Clover Practice

Updated 15 August 2022

Background to Clover Practice

Clover Practice is made up of three sites, Darnall Primary Care Centre, Highgate Surgery and Clover Mulberry Practice. The group has an additional location Clover City Practice which is registered with the CQC separately. The three sites are located at:

Darnall Primary Care Centre, 290 Main Street, Sheffield, S9 4QH

Highgate Surgery, Tinsley, Sheffield, S9 1WN

Mulberry Clover Practice, Mulberry Street, Sheffield, S1 2PJ

All three sites were visited as part of this inspection.

The provider is registered with CQC to deliver the Regulated Activities; diagnostic and screening procedures, maternity and midwifery services, treatment of disease, disorder or injury and family planning.

The practices are situated within the Sheffield Clinical Commissioning Group (CCG) and deliver Alternative Provider Medical Services (APMS) to a patient population of 14,213 patients (8,449 at Darnall Primary Care Centre, 4,370 at Highgate Surgery and 1,394 at Clover Mulberry Practice). This is part of a contract held with NHS England. The practice is also part of a wider Primary Care Network made up of local GP practices who provide shared services to their patients.

The three sites provide NHS healthcare to some of the most vulnerable patients in the city. Information published by Public Health England shows that deprivation within the practice population group is in the lowest decile (one of 10). The lower the decile, the more deprived the practice population is relative to others.

According to the latest available data, the registered population consists of approximately: 57% of patients registered at the Darnall Primary Care Centre site being of black or other ethnic minority (BAME) with 60% of patients first language not being English. The Highgate Surgery had a population of 60% BAME patients with 52% of patients whose first language was not English and the Clover Mulberry Practice site only registered patients who were seeking asylum, refugees or trafficked patients living in temporary accommodation or patients who were homeless. The provider had interpreter services at all sites all the time and all documentation was available in different languages.

There is a clinical director who has oversight of all three sites. Each site has a team of GPs, advanced nurse practitioners, practice nurses, healthcare assistants and they are assisted by support managers and a large administration and reception team. The team have the support of additional employed staff such as inclusive health visitor, pharmacy support, mental health worker. There is a governance structure in place with an operational team, senior management team and senior leadership team who report to the board of directors for the organisation.

All sites are open 8am to 6pm Monday to Friday with Darnall Primary Care Centre and Highgate Surgery closing at 12 noon on Thursdays. Patients at these two sites could access care at the Mulberry Clover Practice on Thursday afternoons.

Weekend and evening appointments are offered at one of the extended hours satellite clinics in Sheffield, in partnership with other practices in the area. When the practice is closed, patient calls are automatically transferred to the Sheffield Out of Hours Service which is located at the Northern General Hospital.

Updated 15 August 2022

We carried out an announced inspection at Clover Practice on 1st and 8th June 2022. Overall, the practice is rated as Outstanding.

Ratings for each key question:-

Safe - Good

Effective -Good

Caring - Good

Responsive - Outstanding

Well-led - Outstanding

Why we carried out this inspection

This inspection was a comprehensive inspection of a new provider for the location. The previous provider was the NHS Foundation Trust. However, the new provider had previously carried out the day to day management of the service in conjunction with the Trust. Primary Care Sheffield Limited took over the responsibility of the location on 15 July 2021 and changed their registration with the Commission to be the registered provider for the regulated activities.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

• Conducting staff interviews using video and telephone conferencing.
• Completing clinical searches on the practice’s patient records system and discussing findings with the provider.
• Reviewing patient records to identify issues and clarify actions taken by the provider.
• Requesting evidence from the provider.
• Requesting staff to complete a short questionnaire.
• A short visit to all three sites.

Our findings

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as Outstanding

We found that:

• Leaders and staff had an in depth understanding of their patient population and demographics and had been proactive in adapting and implementing systems, processes and services to meet the needs of some of the most vulnerable patients in the city.
• There was evidence of proactive, effective and strong leadership with embedded governance structures resulting in improvement for patients since the service was last inspected with negative feedback from patients being dramatically reduced.
• Patients received effective care and treatment that met their needs. The service had a high turnover of transient patients which effected their national prevention and survey data outcomes. However, despite data being lower than national averages in some areas, the provider had implemented systems and had adapted services to meet the needs of its population groups.
• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Staff dealt with patients with kindness and respect.
• The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.
• The provider had gone to significant efforts to respond to the needs of some of the most vulnerable individuals in the city to support them to access health and social care. They had adopted an holistic approach by responding to all the needs of the patient, including their physical, mental, and emotional health, while taking social factors into consideration.

Whilst we found no breaches of regulations, the provider should:

• Standardise medication reviews to ensure monitoring checks are reviewed.
• Update staff on who the freedom to speak up guardian is for the organisation.
• Continue to improve uptake of national screening programmes.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care