Adderley Green Surgery

Updated 26 September 2017

Adderley Green Medical Services Limited (known as Adderley Green Surgery) is located in Stoke-on-Trent and is registered with the CQC as an organisation. The provider holds a General Medical Services contract with NHS England and is a member of the NHS Stoke-on-Trent Clinical Commissioning Group (CCG). A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the most common form of GP contract. The practices provide Directed Enhanced Services, such as family planning services, minor surgeryand childhood immunisations.

The practice has approximately 5068 registered patients. The area is one of higher deprivation when compared with the national average. The practice age distribution is mainly in line with the Clinical Commissioning Group (CCG) and national averages.

Patients can access services at either of the practices two locations at their convenience.

• Longton Health Centre, Drayton Road, Stoke-on-Trent, ST3 1EQ (main practice).

• 28-30 Weston Street, Adderley Green, Longton, Stoke-on-Trent, ST3 5DQ (the branch practice providing limited surgeries).

The practice is an accredited teaching practice for medical students and is also involved with medical research in partnership with a local university.

The practice staffing comprises of:

• One male and one female GP 1.5 whole time equivalent (WTE) plus one female locum GP (working two sessions per month).

• One female nurse practitioner (0.9 WTE) plus one female locum advanced nurse practitioner (0.18 WTE)

• Two female practice nurses (1.5 WTE) plus one female locum practice nurse (0.2 WTE)

• One female practice pharmacist (0.1 WTE) and one male locum pharmacist (non-prescriber)

• One female health care assistant (0.1 WTE) increasing to full time from September 2017.

• One practice manager (1 WTE).

• Seven reception and administrative staff working a variety of hours.

Both the main and branch practices are open between 8.00am and 6pm Monday to Friday and 8am to 1.00pm on a Thursday. GP surgery times at the main practice are between 8.30am to 12.30pm and from 1.30pm to 5.30pm. Extended opening hours are offered between 6pm to 8.00pm on a Monday evening at the main practice. A GP surgery is held at the branch practice once a week on a Friday morning between 9am and 12 noon. Patients can access a range of nurse clinics provided at the main location throughout the week in addition to nurse clinics on a Monday between 8.30am and 6pm and on a Tuesday between 9am and 2pm at the branch practice. Urgent appointments are available for children and those that need them. Routine appointments can be booked in person, by telephone or on-line. Home visits are triaged by a clinician to assess whether a home visit is clinically necessary and the urgency of the need for medical attention. The practice has opted out of providing cover to patients in the out-of-hours period and Thursday afternoons. During this time services are provided by Staffordshire Doctors Urgent Care, patients access this service by calling NHS 111.

Updated 26 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Adderley Green Surgery on 8 August 2017. Overall the practice is rated as good.

Dr Sridharaprumal Shanmugasundaram was formally registered with the Care Quality Commission (CQC) as a single handed GP practice known as Adderley Green Surgery located at Weston Street, Adderley Green, Stoke on Trent. The practice had not previously been inspected by CQC. In February 2017 the provider was successful in winning the contract to manage The Practice Drayton Road, located within Longton Health Centre which was previously managed by Chilvers & McCrea Limited. This became effective from 1 April 2017. The patient lists merged and the provider designated the Drayton Road practice as the main location and head office with the practice at Weston Road becoming a branch surgery. The two practices are less than one mile apart.

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

• Staff understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. However, the provider had not had the opportunity to document all events identified as a result of taking over the main practice.
• Most risks to patients were assessed and managed
• There was a staffing structure in place and staff were aware of their own roles and responsibilities.
• The nurse practitioner had recently completed an independent prescriber course however; there was no formal system in place to support them in this extended role.
• 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 for the former Adderley Green Practice showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment. However, some patients shared concerns with us about the lack of confidentiality at the the reception desk at the main practice.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients reported considerable difficulty when trying to contact the practice by telephone and expressed dissatisfaction with the availability of appointments.
• 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 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 areas where the provider should make improvement are:

• Review and improve arrangements for making appointments.

• Consider obtaining an Automated External Defibrillator (AED) in the practice as recommended in the ‘Primary care – Quality Standards’ published by the Resuscitation Council UK or alternatively review the current risk assessment to ensure it is comprehensive and clearly details why an AED is not required.

• Implement a formal system to support the nurse practitioner in their extended role.

• Ensure all outstanding significant events are recorded and investigated.

• Consider reviewing the confidentiality arrangements at the main practice reception desk.

• Carry out a review of staffing to ensure there is sufficient clinical capacity to meet patient demand.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 September 2017

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

• Self-management plans were in place for patients with health conditions such as diabetes, asthma and chronic obstructive pulmonary disease (COPD). A pre-diabetes questionnaire was available in the waiting area to identify any patients that may be diabetic so that intervention could be put in place at the earliest opportunity.

• There was a system to recall patients for a structured annual review to check their health and medicine needs were being met.

• Members of the clinical team had lead areas of specialism, for example COPD, mental health, diabetes and attended external training updates on the management of these conditions.

• The practice followed up on patients with long-term conditions discharged from hospital within two days and ensured that their care plans were updated to reflect any additional needs.

• Staff were qualified to perform lung function testing.

• All these patients had a named GP that worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 26 September 2017

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

• Children aged 12 and under were given priority access to appointments. If no appointments were available on the same day, GPs triaged each appointment request and decided whether they needed to see the child as an additional patient to their clinic.

• Immunisation rates were relatively high for all standard childhood immunisations.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice worked with a midwife who visited the practice weekly, 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 was a Developing All Sexual Health (DASH) practice and provided sexual health advice and contraceptive supplies for young people aged 24 and under, including chlamydia screening.

• A women’s health clinic was provided for the fitting and removal of intrauterine device (coil) and contraceptive implant.

Updated 26 September 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 was responsive to the needs of older patients and requests for home visits were triaged within an hour to help prevent hospital admissions.

• Patients aged 85 and over were identified as vulnerable adults and included on the practice vulnerable adult register.

• The practice was proactive and provided personalised holistic assessments covering medical, social and mental health needs in addition to care plans for patients at risk of hospital admission.

• The nursing team carried out home visits for routine health checks, chronic disease management, blood tests as well as administering seasonal flu vaccinations for the housebound.

• Patients aged 75 years or over had a named GP and wherever possible they see their named GP for continuity of care.

• The practice offered holistic ‘Keep Well’ Health Checks for patients aged 65 and over.

Updated 26 September 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 hours were provided on a Monday evening until 8pm at the main practice.

• Telephone appointments were available by request to benefit working patients that were unable to attend the practice. The practice was also looking to provide video consultations in the future for working age patients.

• 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.

• The practice enabled the temporary registration of students whilst home on holiday leave.

• Health checks were provided to include well man checks, new patient health checks and NHS Health checks for patients aged 40 to 74 years.

Updated 26 September 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 for the former Adderley Green Practice was mainly comparable to the local CCG and national averages. For example, the percentage of patients with an agreed care plan documented in the preceding 12 months was 90% which was the same as the CCG average and comparable with the national average of 89%. However, the practice clinical exception rate of 0% was lower than the CCG average of 11.5% and the national average of 13%, meaning more patients were included.

• The practice considered these patients to be vulnerable and included them on their vulnerable patient register.

• Patients with severe mental health conditions were seen the same day, their medicines were reviewed by a GP and weekly prescriptions issued if deemed appropriate to help safeguard these patients.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia. An external counsellor from Healthy Minds held regular clinics at the practice to see patients registered at the practice in addition to patients registered elsewhere.

• Patients at risk of dementia were identified and offered an assessment with a lead dementia nurse in their own homes if needed. The practice was working towards becoming a dementia friendly practice.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

Updated 26 September 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 those with dementia, a learning disability, patients aged over 85 and housebound patients.

• 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 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 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.