The Meridian Practice

Updated 23 August 2017

The Meridian Practice is located within the City of Coventry Healthcare Centre in Coventry and is operated by Virgin Care Coventry. It has a Alternative Provider Medical Services (APMS) contract with NHS England. The APMS contract is the contract between general practices and NHS England for delivering primary care services to local communities.

The practice is a specialist one established in 2002 to provide GP services for all asylum seekers within Coventry. At the time of our inspection there were 2452 patients registered and the provider had recently had its contract extended to provide these services until the end of March 2018. To register with the practice, patients must provide details of their asylum seeker status. The majority of patients come from Syria, Afghanistan, Iran, Eritrea and Sri Lanka. Several hundred patients registered at the practice are in the area through the Government’s Syrian refugee Resettlement Project coordinated through Coventry City Council. This includes 100 ’looked after’ children who are in the UK without parents or guardians. The specialist nature of the practice is unique in the West Midlands.

The practice has two GPs (male and female) and two practice nurses. They are supported by a local and a regional practice management team, along with administrative and reception staff.

The practice is open from 8am to 6.30pm during the week and appointments are available throughout these times. Extended hours appointments are available on Tuesdays until 7.30pm. When the practice is closed, patients can access out of hours care provided by the Coventry and Warwickshire Partnership Trust through NHS 111. The practice has a recorded message on its telephone system to advise patients. This information is also available on the practice’s website.

There is also an online service which allows patients to order repeat prescriptions and book new appointments without having to telephone the practice.

Although home visits are not available to patients who cannot not reach the practice, any such patients are provided with a taxi paid for by the practice. This is also arranged for patients who are blind, partially sighted or who have severe mobility problems. All patients registered at the practice have their travel costs paid for. At the time of our inspection no patients registered at the practice required home visits, although this would be reviewed if the need arose.

The practice treats patients of all ages, although the majority of patients are aged between 20 and 40 with twice as many men than women. They receive a full range of medical services. This includes minor surgery and disease management such as asthma, diabetes and heart disease. Other appointments are available for blood tests, family planning and smoking cessation.

Updated 23 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Meridian Practice on 13 June 2017. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• Patients’ needs were assessed and care was delivered in line with current guidelines. Staff had the appropriate skills, knowledge and experience to deliver effective care and treatment.
• Some areas of the Quality and Outcomes Framework (QOF) were below average or the locality and nationally, particularly for patients with poor mental health.
• Services were planned and delivered to meet the needs of the practice population, for example, all GP appointments lasted for 20 minutes to take into account the complex needs and language requirements of the majority of patients.
• Patients told us they were treated with dignity, respect and compassion. Patients were involved in decisions about their care and treatment.
• Urgent same day patient appointments were available when needed. All patients we spoke with and those who completed comment cards before our inspection said they were always able to obtain same day appointments.
• Information about how to complain was available and easy to understand. The practice received very few complaints from patients and reviewed complaints to ensure lessons learned were not repeated.
• Patients said GPs gave them enough time.
• Risks to patients were assessed and well managed.
• There were clearly defined processes and procedures to ensure patients were safe and an effective system in place for reporting and recording significant events. They were fully reviewed at every staff meeting.

• The practice participated in national screening programmes for breast and bowel cancer, however averages were below those reported locally and nationally.

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

• Continue to take appropriate action to ensure the highest possible outcomes are obtained through the Quality and Outcomes Framework (QOF) for patients who experienced poor mental health, within the demands created by a rapidly changing patient population.

• Take appropriate action to encourage patients to take part in national screening programmes for breast and bowel cancer.

• Continue to actively identify patients who are carers.
• Continue to ensure all patients who receive disease modifying medicines (such as those for rheumatoid arthritis) have an alert placed on their patient record to ensure clinical staff were immediately aware of this.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 23 August 2017

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

• Patients had a named GP and a review every three to 12 months to monitor their condition and ensure they received correct medicines. The frequency of the review depended on the severity of the patient’s condition and the complexity of their needs.

• All patients with a long term condition were invited for an annual review in the month of their birth. The practice found this simplified the call/recall system as patients were more aware of when their review was due. Attendance had increased as a result.

• Nursing staff had received appropriate training in chronic disease management, for example asthma and diabetes.

• The practice achieved a 96% vaccination record for diabetes patients during 2015-2016.
• Longer appointments were available when needed.

Updated 23 August 2017

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

• Systems were in place to identify children and young people who might be at risk, for example, those who were in the UK without parents or guardians (100 patients) and those who had a high number of A&E attendances.

• A total of 88% of eligible patients had received cervical screening in the last 12 months. This was above the national average of 81%.

• There were appointments outside of school hours and the practice building was suitable for children and babies.

• Outcomes for areas such as child vaccinations were in line with or above average for the Clinical Commissioning Group (CCG).

• We saw positive examples of joint working with midwives who were available at the practice weekly. The practice also worked with two specialist health visitors who were fully trained to meet the complex needs of patients.

• Family planning services were available and all the practice nurses were trained to carry out contraceptive pill checks.

• Staff were fully trained to recognise and take appropriate action regarding female genital mutilation (FGM). Any cases of FGM were immediately referred to social services.

Updated 23 August 2017

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

• Older patients were given personalised care which reflected their needs. There were only a small number of such patients registered at the practice, with only 28 patients aged over 60.

• Over the last 12 months all patients aged 75 and over had been invited for a health check. This included blood tests, fracture assessment, frailty assessment, and checks for depression and dementia. From those checks, the practice identified patients who needed further investigation and referred them appropriately. These checks were also incorporated into the checks provided for new patients if they were aged 75 or over.

• Although home visits were not available to patients who could not reach the practice, any such patients were provided with a taxi paid for by the practice.

• Nationally reported data showed that outcomes for patients were average for conditions commonly found in older people.

Updated 23 August 2017

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

• The practice ensured it provided services to meet the needs of the working age population. For example, extended hours appointments were available on Tuesday evenings. Only those patients granted leave to remain in the UK were eligible to work and at this stage patients often moved on from the practice.

• Telephone consultations were available for patients who were unable to reach the practice during the day.

• A full range of services appropriate to this age group was offered, including travel vaccinations.

• The practice encouraged its patients to attend national screening programmes for bowel and breast cancer screening; however the numbers of patients tested were below the national average. For bowel cancer 41% of eligible patients were tested against the national average of 58% and for breast cancer screening, 59% were tested against the national average of 73%.

Updated 23 August 2017

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

• Performance for mental health related indicators was below the local and national average, at 41% with an exception rate of 5%. This was below the CCG average of 89% with an exception rate of 11% and below the national average of 93% with an exception rate of 14%.

• The practice had identified gaps in local mental health provisions available to this patient group and had obtained funding for a counselling service for appropriate patients. Between 100 and 120 counselling sessions were provided each month.

• The practice worked with multi-disciplinary teams to provide appropriate care for patients with poor mental health. This included patients with dementia.

• Patients were signposted to appropriate local and national support groups.

• Staff demonstrated a good working knowledge of how to support patients with mental health needs and dementia.

Updated 23 August 2017

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

• The background and current situation of most patients meant the majority of them were vulnerable in some way. All practice staff, both clinical and clerical, had received detailed training into the cultural background of patients represented at the practice to ensure patients could be handled appropriately and with compassion and dignity.

• There was a register of vulnerable patients including those with a learning disability.

• All patients received longer appointments.

• The practice worked with other health care professionals to provide care to vulnerable patients, for example, there were two dedicated health visitors and district nursing team.

• Staff could recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities to share appropriate information, record safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

• The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 0.5% of the practice list as carers.