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Stockton Heath Medical Centre Good Also known as Dr Palmer and partners

Inspection Summary


Overall summary & rating

Good

Updated 29 August 2018

We previously carried out an announced focused inspection at Stockton Heath Medical Centre 16 February 2017. The inspection was to check if the provider had carried out their plan to meet the legal requirements in relation to the breaches made during the announced comprehensive inspection on 24 February 2016.

The overall rating for the practice was good with a rating of requires improvement for the key question of responsive. The focused inspection report on the 16 February 2017 and the full comprehensive report on 24 February 2016 inspection can be found by selecting the ‘all reports’ link for Stockton Heath Medical Centre on our website at www.cqc.org.uk.

This announced, focused inspection was carried out on 26 July 2018 was to confirm that action had been taken to improve capacity for the provision of clinical appointments and to improve patient experience of access to the service as identified at our previous inspection on 16 February 2017. This report covers our findings in relation to these shortfalls found at our last inspection.

The practice is still rated as good overall and following this inspection rated as good for providing a responsive service.

Our key findings were as follows:

The practice had made improvements and addressed the issues identified in the previous inspection. Improvements included:

  • Action had been taken to improve capacity for the provision of clinical appointments and improve patient experience of access to the service.
  • The practice had recruited four new GPs and had used locum GPs to cover maternity leave.
  • Extended access appointments with the nurse practitioner are available from 7.15am Tuesday, Wednesday and Thursday.
  • Two new trainee assistant practitioners have been employed and the assistant practitioner has commenced training for GP assistant role.
  • The practice employs an administration assistant who manage clinical correspondence to assist the GPs.
  • There had been an increase of online appointments available and patients have been recommended to sign up for on-line access.
  • The appointment system has been weighted to manage daily urgent care demand during morning sessions and pre-bookable appointments in the afternoon.
  • Reception staff have received training in Care Navigation so they are now trained patient advisors.

At our previous inspection on 24 February 2017, we rated the practice as requires improvement for providing responsive services because although we found action had been taken to improve access to the service further improvement was needed.

At the 24 February 2017 inspection we found the practice should improve capacity for the provision of clinical appointments and improve the patient experience of access to the service.

At this focused inspection we found that improvements had been made to patient access and the number of available appointments had increased. The practice is now rated as good for providing responsive services.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Effective

Good

Caring

Good

Responsive

Good

Updated 29 August 2018

At our previous inspection on 16 February 2017, we rated the practice as requires improvement for providing responsive services. At that inspection we found improvements had been made since the inspection on 24 February 2016 and they were no longer in breach of the regulation. However, we found further improvements were required and due to that the practice continued to be rated as ‘requires improvement’ for being responsive.

At the last inspection we found that although a review of staffing and roles had been carried out the practice had not reached sufficient capacity to meet appointment demand in correlation to the size of the practice population.

The appointment system was still not flexible enough to be fully responsive to patient needs. This was particularly the case for more vulnerable patients who may have additional difficulty navigating the system.

At this inspection we found significant improvements had been made.

The practice is now rated as good for providing services responsive to people’s needs.

Timely access to care and treatment

  • At the previous inspection we found the results from the national GP patient survey showed that 23% of patients gave a positive answer to ‘Generally, how easy is it to get through to someone at your GP surgery on the phone?’ (CCG average 60%, national average 72%). At this inspection we saw that the figure had increased to 40% which was comparable to the CCG average of 60% and the national average of 71%.
  • At the previous inspection we found the results from the national GP patient survey showed that 58% said the last time they wanted to see or speak to a GP or nurse from their GP surgery they were able to get an appointment (CCG average 70%, national average 75%). At this inspection we found that the figure had increased to 70% which was comparable to the CCG average of 73% and the national average of 75%.
  • At the previous inspection we found the results from the national GP patient survey showed that 41% described their experience of making an appointment as good (CCG average 68%, national average 73%). At this inspection we found that the figure had increased to 68% which was comparable to the CCG average 71% and the national average of 72%
  • At the previous inspection we found the results from the national GP patient survey showed that 49% of patients responded that they were ‘very satisfied' or 'fairly satisfied' with their GP practice's opening hours was 49% compared to the Clinical Commissioning Group (CCG) average of 69% and a national average of 75%. At this inspection we found that figure had increased to 75% which was comparable to the CCG average of 77% and the national average of 80%.
  • At the previous inspection we found the provider had analysed data between 2015 and 2017 which showed a significant increase in the number of clinical appointments provided over those two years. The practice had calculated they were running eleven GP sessions below what was required. To address this we found, since the last inspection, the practice had employed four more GPs and implemented a strategy plan to increase patient access.
  • At this inspection we found improvements had been made to make patient access easier.
  • Since the last inspection four new GPs had been recruited and regular locum GPs are used when necessary.
  • At this inspection we saw the nurse practitioner provided extended access by providing appointments from 7.15am Tuesday to Thursday.
  • Since the last inspection the practice has recruited two trainee assistant practitioners who worked alongside the assistant practitioner to provide a clinical assistant role. In addition, the assistant practitioner had commenced training as a GP assistant.
  •  The Practice has introduced on-line appointments with the Practice Nurse for smear tests and asthma checks.

  • Since the last inspection the practice had employed an additional GP administration assistant. This helped manage the workload of clinical correspondence ensuring GPs saw the relevant paperwork from secondary care, adding codes to clinical system and working with the practice clinical pharmacist to ensure the patients were compliant with new medicines following discharge from hospital or seeing secondary care consultants.
  • We saw in an attempt to reduce demand on telephone access patients had been encouraged to sign up for on-line access. We saw that 22% of patients had registered for this.
  • At the last inspection we found that patients we spoke with said they found it difficult to get through to the practice by phone and were frustrated at having to start the process again the following day if they had not been successful in getting an appointment. At this follow up inspection the patients we spoke told us they still found it difficult to get through on the phones first thing in the morning to make an appointment. This was discussed with the practice manager and the executive lead nurse practitioner who were aware of this issue. In an attempt to address the issue, we saw that the provider had applied for a resilience bid to NHS England for an upgraded telephone system. The bid had been rejected but a meeting had been arranged the week following the inspection with a company to discuss the implementation of a new, upgraded telephone system. In addition, the GPs and nurses had mobile phones that they used so that the landlines were free for incoming patient calls.
  • The appointment system had been weighted to help manage daily urgent care demand during the morning sessions with the ability to pre-book appointments in the afternoon. This had helped to accommodate patient’s needing routine reviews. GPs could pre-book patients who require a face to face review and pre-book telephone consultations for those patients who do not require a face to face review.
  • Medication review appointments were now pre-bookable and on-line appointments were available throughout the day including early morning.
  • Alerts had been added to patients’ records when they have been identified as being vulnerable and who had carers to allow for more flexible booking.
  • Since the last inspection the reception team had undertaken training in Care Navigation and were now trained ‘Patient Advisors’. This meant they were able to help patients access the appropriate service for their particular need.
  • The practice had almost 200 patient’s living in local Nursing/Care Homes so in attempt to reduce demand and work more proactively to provide care dedicated GP time had been allocated to some of the larger homes.
  • The patient advisor team used READ codes when a patient has been asked to call back or been directed to another provider so the practice could monitor if the patient’s phoned a second time and were able to accommodate them.
  • During this inspection we spoke with members of the Patient Participant Group (PPG) who said since the last inspection the practice had worked hard at improving access and were continuing to make improvements.
  • At the previous inspection we found issues around access to the practice had been cited in three complaints. At this follow up inspection we found one complaint had been made since the last inspection in March 2017 in relation to access. We saw that the complaint had been appropriately dealt with the complainant received a written response which they were satisfied with.
  • Since the last inspection the practice had undertaken a patient satisfaction survey relating to access to a clinician. We saw the results demonstrated that 48% of patients were very satisfied with the appointment booking process, 31% were satisfied, 11% were not satisfied and 7% were not at all satisfied. Comments from patients indicated that they satisfied with the appointment system.

Please refer to the Evidence Tables for further information.

Well-led

Good
Checks on specific services

People with long term conditions

Good

Updated 29 April 2016

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

  • The practice held information about the prevalence of specific long term conditions within its patient population. This included conditions such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. The information was used to target service provision, for example to ensure patients who required immunisations received these.
  • Some of the GPs had lead roles in chronic diseases and practice nurses held dedicated lead roles for chronic disease management. As part of this they provided regular, structured reviews of patients’ health.
  • Data from 2014 to 2015 showed that the practice was comparable with other practices nationally for the care and treatment of people with chronic health conditions such as diabetes. For example, the percentage of patients with diabetes, on the register, who had had an influenza immunisation was 98% compared to a national average of 94.45%.
  • Patients with long term conditions could make pre-bookable appointments with the practice nurses. Longer appointments and home visits were available for patients with long term conditions when these were required. However, as with all of the population groups the management of the appointment system required improvement to ensure it was responsive to the needs of all patients.
  • The practice provided an in house phlebotomy service five days per week and this was reported to be more convenient for patients. The practice also provided a wound and leg ulcer clinic.
  • The practice contacted patients following admission to hospital to check if they required any services from the practice.
  • The practice held regular multi-disciplinary meetings to discuss patients with complex needs and patients receiving end of life care.

Families, children and young people

Good

Updated 29 April 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 those who were at risk, for example, children and young people who had a high number of A&E attendances.
  • Staff we spoke with had appropriate knowledge about child protection and they had ready access to safeguarding policies and procedures.
  • Child surveillance clinics were provided for 6-8 week olds and immunisation rates were comparable to the national average for all standard childhood immunisations. The practice monitored non-attendance of babies and children at vaccination clinics and staff told us they would report any concerns they had identified to relevant professionals.
  • Family planning services were provided and the practice had a lead for Women’s health. The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 80.56% which was comparable to the national average of 81.83%.
  • Appointments were available outside of school hours. However, parents we spoke with told us they had the same difficulties as other patients in getting through to the practice by telephone and they were not able to make a pre-booked appointment with a GP for their child. As with all of the population groups the management of the appointment system required improvement to ensure it was responsive to the needs of all patients.
  • The premises were suitable for children and babies and baby changing facilities were available.

Older people

Good

Updated 29 April 2016

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

  • The practice offered proactive, personalised care and treatment to meet the needs of the older people in its population. The practice kept up to date registers of patients with a range of health conditions (including conditions common in older people) and used this information to plan reviews of health care and to offer services such as vaccinations for flu.The practice provided a range of enhanced services, for example, the provision of care plans for patients over the age of 75 and screening patients for dementia.
  • The practice had a higher than average percentage of older patients within the practice population. Nationally reported data showed that outcomes for patients for conditions commonly found in older people were similar to or better than local and national averages. Screening uptake for bowel cancer and breast cancer were higher than local and national averages. For example, 80.4% of females aged 50-70 had been screened for breast cancer compared to a national average of 72.2%.

  • The practice contacted patients following admission to hospital to check if they required any services from the practice.
  • GPs carried out regular visits to local care homes to assess and review patients’ needs and to prevent unplanned hospital admissions. Home visits and urgent appointments were provided for patients with enhanced needs. However, as with all of the population groups the management of the appointment system required improvement to ensure it was responsive to the needs of all patients.
  • The practice used the ‘Gold Standard Framework’ (this is a systematic evidence based approach to improving the support and palliative care of patients nearing the end of their life) to ensure patients received appropriate care.
  • A number of GPs held a special interest in elderly care including for those with complex conditions and one GP had a special interest in end of life care.
  • Practice staff had been provided with training in dementia awareness to support them in supporting patients with dementia care needs.
  • The practice hosted a local service that promoted healthy lifestyles and encouraged people to increase their participation in activities.

Working age people (including those recently retired and students)

Requires improvement

Updated 29 April 2016

The practice is rated as requires improvement for the care of working-age people (including those recently retired and students).

  • The practice had not adjusted the appointments system sufficiently to ensure the service was flexible to meet the needs of this group. Concerns with regards to the appointment system were particularly challenging for this group.
  • The telephone consultation system was advantageous for some people in this group as they did not always have to attend the practice in person.
  • The practice was part of a cluster of practices whose patients could access appointments at a local Health and Wellbeing Centre up until 8pm in the evenings Monday to Friday, and from 8am to 8pm Saturdays and Sundays, through a pre-booked appointment system.
  • The practice offered a range of online services as well as a range of health promotion, NHS screening and health checks that reflected the needs of this age group. 

People experiencing poor mental health (including people with dementia)

Requires improvement

Updated 29 April 2016

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

  • Data about how people with mental health needs were supported showed that outcomes for patients using this practice were similar to or better than average. For example, data showed that 82.4% patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. This compared to a national average of 84.01%.
  • GPs carried out cognitive assessments with patients and referred people to a local memory clinic for support if required. The practice provided an enhanced service for screening patients to identify patients at risk of dementia and to develop care plans with them. Practice staff had been provided with training in dementia awareness to support them in supporting patients with dementia care needs.
  • The practice worked with multi-disciplinary professionals in the case management of people experiencing poor mental health, including those with dementia.
  • Patients were given screening tools to help in the diagnosis of their mental health.

  • As with all of the population groups the management of the appointment system required improvement to ensure it was responsive to the needs of patients. People experiencing poor mental health may find the appointments system more challenging.
  • A system was in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
  • Processes were in place to prompt patients for medicines reviews at intervals suitable to the medication they took.
  • The practice hosted a psychotherapy service and patients experiencing poor mental health were informed about how to access various support groups and voluntary organisations. Patients were also referred to secondary care as appropriate.

People whose circumstances may make them vulnerable

Requires improvement

Updated 29 April 2016

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

  • The practice held a register of patients living in vulnerable circumstances in order to provide the services patients required. For example, a register of people who had a learning disability was maintained to ensure patients were provided with an annual health check and to ensure longer appointments were provided for patients who required these.
  • The practice provided primary care to vulnerable people living in a number of residential settings.
  • As with all of the population groups the management of the appointment system required improvement to ensure it was responsive to the needs of patients. People whose circumstances make them vulnerable may find the appointment system more challenging.

  • 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.

  • The practice was accessible to people who required disabled access and facilities and services such as a hearing loop system (used to support patients who wear a hearing aid) and translation services were available. The practice had undergone an assessment by the ‘Deaf support network’ to ensure the services provided met the needs of deaf people and those with hearing difficulties. The practice also provided some information in easy read format.
  • The practice told us they had strong links with the travelling community and they tailored the way they communicated with patients from the travelling community to ensure it was to best effect.
  • The practice hosted a monthly support service for people recovering from substance misuse.
  • Information and advice was available about how to access a range of support groups and voluntary organisations.