that health care providers are open and honest with the people who use their services.

We saw one area of outstanding practice:

• Although no figures were available, the practice was able to describe how they had reduced the need for referrals of some patients to secondary care (hospital) services due to the expertise of the GPs in mental health and dermatology (skin conditions).

However there are areas where the provider needs to make improvements.

Importantly the provider should:

• Improve patient confidentiality by diverting incoming patient calls away from the front reception desk

• Establish regular formal meetings with health visitors to discuss vulnerable children and families

• Document all annual infection prevention and control (IPC) audits

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 March 2016

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

• Nursing staff had lead roles in some chronic disease management with GPs taking the lead on others, and patients at risk of hospital admission were identified as a priority.

• Data showed that 96% of patients on the diabetes register had a recorded foot examination in the preceding 12 months compared to a national average of 88%.

• Longer appointments, up to 30 minutes, and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check that their health and medicines 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.

Updated 17 March 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 were at risk, for example, children and young people who had a high number of accident and emergency ( A&E) attendances. Immunisation rates were relatively high 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.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The health visiting team were co-located in the practice building and ad hoc liaison and information sharing took place.Improvement could be made by establishing regular formal  meetings and keeping minutes to record any discussions.

Updated 17 March 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.

• Although the number of older people on their patient list was small, the practice was responsive to the needs of this group of patients, and offered home visits and urgent appointments for those with enhanced needs.

Updated 17 March 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 as well as a full range of health promotion and screening that reflects the needs for this age group.

• Data showed that 79% of elegible women had a recorded cervical screening test performed within the last five years compared to a national average of 82%.

Updated 17 March 2016

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

• 93% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the preceding 12 months

• 100% of patients with physical and/or mental conditions had had their smoking status recorded in the preceding 12 months

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

• It carried out advance care planning for patients with dementia.

• Due to the expertise in mental health of one of the GPs, many mental health conditions could be managed in-house, reducing the reliance on secondary care services. The practice also gave patients experiencing poor mental health information about various support groups and voluntary organisations.

• The practice had access to a local NHS ‘Talking Therapies’ service which patients were able to benefit from without a referral from a clinician.

• It 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 gave good examples of how they supported people with mental health needs and dementia

Updated 17 March 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 carers and those with a learning disability.

• It offered longer appointments for people with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• It gave vulnerable patients information 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.