Penkridge Medical Practice

Updated 25 May 2017

Penkridge Medical Practice is registered with the Care Quality Commission (CQC) as a partnership provider. The practice holds a General Medical Services (GMS) contract with NHS England. A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract. It is a member of the Stafford and Surrounds Clinical Commissioning Group (CCG). Penkridge Medical Practice is located in a semi-rural location in Stafford and the premises are purpose built, providing services over two floors. A lift is available to support patients with mobility difficulties. A pharmacy is attached to the building and third party providers work from the premises to include a number of other health and social care professionals.

The practice area is one of low deprivation when compared with the national and local CCG area. At the time of our inspection the practice had 9994 patients. The practice has a higher than average over 65 years population of 25% in comparison with the CCG average of 22% and national average of 17%. The percentage of patients with a long-standing health condition is 58% which is slightly higher than the local CCG average of 55% and the national average of 53%. The practice is a training practice for recently qualified doctors to gain experience in general practice and family medicine.

The practice staffing comprises of:

• Five GP partners, two male and three female.

• A female salaried GP.

• Three practice nurses and three health care assistants.

• A practice manager.

• A deputy practice manager.

• A team of secretaries, administrators and receptionists working a range of hours.

The practice is open from 8am to 6.30pm on a Monday, Tuesday and Friday and from 8am to 7.45pm on a Wednesday and Thursday. The practice is closed from 12pm to 2pm on a Thursday for staff training. Consultation times with GPs are available in the mornings from 8.30am to 11.30am and in the afternoon from 3pm to 6pm. Consultation times with nurses are available in the mornings from 8.30am to 12pm and in the afternoons from 3pm to 6.10pm. Phlebotomy appointments are available from 8.30am to 11am and from 2pm to 3.40pm.

The practice has opted out of providing cover to patients in the out-of-hours period. During this time services are provided by Staffordshire Doctors Urgent Care, patients access this service by calling NHS 111. The nearest hospital with an A&E unit is the County Hospital, Stafford but this is not a 24-hour service. The nearest minor injuries hospital is in Cannock.

Updated 25 May 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Penkridge Medical Practice on 7 June 2016. The overall rating for the practice was Good with requires improvement in providing safe services. The full comprehensive report on the 7 June 2016 inspection can be found by selecting the ‘all reports’ link for Penkridge Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 17 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 7 June 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as Good.

Our key findings were as follows:

• Significant events were recorded, shared with staff and audited to identify trends.

• Patients had been made aware of how to raise complaints. Complaints were recorded and monitored to identify trends.

• Systems and processes had been implemented to identify patients who were vulnerable adults.

• There was a system in place for tracking blank prescriptions throughout the practice.

• Appropriate recruitment checks had been carried out.

• Staff had completed fire training.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Add alerts to the practice’s computer system to inform staff if a patient is a vulnerable adult.

• Implement their significant events policy to ensure that staff who do not attend staff meetings are made aware of the learning from significant events.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 July 2016

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

• The practice provided a large medical and clinical team. All GPs within the team led on a particular long term condition/ speciality. They were supported by the nursing team that also provided specific and advanced knowledge in their chose clinical areas, for example respiratory management.

• The practice provided a ‘one stop shop’ for patients with multiple conditions involving the senior health care assistant, nurse and pharmacist. The practice told us the recent addition of a pharmacist had provided specialised support to patients taking multiple medicines and those with complex needs. The pharmacist also specialised in the management of hypertension.

• The practice offered specialist clinics to address the needs of patients with long-term conditions such as diabetes, asthma and hypertension.

• Performance for the five diabetes related indicators was better or comparable to the local and national averages. For example, the percentage of patients with diabetes, on the register, in whom a blood pressure reading was recorded was 79% compared with the local average of 73% and national average of 78%.

• Longer appointments and home visits were available when needed.

• Patients had a structured annual review to check their health and medicines needs were being met and were supported by a multi-disciplinary team.

Updated 21 July 2016

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

• The practice had dedicated leads for children’s care, women’s health and sexual health.

• The practice provided a full range of contraception services including oral contraception, implant fitting and coil insertion with a GP and were hoping to develop an emergency contraception service.

• Patients under five years old had access to same day appointments without triage. Appointments were available outside of school hours and the premises were suitable for children and babies.

• 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 protection plans in place. Children who did not attend appointments were followed up or reported to the health visitor.

• Immunisation rates were comparable to local averages for all standard childhood immunisations.

• The practice’s uptake for the cervical screening programme was 80%, which was the same as the CCG and slightly lower than the national average of 82%.

• The health visiting team were based at the practice and accessible for patients and staff.

• Staff had developed positive working relationships with school nurses and health visitors. A baby clinic, child immunisations and antenatal clinics were held on site. A breast-feeding area was available.

Updated 21 July 2016

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

• The practice had assessed and modified the care provided to address the needs of older people in its population.

• The practice offered flexible appointments and we saw reception staff were flexible in their approach when dealing with older people that attended the practice in person or who telephoned for appointments. A wheelchair was provided by the practice for patients with mobility difficulties.

• The practice had a robust call and recall system to ensure older people attended appointments when necessary and was responsive to the needs of older people. Patients aged 75 and older had a named GP. Patients aged 80 or older had access to same day appointments without triage. Home visits were also available for patients with enhanced needs.

• The practice provided a flu clinic for patients accommodated in a local sheltered housing scheme and care homes. They visited local care homes weekly to review patients and provide patients with continuity of care.

• Repeat dispensing dosette (medicine) boxes were available for patients on 28-day prescriptions and were monitored by the pharmacist employed by the practice.

• The practice had been proactive in producing care plans for vulnerable older people.

Updated 21 July 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. The practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. For example, the practice offered a range of appointments at different times of the day, including early mornings and late evenings to allow flexibility for patients.

• A range of online services were available, including booking appointments, prescriptions and access to health medical records. Pre-bookable telephone consultations were also available. The practice had recently introduced a triage system for same day appointments.

• The practice utilised the electronic prescribing system (EPS) which meant prescriptions could be sent directly to the patient’s chosen pharmacy at the time of the consultation. The practice were actively promoting the use of repeat dispensing, where appropriate and the practice pharmacist was leading on this initiative.

• The practice used the appointment reminder text service to remind patients of their appointments.

• A chlamydia testing service was available to young people up to the age of 25.

Updated 21 July 2016

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

• The practice had a designated lead GP in mental health.

• Patients with severe poor mental health were invited for an annual review of their health including a full physical and mental assessment with the practice nurse and Community Mental Health Nurse who attended the practice fortnightly.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. Social workers were based in the practice and therefore were readily accessible.

• 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 pharmacist had experience in mental health and was also employed at a local Mental Health Trust.

• The use of dossette boxes supported people with the management of their medicine and enabled the pharmacist to quickly identify if patients had not taken their medicine as prescribed.

• Double appointments were offered to allow sufficient time to deal with any complex issues that may be relevant to a patient’s health and care.

Updated 21 July 2016

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

• The practice displayed information in the waiting area about how to access local support groups and voluntary organisations.

• Staff had developed a ‘gold star’ board. This provided staff with instant access to valuable information about patients’ needs and helped with prioritising appointments.

• There were themed notice boards to encourage uptake of chlamydia screening in addition to information on contraception.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. They held a register of vulnerable patients but the coding of vulnerable adults was not robust.

• 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.

• The practice held a carers register and written information was available to direct carers to the various avenues of support available to them.

• Where information had been shared, the practice had access to vulnerable patients’ key codes to gain access to their homes. Their next of kin was documented in their care plan to enable staff to contact them urgently.

• Two GPs led on the care of patients with a learning disability. Longer appointment times were available and annual physical health checks were offered.

• The majority of patients’ first language was English, however a translation service was available if needed.