Archived: Holmcroft Surgery

Updated 22 June 2016

Holmcroft Surgery is located in Stafford and was established in 1994. For the previous 50 years, it had occupied a site at Lloyd Street off Goal Road. The premises is a single story purpose-built level access building that has been developed and a pharmacy is attached. Further extensions are currently being considered to increase the services that can be offered to patients. Car parking facilities are available and there is access for the disabled.

The practice is owned and managed by six GP partners, two males and four females, 4.5 whole time equivalent GPs. One partner is currently on maternity leave and their work is being covered by a salaried GP and locum GPs. The partners are assisted by two nurse practitioners, one of which is the nurse manager, two practice nurses, a chronic disease nurse, two health care assistants and two phlebotomists. The administration team consists of a practice manager, a general manager, administrators and receptionists. The practice is an accredited GP training practice.

The practice is open each weekday from 8am to 8pm on Monday and Tuesday, 8am to 7pm on Wednesday and Thursday and 8am to 6.30pm on Friday.

• Consultation times with GPs are provided are available in the mornings from: 8am to 12.30pm on Monday and Friday. 8.30am to 12.30pm on Tuesdays. 8am to 12 noon on Wednesdays. 8.30am to 12 noon on Thursdays.    Afternoon appointments with GPs are available from: 3pm to 7.30pm on Monday and Tuesday. 3pm to 6.30pm Wednesday, Thursday and Friday.

• Consultation times with Nurse Practitioners are available weekdays from: 8.30am to 6pm Monday. 8.30am to 7:30pm Tuesday. 9am to 6pm Wednesday. 8am to 6pm Thursday. 9am to 6pm Friday.

When the practice is closed patients are advised to call the NHS 111 service or 999 for life threatening emergencies. The nearest hospital with an A&E unit is the County Hospital, Stafford; however, this is not a 24-hour service.

The practice serves a population of 10,780 patients living in the Stafford and Surrounds CCG area. The population distribution shows above national average numbers of patients over 65 years of age and a less than average distribution of male and females below 39 years of age. The practice is in a less deprived area and has lower unemployment when compared to national averages.

Updated 22 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Holmcroft Surgery on 3 May 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. Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses. Information about safety was recorded, monitored, reviewed and addressed.
• Risks to patients and staff were assessed.
• 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.
• Patients said they were treated with dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. 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 and usually saw the same GP, which helped provide them with continuity of care. Urgent appointments were available the same day.
• The practice was easily accessible, 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 and enjoyed their work. 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 should make improvements are:
• Implement a system to follow up and document outcomes for children who had not attended hospital appointments.
• Implement a system to better inform the out of hour’s service about patients who have ‘do not attempt resuscitation’ (DNAR) and about patients’ palliative care status.
• Improve the system of documenting test results for patients on a shared care basis on high risk medicines.
• Improve the system of acting on medicine alerts to ensure that all relevant patients are effectively reviewed.
• Improve the identification of patients who are also carers.
• Secure all filing cabinets containing confidential medical records outside opening hours.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 June 2016

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

• Longer appointments and home visits were available when needed.

• The practice had just appointed a nurse with a lead role in chronic disease management.

• Patients were invited for annual and regular reviews throughout the year dependent on the severity of their condition and provided with appropriate intervention. For patients with more than one long-term condition recall schedules were adapted to ensure all assessments were completed in one visit to ensure a smooth consistent pathway for each patient.

• Patients had access to visiting clinicians to include the community respiratory team.

• Patients were encouraged to book their appointments with the same GP for continuity of care.

• The practice had a full time specialist who reviewed and monitored patients with the support of the wider practice team.

• For those patients with the most complex needs, the GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• The practice did not have a robust system to inform the out of hour’s service about patients who had a ‘do not attempt resuscitation’ (DNAR) directive or about patients’ palliative care status.

Updated 22 June 2016

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

• The care of expectant mothers was shared across the GPs with the midwives from the local hospital trust. Six weekly mother and baby checks were offered in addition to a weekly in-house child immunisation clinic in order to ensure that vaccinations were given at the recommended and appropriate timescales. Flu clinics were also held during antenatal clinics and school holidays.

• 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 protection plan in place. However, there was no documented evidence of follow up for children who did not attend hospital appointments.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

• There were screening and vaccination programmes in place and the practice indicators were comparable with the local Clinical Commissioning Group averages.

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

• Same day emergency appointments were available for children and young people under the age of 16.

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

• Chlamydia screening was available.

Updated 22 June 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 was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Patients over 75 years had a named GP and were assessed to identify any complex health needs they may have. A proportion of these patients had a specific admission avoidance care plan that ensured a multi-disciplinary approach was maintained and all areas of care were comprehensively managed.

• The practice had a high level of patients in two nursing and residential homes in the CCG area and allocated a named GP to each home. They visited patients regularly to review their care and treatment needs.

• Immunisation was offered against influenza, pneumonia, shingles and any other appropriate vaccinations to reduce the risk of further health complications.

Updated 22 June 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, students had been identified, and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• A range of on-line services were available and the practice offered extended opening hours with appointments available with either a GP or nurse practitioner.

• A full range of health promotion and screening was available that reflected the needs for this age group. For example smoking cessation, weight management and cervical screening.

• The practice offered an electronic prescription service allowing patients to choose or nominate a pharmacy to get their medicines or appliances from near where they worked, shopped or lived.

Updated 22 June 2016

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

• 75% of patients with severe poor mental health had a recent comprehensive care plan in place compared with the CCG average of 89% and national average of 88%.

• The practice regularly worked with other health professionals in the case management of patients experiencing poor mental health, including those with dementia.

• Patients living with dementia were cared for in line with the Gold Standards Framework to ensure they received good end of life care.

• The practice told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Leaflets were available of local support groups such as Mid Staffs Mind and child and adolescent mental health services.

• 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.

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

• The practice offered a GP service to a forensic unit and care homes for people with dementia.

Updated 22 June 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 people with a learning disability.

• The practice offered longer appointments for patients with a learning disability; they were seen promptly at a time to suit them. Annual health checks were carried out.

• The practice worked with other health care professionals in the case management of vulnerable patients.

• The practice informed vulnerable patients 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. They knew who the safeguarding lead was within the practice and had access to information about how to contact relevant agencies in normal working hours and out of hours.

• Staff had access to a translation service should non-English speaking patients require assistance.

• The practice was fully accessible to those patients with limited mobility and wheelchair users.

• The practice offered a GP service to a forensic unit and care homes for people with a learning disability.