Archived: Drs Knight, Hargraves, Flores & Bartlett Also known as Quay House Medical Centre

Updated 8 January 2015

Quay House is situated in a residential area on the northern edge of Hereford city.  It has around 6,000 patients.  The practice is in a purpose built building which also contains a separately owned pharmacy.  Hereford has a mainly white British population with strong agricultural roots and some light industry.  There is a substantial Eastern European population which dates back to the 1940s and has grown in recent years.  The practice has a higher proportion of female patients between 35 and 45 than the England average and a higher proportion of children and young people, particularly in the under 10 age group.  The practice provides primary care services for local armed service families.

The practice has three partners with a fourth (currently salaried) GP who was about to join the partnership.  The practice also has a second salaried GP whose contract is flexible.  This is because they are involved in providing medical services in the voluntary sector.  Three of the GPs are male and two are female.  The practice has two practice nurses and two health care assistants.  The clinical team are supported by a practice manager, deputy practice manager and a team of reception staff and medical secretaries.  All of the practice team are part time.  This provides some inbuilt flexibility for covering annual leave and sickness.

The practice has a branch surgery in the Herefordshire village of Credenhill which provides appointments for two hours every weekday.  The branch surgery also provides a limited dispensing service due to the lack of a nearby pharmacy in its rural location.

The practice has a General Medical Services (GMS) contract with NHS England.  The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities.

This was the first time the CQC had inspected the practice.  Based on information we gathered as part of our intelligent monitoring systems we had no concerns about the practice.  Data we reviewed showed that the practice was achieving results that were in line with the England or Clinical Commissioning Group average in most areas and higher in some.

The practice does not provide out of hours services to their own patients.  Patients are provided with information about the local out of hours services based in Hereford city which they can access by using the NHS 111 phone number.

Updated 8 January 2015

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Drs Knight, Hargraves and Flores (also known as Quay House) on 10 October 2014.  The practice has a branch surgery in the village of Credenhill which we did not inspect on this occasion.  The inspection team was led by a CQC inspector and included a GP specialist advisor, and a second CQC inspector.  We found that Quay House provided a good service to patients in all of the five key areas we look at.  This applied to patients across all age ranges and to patients with varied needs due to their health or social circumstances.

Our key findings were as follows:

• The practice had comprehensive systems for monitoring and maintaining the safety of the practice and the care and treatment they provided to their patients.
• The practice was proactive in helping patients with long term conditions to manage their health and had arrangements in place to make sure their health was monitored regularly.
• The practice was clean and hygienic and had robust arrangements for reducing the risks from healthcare associated infections.
• Patients felt that they were treated with dignity and respect.  They felt that their GP listened to them and treated them as individuals.
• The practice had a well-established and well trained team with expertise and experience in a wide range of health conditions.
• There were areas where the practice needs to make improvements. 

The practice should:

• Review the dispensing training and monitoring of staff employed to work at the branch surgery.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 January 2015

This practice is rated as good for the care of people with long term conditions.  The practice had effective arrangements for making sure that people with long term conditions received regular health checks and had plans in place in the event of their condition deteriorating.  The practice included patients in those groups in their ‘preventing unplanned admissions’ patient register.

Patients whose health prevented them from being able to attend the surgery for appointments were visited at home.  Patients told us they were pleased with the support they or their family members received to help them manage their health.

The practice worked with various local specialist services such as specialist nurses and physiotherapists.  A physiotherapist visited the practice two days a week to provide ease of access to physiotherapy treatment.

Updated 8 January 2015

This practice is rated as good for the care of families, children and young people.  The practice held weekly childhood vaccination clinics for babies and children.  Childhood ‘flu’ vaccinations were also provided.  A midwife came to the practice every week to see pregnant women.  The practice provided a family planning service.  The GPs and nurses worked with other professionals where this was necessary, particularly in respect of children who may be at risk.

Updated 8 January 2015

This practice is rated as good for the care of older people.  Patients over the age of 75 had a named GP and GPs carried out visits to patients’ homes if they were unable to travel to the practice for appointments.  The practice was in the process of delivering its ‘flu’ vaccination programme.  The practice provided a responsive service to patients living in a local care home.

Updated 8 January 2015

This practice is rated as good for the care of working age people, recently retired people and students.  The practice provided extended opening hours until 6pm for people unable to visit the practice during the day and also had arrangements for people to have telephone consultations with a GP.  They were also able to book evening and weekend appointments for patients with a local GP extended hours ‘hub’.  The practice was in the process of inviting patients between the ages of 40 and 74 for NHS health checks.  Students were offered Meningitis C vaccinations before they started at college or university.

Updated 8 January 2015

This practice is rated as good for the care of people experiencing poor mental health (including people with dementia).  The practice had a register of people at the practice with mental health support and care needs and invited them to attend for an annual health check.  Staff described close working relationships with the local NHS mental health trust which worked with the practice to identify patients’ needs and to provide patients with counselling, support and information. 

The practice was alert to the complex needs of people who were living with dementia.  They worked in partnership with a designated dementia nurse from the local NHS mental health trust to provide the care and treatment patients needed. 

Updated 8 January 2015

This practice is rated as good for the care of people living in vulnerable circumstances.  The practice had a learning disability (LD) register and all patients with learning disabilities were invited to attend for an annual health check.  Staff told us that the practice did not have any homeless people or traveller families currently registered at the practice.  Staff at the practice worked with other professionals to help ensure people living in difficult circumstances had opportunities to receive the care, support and treatment they needed.  The staff team were aware of their responsibilities regarding information sharing and dealing with safeguarding concerns.