Archived: Heeley Green Surgery

Updated 30 January 2017

Heeley Green Surgery is located in a purpose built health centre in Heeley Green and accepts patients from the surrounding area. Public Health England data shows the practice population has a higher than average number of patients aged 30 to 60 years old compared to the England average. The practice catchment area has been identified as one of the third more deprived areas nationally.

The practice provides General Medical Services (GMS) under a contract with NHS England for 5606 patients in the NHS Sheffield Clinical Commissioning Group (CCG) area. It also offers a range of enhanced services such as anti-coagulation monitoring and childhood vaccination and immunisations.

Heeley Green Surgery has six GP partners (three female, three male), one female nurse practitioner, a practice nurse, a phlebotomist, a practice manager and an experienced team of reception and administration staff. The practice is a teaching and training practice for medical students and GP registrars.

The practice is open 8am to 6.30pm Monday to Friday. Extended hours are offered Tuesday evenings until 8pm and Friday mornings 6.45am to 8am. Morning and afternoon appointments are offered daily Monday to Friday. When the practice is closed between 6.30pm and 8am patients are directed to contact the NHS 111 service. Patients are informed of this when they telephone the practice number.

The practice was inspected by CQC in November 2013 and found to be compliant.

Updated 30 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Heeley Green Surgery on 2 November 2016. Overall the practice is rated as requires improvement.

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

• There was a system in place for reporting and recording significant events.
• Some risks to patients were assessed although there were shortfalls identified with regards to no COSHH risk assessment of products, no record of fire drills, lack of cleaning schedules and no system to monitor or track blank prescriptions within the practice.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment, although there was limited overview of what training staff had received or when it was due.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a leadership structure and staff told us they 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.

The areas where the provider must make improvement are:

• Implement a system to monitor and track blank prescriptions within the practice as recommended in NHS Protect Security of Prescription Guidance.

• Review fire safety systems to ensure fire escape routes are unlocked when the premises are in use as outlined in the practice’s fire risk assessment and undertake regular fire drills to ensure the manual fire alarm system works effectively.

• Review the control of substances hazardous to health (COSHH) regulations 2002 and complete a COSHH risk assessment of products in the practice.

• Ensure cleaning schedules are in place for all equipment used for direct patient care and records of cleaning are kept.

• Implement a system to document all training staff received and monitor when training updates are due.

• Ensure staff leave their workstations secure and remove their smartcards from the computers  as outlined in the application for NHS Care Record declaration.

The areas where the provider should make improvement are:

• Maintain a complete record of the immunity status of clinical staff as specified in the national Green Book (immunisations against infectious disease) guidance for healthcare staff.

• Monitor the recording of the use of chaperones in patient records in line with the practice policy. 

• Document cleaning schedules to monitor what cleaning of the premises has taken place and when.

• Ensure staff have access to the business continuity plan to provide guidance on contingency plans and assistance in an emergency.

• Complete a risk assessment to review the frequency of training of basic life support for non clinical staff as recommended in the Resuscitation Council (UK) Guidelines for staff working in a primary care organisation.

• Ensure all clinical waste sharps containers are appropriately labelled as outlined in the Health Technical Memorandum 07-01 – Safe management of healthcare waste guidelines.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 30 January 2017

The practice is rated as requires improvement for safety and well-led and good for effective, caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, there were areas of good practice.

• Nursing staff had lead roles in long term condition management and patients at risk of hospital admission were identified as a priority.
• Longer appointments and home visits were available when needed.
• 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 30 January 2017

The practice is rated as requires improvement for safety and well-led and good for effective, caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, there were areas of good practice.

• 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 comparable to others in the area for most standard childhood immunisations.
• Staff told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• Data showed 95% of women eligible for a cervical screening test had received one in the previous five years compared to the national average of 81%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice provided medical care to children in a secure children’s unit by providing a new patient medical to ascertain past medical history and to review any current health needs including immunisation status.
• We saw positive examples of joint working with midwives and health visitors. The practice held monthly safeguarding meetings with the health visitors at the practice.

Updated 30 January 2017

The practice is rated as requires improvement for safety and well-led and good for effective, caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, there were areas of good practice.

• 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.
• The practice provided medical care and weekly routine GP visits to patients who resided in a local care home.

Updated 30 January 2017

The practice is rated as requires improvement for safety and well-led and good for effective, caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, there were areas of good practice.

• 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 evening appointments on a Tuesday and early morning appointments on a Friday morning at the practice and weekend and evening appointments at a local practice through the Sheffield satellite clinical scheme.
• The practice hosted an Occupational Health Advisor from a charitable organisation who provided information and advice for employed and unemployed people with work related health problems.
• The practice offered online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 30 January 2017

The practice is rated as requires improvement for safety and well-led and good for effective, caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, there were areas of good practice.

• Of those patients diagnosed with dementia, 89% had received a face to face review of their care in the last 12 months, which is higher  than the national average of 84%.
• Of those patients diagnosed with a mental health condition, 96% had a comprehensive care plan reviewed in the last 12 months, which is higher than the national average of 89%. The GP told us practice data had identified that 15.8% of patients on the practice list had a history of a long term mental health problem compared to the national average of 5.1%.
• The GP told us the practice had developed a template to use when reviewing the physical health needs of patients with a serious mental illness which had been implemented by other practices in the city.
• The practice regularly worked with multidisciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had advised 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 practice hosted Improving Access to Psychological Therapies Programme (IAPT), a counselling service to support patients’ needs.

Updated 30 January 2017

The practice is rated as requires improvement for safety and well-led and good for effective, caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, there were areas of good practice.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability. The practice had identified that 1.3% of the patient list had a learning disability which was above the national average of 0.4%.
• The practice offered longer appointments for patients with a learning disability and an annual review appointment of their health and wellbeing needs.
• The practice regularly worked with other health care professionals in the case management of patients who may be vulnerable.
• The practice is registered as a place of safety under the Sheffield Safe Places Scheme for patients in the locality, even if not a registered patient of the practice. Staff told us patients seeking help would be offered the use of a telephone to ring support services.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in 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.