Meltham Group Practice

Updated 16 June 2017

Meltham Group Practice provides services for 6,270 patients and is situated at 1 The Cobbles, Meltham, Holmfirth West Yorkshire.

Meltham Group Practice is situated within the Greater Huddersfield City Clinical Commissioning Group (CCG) area and is registered with the Care Quality Commission to provide primary medical services.

The practice is based in a purpose built single storey property with cars parking. It has level disabled access and has disabled facilities including a hearing loop.

They offer a range of enhanced services such as childhood immunisations and extended hours opening.

The practice is situated in an area in the 30% least deprived in the country. The practice has a population predominantly white British, with only 2% population from a south east Asian background.

There are three GP partners one of who is male and two female. There are also two salaried GPs at the practice. The practice employs two practice nurses and two Health Care Assistants (HCA’s) The clinical team are supported by a practice manager and a team of administrative staff.

The practice is open between 8.15am and 6.00pm Monday to Fridays. Appointments are available between these times. Extended hours appointments are offered 6.30pm to 9.15pm on Tuesdays.

Out of hours services are provided by Local Care Direct and can be accessed either by using the practice telephone number or through NHS111.

When we returned for this inspection we checked and saw that the previously awarded ratings were displayed as required in the premises and on the practice’s website.

Updated 16 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the surgery of Meltham Group Practice on 10 August 2016. Overall the practice was rated as good; however a breach of the legal requirements was found which resulted in the practice being as rated as requires improvement for providing safe services.

Following on from the inspection the practice provided us with an action plan detailing evidence of the actions they had taken to meet the standards relating to providing safe services.

We undertook a desk based review on 13 April 2017 and visited the practice on 19 April 2017. This was to review in detail the information the practice had sent to us and to confirm that the practice were now meeting the relevant standards of care.

A full comprehensive report which followed the inspection on 10 August 2016 can be found by selecting ‘all reports’ link for Meltham Group Practice on our website at www.cqc.org.uk.

The practice is now rated as good for providing safe services.

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

• Patients Specific Directions (PSDs) had been developed and were in use for a range of immunisations and specific treatments

• The Health Care Assistant had attended the required vaccination competency update since the last inspection

• The cleaning regime and recording of completion of tasks had been reviewed and implemented.

• The risk assessments for the control of substances hazardous to health (COSHH) had been undertaken and documented.

• The practice had reviewed the cleaning of curtains and now were using disposable curtains, which were changed every six months.

• The serial numbers of blank prescriptions were logged and tracked in line with best practice guidance.

• The recruitment of staff had been reviewed and there was evidence that since the previous inspection two references and proof of identity had been taken prior to commencing employment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 September 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.
• Outcomes for patients with a diagnosis of diabetes were better than the CCG and national averages. For example the percentage of patients on the register who had a flu vaccination was 100%.
• Longer appointments and home visits were available when needed with proactive medication reviews for those patients who took several medications.
• The lead practice nurse visited patients at home who had recently suffered a heart attack to support cardiac rehabilitation.
• 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 met regularly with relevant health and care professionals to deliver a comprehensive multidisciplinary package of care and GPs at the practice had a special interest in areas such as diabetes and dementia.

Updated 7 September 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 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, and we saw evidence to confirm this.
• Young people were contacted on their fifteenth birthday and offered the opportunity to update practice records with their own mobile number and take more control over their personal health. For several years the practice had been recognised by the Kirklees Young People Friendly kite mark for offering a high standard of health services and materials aimed at young people. We saw the motto “Here to listen, not to tell”, was prominently displayed throughout the practice and that in a quiet area of the waiting room a board contained information leaflets for young people.
• The percentage of women whose notes recorded that a cervical screening test had been performed in the preceding 5 years was 82% which was the same as the national average but slightly lower than the CCG average of 85%.
• Appointments were available outside of school hours with both the GPs and the practice nurse and the premises were suitable for children and babies.
• We saw evidence of structured and proactive examples of joint working with midwives, health visitors and school nurses.
• An on-site baby clinic was held weekly with joint care offered by a GP, health visitor and practice nurse.

Updated 7 September 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 arranged appointments for mobile elderly patients to coincide with the local bus service.
• The practice was responsive to the needs of older people, and offered home visits by a GP, nurse or a health care assistant( HCA).
• Urgent appointments were available for those with urgent medical needs.
• The practice supported several care homes in the area and visited them on a regular basis. We were told by the management at the homes we contacted that the care provided to the residents was kind, very caring and of a high quality. The homes confirmed that the practice responded immediately to their requests. Residents at the homes had a named GP.
• Two GPs at the practice were speciality trained in the area of palliative (end of life) care. We saw evidence that these patients were discussed at the weekly primary health care team meetings and actions agreed upon.
• The practice held a drop in session weekly for carers of people diagnosed with dementia and had identified a dedicated carers champion and a dementia champion.

Updated 7 September 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 was proactive in offering online services which included online appointment booking, the ability to order repeat prescriptions online and access to test results.
• Telephone consultations were available.
• A full range of health promotion and screening that reflects the needs for this age group was available including ambulatory blood pressure monitoring and ECG monitoring. (An electrocardiogram (ECG) is a simple test that can be used to check your heart's rhythm and electrical activity).
• The practice offered an extended hours surgery on a Tuesday evening between 6.30pm and 9.00pm.

Updated 7 September 2016

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

• 88% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is better than the CCG average of 85% and the national average of 84%.
• We saw evidence of good outcomes and high quality dementia care in the practice. Opportunistic screening took place and further assessments were supported by a GP with a postgraduate certificate in Dementia for practitioners with a special interest. The practice had a nominated Dementia champion and we saw that staff had been trained as ‘dementia friends’.
• The practice hosted a drop in service for people with dementia and their carers.
• The practice had amended a template within the computer systems to enable them to carry out thorough and timely assessments of capacity with vulnerable people.
• Patients at the practice had access to a drug and alcohol worker one day per week. Patients were reviewed and assessed and all prescriptions reviewed and signed by the GP who also reviewed each patient four times per year. Patient records demonstrated good outcomes for individuals.
• The practice offered a weekly counselling service.
• The percentage of patients with a mental health issue who had an agreed care plan documented in their notes was 94% which was better than the CCG average of 89% and the national average of 88%.
• The practice regularly worked closely 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 had told patients experiencing poor mental health about how to access various support groups and voluntary organisations including walking groups.
• 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; these patients were regularly reviewed and discussed in meetings.

Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 7 September 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.
• The practice offered longer appointments for patients with a learning disability and offered annual health checks. We were told that learning disabled patients at the surgery had also received a folder at their first health check which contained easy read health information.
• Looked after children registered with the practice were discussed monthly in a multi-disciplinary meeting.
• The practice had amended a template within the computer systems to enable them to carry out thorough and timely assessments of capacity with vulnerable people.
• The practice hosted a weekly drug and alcohol clinic where patients could access information and support. The worker would then meet with the lead partner to review the patients and follow up any issues or concerns.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients. The practice held a drop in session weekly for carers of people diagnosed with dementia and had identified a dedicated carers champion and a dementia champion.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Child and adult safeguarding was a priority for the practice and we saw evidence that best practice was followed and cases were discussed at the weekly clinical meetings. 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.