Archived: Highley Medical Centre

Updated 1 July 2016

Highley Medical Centre is registered with the Care Quality Commission as a partnership provider, which includes a GP and practice manager. The provider holds a General Medical Services contract with NHS England. At the time of our inspection 2, 914 patients were registered at the practice. The practice, in line with the local Clinical Commissioning Group (CCG), have a higher proportion of patients aged 65 years and over when compared with the practice average across England. For example, the percentage of patients aged 65 and above at the practice is 28%; the local CCG practice average is 24% and the national practice average, 17%.

Highley Medical Centre is located in a purpose built building. The practice treatment areas and consulting rooms are on the ground floor. As well as providing the contracted range of primary medical services, the practice provides additional services including:

• Minor surgery

• Venepuncture (blood sample taking)

The practice is open each weekday from 8.30am to 6.30pm with the exception of Wednesday when the practice is open between 8.30am and 12pm. Extended hours are provided on Thursday evenings between 6.30pm and 7.15pm. The practice has opted out of providing cover to patients outside of normal working hours. These out-of-hours services are provided by Shropdoc. The on call duty GP provides cover for Wednesday afternoons, the contact details of which are provided on the practice telephone system.

Staffing at the practice includes a full time male lead GP and a female locum GP, who currently provides two sessions per week. There is a managing partner/practice manager, an assistant practice manager, two practice nurses, senior receptionist, three receptionists, a care co-ordinator and cleaner. There are 11 permanent staff in total, working a mixture of full and part times hours.

Updated 1 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Highley Medical Centre on 17 May 2016. Overall the practice is rated as good.

Our key findings were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• 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 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 clear leadership structure and staff 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.

However, there were also areas of practice where the provider should make improvements:

• Continue to review the system for identifying and supporting patients who are carers and take action to ensure that any improvements identified are embedded.

• Consider the reintroduction of NHS Health checks as nursing staff recruitment now complete.

• Improve the documentation of the learning derived from complaints.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 July 2016

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

• Patients at the highest risk of unplanned hospital admissions were identified and care plans had been implemented to meet their health and care needs.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• Nursing staff had lead roles in chronic disease management and had undertaken additional training.
• A practice nurse with specialist diabetic nurse training supported diabetes patients with dietary advice, referred patients to a structured education program, foot screening service and retinal screening service when they were first diagnosed.

Updated 1 July 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.

• The practice uptake of flu vaccinations in pregnant women in 2015/16 was15 out of 22 patients. The practice had recorded five non responders, one patient had contraindications and one self-referred to a midwife.

• The practice’s uptake for the cervical screening programme was 75% which was slightly lower but comparable with the CCG average of 83% and national average of 82%.

• The practice was young person-friendly and provided pregnancy testing and chlamydia testing for all aged 15-24.

Updated 1 July 2016

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

• There were 815 patients over the age of 65 (list size 2,914). Uptake of the flu vaccination for this age group between 2015/16 was 534 out of 815 patients (66%).

• The practice GP completed the Care Home’s Advanced Scheme II (CHAS2) care plans. This is a local initiative supported by the Shropshire Clinical Commissioning Group (CCG) that allows and empowers the practice to dedicate more time and resources looking after their frail patients. All the patients had a care plan and 100% of these had been reviewed within six months.

• The practice offered proactive, personalised care to meet the needs of the older people in its population. They were responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice employed a part-time care coordinator who reviewed care plans, reviewed hospital admissions and provided further support coordinating with other organisations such as district nurses, physiotherapists and charity and other voluntary organisations.

Updated 1 July 2016

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

• The practice offered appointments outside of core working hours on a Thursday between 6.30pm and 7.15pm.

• The practice provided online services to enable patients to book appointments, order repeat medicines and access some parts of their health records online.

• Health promotion and screening services reflected the health needs of this group.

• The practice had recently recruited another practice nurse to meet the needs of patients.

Updated 1 July 2016

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

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• 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.

• Performance for poor mental health indicators was slightly lower than the national averages. For example, 80% of patients with enduring mental health had a recent comprehensive care plan in place compared with the CCG average of 89% and national average of 88%. Clinical exception reporting was higher at 16.67%, when compared with the CCG average of 12% and national average of 13%; however, this represented one patient. (Clinical exception rates allow practices not to be penalised, where, for example, patients do not attend for a review, or where a medicine cannot be prescribed due to side effects).

• Staff had a good understanding of how to support patients with mental health needs and dementia. For example the percentage of patients with dementia care plans on their dementia register was 23 out of 28 patients (85%). Of the remaining five patients the practice found two electronic clinical coding issues that were rectified, one patient chose to decline, one patient was seen in April 2016 and a new patient who required review.

Updated 1 July 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 known vulnerable adults, those who were housebound and patients with a learning disability.

• The practice regularly 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.

• The practice held a register of the practices’ frail and vulnerable patients and had identified patients who may be at risk of unplanned hospital admissions.

• The practice facilitated patients at a local drug and alcohol rehabilitation centre to register as temporary residents. The care co-ordinator supported patients and signposted to other allied health and social care professionals, voluntary agencies and charitable agencies when required.