Milehouse Medical Practice

Updated 21 September 2017

Milehouse Medical Practice is registered with the Care Quality Commission (CQC) as a partnership provider in Newcastle, Stoke-on-Trent. The practice holds a General Medical Services (GMS) contract with NHS England. A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract. The practice area is one of high deprivation when compared with the national and local Clinical Commissioning Group (CCG) area. At the time of our inspection the practice had 2,448 patients.The practice age distribution is in line with the national and CCG area however 4% of the practice population is aged 85 years and over. This is higher than the CCG and national averages of 2%. The percentage of patients with a long-standing health condition is 61% which is higher than the local CCG average of 57% and the national average of 53%.

The practice is open between 8.15am and 6pm Monday to Friday except Thursdays when it closes at 1pm. They provide a sit and wait surgery between 9am and 10.30am and 4.15pm and 6pm Monday to Friday. Patients can pre-book appointments Tuesday between 4.30pm and

6pm and Wednesday between 5pm and 7pm. Appointments can be booked four weeks in advance. Extended hours appointments are available on Monday and Wednesday between 6.30pm and 7pm. The practice does not routinely provide an out-of-hours service to their own patients but patients are directed to the out-of-hours service, Staffordshire Doctors Urgent Care when the practice is closed.

The practice team consists of:

• Two male GP partners

• A practice nurse

• A health care assistant

• A practice manager

• Three reception and administrative staff.

The practice provides a number of specialist clinics and services. For example long term condition management including asthma, diabetes and high blood pressure. It also offers services for child health developmental checks and immunisations and travel vaccinations.

Updated 21 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Milehouse Medical Practice on 5 September 2017. Overall the practice is rated as good.

Milehouse Medical Practice was previously registered with the Care Quality Commission (CQC) as a single handed GP practice as Dr Latif Hussain. We carried out a comprehensive inspection of the previous provider, Dr Latif Hussain, on 4 August 2015 and rated the practice as requires improvement overall with requires improvement for providing safe and well led services. A follow up comprehensive inspection was carried out on 18 August 2016 and the practice was rated as requires improvement overall with requires improvement for providing safe and effective services and inadequate for providing well led services. We issued a warning notice for Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Good Governance, and a requirement notice for Regulation 12, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe Care and Treatment. We carried out a focused inspection on 10 January 2017 to check that the practice had taken urgent action to ensure they met the legal requirements of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Good Governance and saw that they had. Since our inspection on 10 January 2017 a change of provider has taken place at the practice. The reports for the inspections carried out on 4 August 2015, 18 August 2016 and 10 January 2017 can be found by selecting the ‘all reports’ link for Dr Latif Hussain on our website at www.cqc.org.uk.

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 maintained a spreadsheet of significant events however there was a lack of overall structured analysis to identify trends within the practice.

• The practice had defined and embedded systems to minimise risks to patient safety.

• Clinical staff had received appropriate immunisations against health care associated infections however, non-clinical staff had not. A risk assessment had not been completed to demonstrate how potential risks to staff and patients would be mitigated.

• Recruitment information obtained by the practice was not always available in staff records.

• 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 published in July 2017 showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment. Feedback from patients about their care was consistently and strongly positive.
• Information about services and how to complain was available.
• Data from the national patient survey, the practice’s survey and CQC patient comment cards showed that patients found it very easy to make an appointment with a GP, there was continuity of care and urgent appointments were 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 the management.
• The practice proactively sought feedback from staff and patients, which it acted on.

• The Patient Participation Group (PPG) had reduced to only one member. The practice was exploring options of how to increase the PPG membership and had highlighted this as a challenge in their business plan.

The areas where the provider should make improvement are:

• Carry out an overall structured analysis of significant events to identify any trends.

• Complete a risk assessment to demonstrate how potential risks to patients and staff will be mitigated from non-clinical staff who have not received appropriate immunisations against health care associated infections.

• Ensure that recruitment information obtained by the practice is stored in all staff files.

• Continue to explore options of increasing the membership of the PPG.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 September 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. There was a system to recall patients for a structured annual review to check their health and medicines needs were being met.

• The percentage of patients with diabetes, on the register, who had their blood pressure reading measured in the preceding 12 months and it was within recognised limits was 88%. This was higher than the CCG average of 77% and the national average of 76%.
• The practice followed up patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• Patients with long term conditions such as diabetes, chronic obstructive pulmonary disease and asthma had individualised care plans. This group of patients were monitored and reviewed six to 12 monthly by a GP or practice nurse.

Updated 21 September 2017

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

• There were systems to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children who had a child protection plan in place.

• There was an informal system in place to follow up children who did not attend hospital appointments.

• 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 worked with midwives and health visitors to support this population group. The practice had recently held a meeting with the Health Visitor to discuss any children of concern. The practice also liaised with school nurses when required.

• The practice had emergency processes for acutely ill children and young people.

• The GPs provided neo-natal checks for new born babies and development checks for babies at six weeks of age. They also provided post-natal checks for mothers when their babies were six weeks old.

• Same day appointments were available for children and young people.

Updated 21 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 offered proactive, personalised care to meet the needs of the older patients in its population. Older patients were offered a falls risk assessment and their medication reviewed to prevent falls where necessary.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• The practice provided care and treatment to over 100 patients living in care or residential homes. Regular review visits for these patients were provided by a GP or practice nurse.

• The practice participated in the Clinical Commissioning Group (CCG) scheme of proactive management of patients over 75 years of age. This group of patients were invited for a health check and if necessary, referred to other services such as voluntary services and supported by an appropriate care plan. Home visits and assessments were provided for patients that were housebound. Over a 12 month period the practice had offered 179 patients a health check and 175 of these checks had been carried out.

• The practice followed up older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

Updated 21 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 opening hours and GP telephone consultations.

• 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 had established a social media page on Facebook and had recently used this to target university students and promote the uptake of meningitis immunisation.

• The practice offered extended hours on a Monday and Wednesday evening until 7pm for working patients who could not attend during normal opening hours.

Updated 21 September 2017

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

• The practice provided support and weekly visits to two residential homes that provided care for patients suffering from dementia. Regular multi-disciplinary team meetings were held with the practice nurse and other specialists and care plans put in place to support these patients.

• Staff were undertaking further training to enable them to become dementia friends.

• 81% of patients diagnosed with dementia had a care plan in place that had been reviewed in a face-to-face review in the preceding 12 months. This was comparable with the CCG average of 87% and national average of 84%.

• 95% of patients with a diagnosed mental health condition had a comprehensive, agreed care plan documented in their record, in the preceding 12 months. This was higher than the CCG and national averages of 89%.

• 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.

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

Updated 21 September 2017

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

• The practice maintained a register of 18 patients with a learning disability and offered this group of patients an annual health check. Over a 12 month period the practice had carried out 13 health checks (72%).

• The practice offered longer appointments for patients 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 regularly worked with other health care professionals in the case management of vulnerable patients. For example the Integrated Local Care Team (ILCT), a team that included health and social care professionals, and the palliative care team to provide effective care to patients nearing the end of their lives and other vulnerable patients.

• 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.

• The practice had identified patients whose first language was not English and patients who had communication problems due to deafness and blindness. Where necessary, the practice arranged interpreter services and sign language specialists.
• Home visits were available for older patients and patients who had clinical needs which resulted in difficulty attending the practice.