Archived: Stourport Health Centre

Updated 4 July 2017

Stourport Health Centre is situated at the edge of Stourport-on-Severn in a County Council complex which includes the local fire and police stations, as well as the public library. The practice is registered with the Care Quality Commission (CQC) as a partnership provider and holds a General Medical Services (GMS) contract with NHS England. The GMS contract is a contract agreed nationally between general practices and NHS England for primary care services to local communities. At the time of our inspection, Stourport Health Centre was providing medical care to approximately 9030 patients.

The practice is one of six sites which form the Wyre Forest Health Partnership (WFHP). Functions such as human resources and finance are undertaken by staff at the WFHP. Policies are set at organisational level, but tailored to individual sites. Many of the governance functions are undertaken by the WFHP. For example, significant event analysis is routinely shared by all six sites.

Car parking is available on the lower level of the complex and disabled car parking spaces are provided at the front of the practice. The practice has facilities for disabled patients and a wheelchair is available for patients’ use. There is a screen in the reception area, which displays general NHS information as well as information that is personalised for the practice. Magazines are provided for patients and there are books for children and a play table in the reception area.

There are four GP partners (two male and two female) and three salaried GPs (one male and two female). They are supported by the site manager, two advanced nurse practitioners (plus a visiting advanced nurse practitioner), three nurses, two health care assistants, a pharmacist, two phlebotomists and reception and administrative teams. The site manager works across two sites, and is based at the Stourport Health Centre on Thursdays and Fridays. The other site is also part of the WFHP and is a few minutes’ walk away.

Stourport Health Centre is an approved training practice. There is currently one foundation year two doctor working at the practice.

Core opening hours are between 8am and 6.30pm Monday to Friday. Appointments are available during these times. Extended hours appointments are offered on Monday evenings from 6.30pm until 8pm and on one Saturday morning each month from 8am until 10am. Out of hours cover is provided by the NHS 111 service.

Updated 4 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stourport Health Centre on 17 May 2017. Overall the practice is rated as good.

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

• The practice was one of six sites which formed the Wyre Forest Health Partnership (WFHP). Functions such as human resources and finance were undertaken by staff at the WFHP. Many of the governance functions were carried out in conjunction with the WFHP.
• There was an open and transparent approach to safety and a system for reporting and recording significant events, including positive events. Learning was routinely shared across six practices.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff had the skills, knowledge and experience to deliver effective care and treatment in line with current evidence based guidance.
• Results from the National GP Patient Survey published in July 2016 evidenced that patients felt that they were treated with kindness, dignity and courtesy and that clinical staff involved them in discussions about their care and treatment options.
• There were high levels of satisfaction regarding access to care and treatment. The appointment system ensured that patients could be triaged and receive a telephone call from a clinician the same day. Same day face to face consultations were always available.
• Information about services and how to complain was available both in the reception area and on the practice website. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice implemented suggestions for improvements and made changes to the way it delivered services in response to feedback from patients and from the Patient Participation Group (PPG). For example, the PPG had recommended that a patient information screen be installed in the reception area and this was actioned.
• Patients we spoke with said that it was easy to make an appointment with a named GP and that there was continuity of care. Urgent appointments were always 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 told us that they felt supported by the management team. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The area where the provider should make improvement is:

• Maintain a record of vaccination stock levels.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 July 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority. For example, the nursing team carried out reviews for patients with asthma, diabetes and heart disease.
• The percentage of patients with diabetes on the register in whom the last diabetic reading was at an appropriate level in the preceding 12 months was 84%, which was the same as the CCG average and 6% above the national average.
• The practice routinely followed up on patients with long-term conditions who had been discharged from hospital and ensured that their care plans were updated to reflect any necessary changes.
• All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• There was a section on the practice website which provided information for patients with long term conditions, such as asthma, heart disease and diabetes.
• Facilities were available for patients with hearing impairments. There was a hearing loop, and a member of staff had been trained to use British Sign Language. Type Talk (the telephone relay service which enabled people who were hard of hearing, deaf or speech impaired to communicate with hearing people using the telephone network) was provided for patients.

Updated 4 July 2017

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

• From the sample of documented examples we reviewed we found that there were systems 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 accident and emergency (A&E) attendances.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies. A play table and children’s books were provided for children in the reception area.
• There were priority telephone triage calls for all children aged less than one year.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• The practice had emergency procedures for acutely ill children and young people and for acute pregnancy complications.

Updated 4 July 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice had signed up to the admissions avoidance scheme, which identified patients who were at risk of inappropriate hospital admission.
• Older patients who were more frail were offered proactive, personalised care to meet their needs.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• A specialised visiting service, supported by an advanced nurse practitioner, had been implemented for housebound patients, including older people.
• Nominated GPs provided care and support for patients at local care homes with monthly visits and responded to urgent health care needs when required.
• The practice had a system to follow up on older patients who had been discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

Updated 4 July 2017

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

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours every Monday evening and Saturday morning once a month.
• Flexible telephone call times could be arranged, for example, during lunchtimes and in the evenings.
• Patients could sign up to receive text messages for appointment reminders.
• NHS Health Checks were offered by the nursing team, who also gave advice on smoking cessation, diet, exercise and alcohol consumption.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group. Health promotion material was accessible at the practice and on its website.

Updated 4 July 2017

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

• The practice carried out advance care planning for patients living with dementia.
• 75% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was 10% below the Clinical Commissioning Group (CCG) average and 9% below the national average. Unpublished results from 2016/17 data showed that this had risen to 89%.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• 92% of patients with poor mental health had a comprehensive care plan documented in the last 12 months, which was comparable to the CCG average and 3% above the national average.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment. The practice had a dementia champion.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The GPs and practice nurses understood the importance of considering patients’ ability to consent to care and treatment and dealt with this in accordance with the requirements of the Mental Capacity Act 2005. There was a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff interviewed had an understanding of how to support patients with mental health needs and dementia. A member of staff had attended Dementia Friendly training and was going to give a talk about the training at the next staff meeting, which was scheduled for the week after our inspection.
• A section on the practice website gave details of how patients could self-refer to an anxiety and depression management course run by the Worcestershire Improving Access to Psychological Therapies service.

Updated 4 July 2017

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 homeless people, travellers and those with a learning disability.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients with a learning disability. The practice had carried out annual reviews for 42% of the patients on their register (31). The practice explained that historically they had reviewed the patients who were considered to have moderate or severe learning disabilities, but that they planned to review all patients on the learning disability register in the future.
• A learning disability nurse saw patients at the practice on an ad hoc basis.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed could explain how they would recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.