The Heights General Practice

Updated 16 November 2017

The Heights General Practice provides primary medical services in Salford, from Monday to Friday. The practice is open and offers appointments between 8.00am to 8.00pm Monday to Friday and 9:30am to 11:30am on a Saturday.

The Heights General Practice is situated within the geographical area of Salford Clinical commissioning Group (CCG).

The practice has an Alternative Provider Medical Services (APMS) contract. The APMS contract is the contract between general practices and NHS England for delivering primary care services to local communities.

The Heights General Practice is responsible for providing care to 4465 patients.

The practice consists of five GPs, one lead GP and three sessional doctors, three of whom were female, a practice nurse and a health care assistant. The practice was supported by a practice manager, assistant manager, receptionists and secretary. The practice is a training practice and has one GP trainee and a 4th year medical student.

The practice is part of SSP Health Primary Care Limited, a federated organisation which provides support from the internal leadership and governance teams. The practice has access to support and leadership from, for example a nursing lead and pharmacist as well as access to human resources, auditing and finance teams. When the practice is closed patients are directed to the out of hours service.

Updated 16 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Heights General Practice on 22 August 2017. The Heights General Practice is a location of SSP Health Primary Care Limited. Overall the practice is rated as outstanding.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• The practice used innovative and proactive methods to improve patient outcomes and working with other local providers to share best practice. For example, ‘chaperone bubbles’ (chaperone bubbles are notices attached to the GPs desk informing patients chaperone were available) were implemented within the practice which led to an increase in the number of patients requesting a chaperone.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• The practice worked closely with other organisations such as Age UK and also the local community in planning how services were provided to ensure that they met patients’ needs.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• Patients we spoke with 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

We saw areas of outstanding practice:

• The practice had identified that there were a number of patients suffering from financial hardship. In response to this the practice initiated a local foodbank and had collected food donations that had fed over 3000 people; 1200 of which were children.
• The practice had recognised that loneliness can impact on the health and wellbeing of its patient population and had addressed this through community integration. This had been driven by the practice and the PPG. It had included the production of a comprehensive newsletter which had been distributed across the population, offering patient transport to those who had difficulty in attending the practice and facilitating social events both in the practice and the local community hall. We saw evidence that this had reduced social isolation and increased well-being for several patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 November 2017

The practice is rated as outstanding 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.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• The practice offered appointments up to 45 minutes for those with multiple long term conditions, offering a holistic review.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• 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.

Updated 16 November 2017

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

• From the sample of documented examples we reviewed we found 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 high for all standard childhood immunisations.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.
• Breast feeding facilities were available.

Updated 16 November 2017

The practice is rated as outstanding 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 offered proactive, personalised care to meet the needs of the older patients in its population. All patients over the age of 75 were offered health checks and care plans.
• 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.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Where older patients had complex needs, the practice shared summary care records with local care services.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 16 November 2017

The practice is rated as outstanding 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 and Saturday appointments.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 16 November 2017

The practice is rated as outstanding 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.
• 87% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is above to the national average of 84% and the CCG average of 84%.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• 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 information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 16 November 2017

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

• The practice held a register of patients living in vulnerable circumstances known as the ‘important patient register’ including homeless people and those with a learning disability.
• The practice had identified that there were a number of patients suffering from financial hardship. In response to this the practice initiated a local foodbank and had collected food donations that had fed over 3000 people including patients from this practice and other practices in the local area. 1200 of these patients were children.
• 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 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.
• The practice used telephone translation services and routinely offered extended appointments (30 to 45 minutes) to those requiring a translator.
• Staff interviewed knew how to 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.