Archived: Southglade Medical Practice Also known as Southglade Health Centre

Updated 5 March 2018

Southglade Medical Practice provides primary medical services to approximately 2,700 patients through an alternative provider medical services (APMS) contract. The practice is located in the Bestwood area of Nottingham, approximately four miles from the city centre. It is run by Southglade Medical Practice Ltd who took over as the provider of services at the practice on 5 January 2017. The directors operate under the brand Tudor House Medical Group, and run another practice 1.3 miles away called Tudor House Medical Practice.

The premises were newly built in 2012 and are rented from the previous providers who own the building. The practice use six clinical rooms and two non-clinical rooms, whilst the rest of the building is shared with other local community health services including a pharmacy. They are located within Southglade Park alongside council owned services such as the leisure centre, community access centre and Sure Start Children’s Centre.

The level of deprivation within the practice population is above the national average. The practice is in the first most deprived decile meaning that it has a higher proportion of people living there who are classed as more deprived than most areas. Data shows the number of younger people aged below 40 years registered at the practice is significantly higher than the national average, and the proportion of 40 to 85+ year olds is significantly lower than national averages.

The practice team comprises of two GP directors (male), two long term locum doctors (male and female), an advanced nurse practitioner, a practice nurse, a health care assistant, a group practice manager, a deputy practice manager and two receptionists. They are supported by a premises officer and a cleaner employed by the landlord.

The practice is open between 8am and 6.30pm Monday to Friday. Appointment times start at 8am and the latest appointment offered at 5.50pm daily. The practice does not provide the extended hours service.

When the practice is closed, patients are advised to dial NHS 111 and they will be put through to the out of hours service which is provided by Nottingham Emergency Medical Services.

Updated 5 March 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Southglade Medical Practice on 26 September 2017. The overall rating for the practice was inadequate, and it was placed into special measures. Two warning notices were issued to the provider in response to identified breaches in regulations. The full comprehensive report on the September 2017 inspection can be found by selecting the ‘all reports’ link for Southglade Medical Practice on our website at www.cqc.org.uk.

The overall rating of inadequate will remain unchanged until we undertake a full comprehensive inspection of the practice within the six months of the publication date of the report from September 2017.

This inspection was an announced focused inspection carried out on 7 February 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations set out in the warning notices issued to the provider.

The warning notices were issued in respect of regulations related to safe care and treatment, and staffing. Specifically, the service provider had not done all that was reasonably practicable to mitigate risks to the health and safety of service users receiving care and treatment; there was limited supervision and clinical oversight of some staff.

Our key findings were as follows:

• The practice had complied with the warning notices that we issued and had taken action to ensure they met with legal requirements.

• The process in place to review and act on safety alerts had improved significantly. A comprehensive log was maintained to summarise the receipt of incoming alerts, their dissemination and the follow up actions taken.

• Procedures relating to the management of vaccines had been strengthened. Staff recorded daily temperature logs for the vaccine fridges, and followed cold chain procedures by recording reasons for any temperature readings out of the recommended range.

• Recruitment files showed steps had been taken to ensure appropriate checks were carried out for staff working with vulnerable people. These included immunisation records for relevant clinical staff.

• There was increased supervision and clinical oversight of clinical staff. Eligible staff had received annual appraisals; some appraisals were in progress at the time of our inspection. These included reviewing the performance of staff and supporting them with their personal development plans.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 December 2017

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

The provider was rated as inadequate for safety and for well led, requires improvement for effective and good for being caring and responsive. The issues identified as being inadequate overall affected all patients including this population group. There were, however, examples of good practice.

• Nursing staff had lead roles in chronic disease management. Patients were recalled in the month of their birthday, and those with multiple conditions were reviewed in a single appointment. They worked collaboratively with a community specialist diabetes nurse on their more complex patients with diabetes to improve outcomes for these patients.

• A structured annual review was carried out 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 multi-disciplinary package of care.

• There were a large number of leaflets available which provided education and self-care advice and patients were directed to online resources. The practice actively encouraged patient education sessions for patients with conditions such as diabetes, for example a type 2 diabetes insulin course. There were self-management plans for patients with asthma. A specialist diabetes nurse visited the practice quarterly to review complex patients and provided support to the clinicians.

• The practice promoted self-referral to services such as podiatry, physiotherapy and psychological therapies, whose clinics were offered in the practice premises.

• Longer appointments and home visits were available and offered when needed.

Updated 14 December 2017

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

The provider was rated as inadequate for safety and for well led, requires improvement for effective and good for being caring and responsive. The issues identified as being inadequate overall affected all patients including this population group. There were, however, examples of good practice.

• The practice worked closely with midwives, health visitors and family nurses attached to the practice. 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 Accident and Emergency (A&E) attendances.

• The practice held meetings once every two months with the health visitor, and also reviewed any children on a child protection plan at their clinical meetings. Feedback from the health visitor was positive about communications with the practice regarding any children and families of concern.

• Practice supplied data showed immunisation rates for vaccinations given to under two year olds were 96%, and those for five year olds were 94% in first quarter of 2017/18.

• Appointments were available outside of school hours with urgent appointments available on the day for children and babies.

• Joint appointments with the GP and practice nurse were offered for the eight week post-natal check. This allowed mothers and babies to have their post-natal check, baby check and first immunisation carried out in one visit.

• The practice offered a full range of family planning services including fitting of intra-uterine devices (coil) and contraceptive implant fitting.

• The premises were suitable for children and babies. Baby changing facilities were available and the practice accommodated mothers who wished to breastfeed.

Updated 14 December 2017

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

The provider was rated as inadequate for safety and for well led, requires improvement for effective and good for being caring and responsive. The issues identified as being inadequate overall affected all patients including this population group. There were, however, examples of good practice.

• The practice had a significantly lower elderly population with approximately 6% aged over 65 years, compared to a national average of 17%. They offered proactive, personalised care to meet the needs of the older people in their population.

• GPs were responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Feedback from a care home where 45 residents are registered with the practice indicated that a named GP carried out review visits and responded to urgent requests when needed to ensure continuity of care. In their absence, there was sufficient cover from other clinicians at the practice and telephone advice was given as necessary. They told us the GPs worked effectively with multi-disciplinary teams including community care homes teams to ensure patient needs were met and referrals to other services were made promptly.

• The practice was signed up to provide tailored care for vulnerable and older people through a local enhanced service.

• Flu vaccinations were offered to people aged 65 years and older. The practice held drop in clinics at the practice and visited housebound patients eligible for the vaccinations. A recall programme was in progress for patients eligible for pneumococcal and shingles vaccinations.

Updated 14 December 2017

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

The provider was rated as inadequate for safety and for well led, requires improvement for effective and good for being caring and responsive. The issues identified as being inadequate overall affected all patients including this population group. There were, however, examples of good practice.

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. This included access to telephone appointments, and the availability of early morning appointments from 8am on weekday mornings. The practice did not provide the extended hours service. However, staff told us patients could be offered early appointments from 7.30am and late appointments up to 7.30pm on Monday at the other practice in their group if needed.

• Appointments with the health care assistant were available from 8.15am on Monday to Thursday, and the latest appointment was offered at 5.30pm on a Wednesday.

• The practice was proactive in offering online services such as prescription requests, appointments, and accessing medical records to view pathology results. They were aware that use of online services by patients was low and there were plans to promote the use of the practice website to patients.

• There was a full range of health promotion and screening information in the practice that reflected the needs for this age group. Self-referral was encouraged for accessing psychological services, podiatry and physiotherapy.

Updated 14 December 2017

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

The provider was rated as inadequate for safety and for well led, requires improvement for effective and good for being caring and responsive. The issues identified as being inadequate overall affected all patients including this population group. There were, however, examples of good practice.

• There were 38 patients on the mental health register and five of them had been reviewed between April 2017 and the day of our inspection. There were no patients on lithium therapy.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia and had urgent access to a psychogeriatrician.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. A psychotherapy service was provided from the practice premises to both registered and non-registered patients.

• 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.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 14 December 2017

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

The provider was rated as inadequate for safety and for well led, requires improvement for effective and good for being caring and responsive. The issues identified as being inadequate overall affected all patients including this population group. There were, however, examples of good practice.

• The practice had identified eight patients with a learning disability which included children, and worked with a learning disabilities facilitator to ensure their registers were up to date. Staff told us there were plans to invite the suitable patients for annual health checks.

• The practice offered longer appointments for patients with a learning disability. All staff were invited to a refresher training event on how to help patients with learning difficulties.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. Multi-disciplinary meetings were held once every two months to enhance and review care planning of vulnerable patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations. There was a nominated frailty clinical lead. Patients with a terminal illness were allocated a named GP and visits were planned in consultation with their families or carers.

• The practice identified a need for additional support for people who experienced domestic violence. They liaised with a local voluntary support group to provide drop in sessions from the practice premises which would be open to both registered and non-registered patients and these were due to start in the near future.

• Staff told us they were aware of how to access interpreting and text talk services for their patients with hearing impairment and an interpreter could be arranged for those who could not speak in English through a Language Line translation service. A hearing loop was available in the practice.

• The practice’s computer system alerted GPs if a patient was also a carer to enable them to offer support including flu vaccinations.