Middleton Health Centre

Updated 2 June 2016

Middleton Health Centre is one of four GP practices in Greater Manchester run by Hope Citadel Healthcare CIC. Hope Citadel Healthcare CIC was set up with the aim of providing NHS services to those in under-doctored and deprived areas. They are a not for profit community interest company and offer whole person healthcare which they refer to as ‘focussed care’.

They have been commissioned by the Clinical Commissioning Group (CCG) under an Alternative Provider Medical Services (APMS) contract. This enables them to deliver services through a wide range of providers specifically tailored to the needs of the local population. The practice work with their in-house counsellors, focussed care workers and external organisations such as the local council and social care to help with health and social care issues within the community.

The practice provides primary medical services in Middleton near Manchester from Monday to Friday. The practice is open between 8am and 7pm Monday to Friday. The first appointment of the day is 8am and the last appointment is 6.15pm Monday to Friday.

Middleton Health Centre is situated within the geographical area of Heywood, Middleton and Rochdale Commissioning Group (CCG) and is responsible for providing care to 2924 registered patients.

The practice consists of three male GPs and four female GPs, practice nurses, counsellor, focussed care worker and a health care assistant. The practice is supported by a practice manager and an administration and reception team.

When the practice is closed patients were directed to the out of hour’s service.

Updated 2 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hope Citadel Healthcare Community Interest Company on 5 April 2016. Overall the practice is rated as outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• Feedback from patients about their care was consistently positive.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Information about how to complain was available and patients who had difficulties understanding were encouraged to complain verbally and were supported in the process.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• All staff employed by the practice had received a disclosure and barring check (DBS check). (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).
• The practice had a clear vision which had quality and safety as its top priority. A business plan was in place , was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• Locally the practice is known as Middleton Health Centre and is part of a larger not for profit organisation called Hope Citadel Healthcare.

We saw several areas of outstanding practice including:

• The practice had increased the flexibility and length of its appointments to 13 minutes instead of 10 and could demonstrate the impact of this by reduced use of the accident and emergency services and positive results from clinical audits.
• The practice had a good skill mix of staff which included a nurse prescriber, counsellors and focussed care workers who organised a wide variety of health and social care related support in order to manage and improve the health and lives of patients in need of this. They were able to demonstrate the positive impact for this group of patients. For example some patients asked to speak to us and told us of their different personal experiences of how the practice had made a positive difference to their lives. These examples resulted in a reduction of inappropriate attendance at other services such as accident and emergency. We also saw evidence, through audit, of households becoming substance free and 65% of patients had better compliance with their medication.
• The focussed care team organised social activities such as weekly coffee mornings and craft classes for female patients, open days and boogie babies. They did this to build relationships with the patient population, reduce social isolation, help patients learn new skills whilst keeping informal contact with the practice and reduce inappropriate attendance at other acute services such as walk in centres or accident and emergency departments. Audit showed that families accessing focussed care presented 57% less often in the year following the support provided.
• All staff undertook 360 degree feedback and appraisals that identified learning needs from which action plans were documented. Our interviews with staff confirmed that the practice was proactive in providing training and funding for relevant courses to enhance individual development and skills for the benefit of patients.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 2 June 2016

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

• GPs and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• All the GPs in the practice were developing their roles to include a special interest with the aim of reducing referrals into other services.
• Longer appointments and home visits were available when needed.
• All these patients had 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 2 June 2016

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

• The practice organised social activities such as weekly coffee mornings and craft classes for female patients, open days, boogie babies and food parcels for patients in need.They did this to build relationships with the patient population, reduce social isolation, learn new skills whilst keeping informal contact with the practice and reduce inappropriate attendance at other services such as walk in centres or accident and emergency departments.
• Care plans were in place for complex families and the practice worked closely with other agencies to resolve issues such as substance abuse, housing, relationship and mental health. The practice were able to evidence positive outcomes for this group of patients.
• 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 A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• 82% of women aged between 25 and 64 had in their notes recorded that a cervical screening test had been performed in the preceding five years which was the same as the national average.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• Same day appointments were available for children under the age of 12.
• The practice welcomed breast feeding mothers by offering them a dedicated area for this.

Updated 2 June 2016

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

• Clinical staff were educated and mindful about polypharmacy issues including possible interactions, compliance issues and national guidelines. They worked closely with pharmacies, encouraging dosette boxes where required to reduce error. (Polypharmacy is the use of multiple medicines).
• Hampers were arranged by the staff for those patients in need of them and the practice worked closely with Age Concern and social care services.
• All elderly patients were offered double appointments if required.
• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered planned and unplanned home visits and urgent appointments for those with enhanced needs.
• Patients aged over 75 had a named GP and a structured annual review to check their health and medicine needs were being met. For those patients with the most complex needs, the named GP worked with the relevant health and care professionals to deliver a multidisciplinary package of care.

• The practice embraced the Gold Standards Framework for end of life care. This included supporting patients’ choice to receive end of life care at home.

Updated 2 June 2016

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

• The focussed care worker, employed by the practice, assisted families with housing issues and the completion of documentation. The practice provided evidence to show that 53% of housing problems were resolved after working with the focused care worker.
• Patients with difficulty reading and/or writing were encouraged to provide feedback, complaints and comments verbally and these were all logged and dealt with.
• 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.
• The practice offered extended hours every Monday and Thursday evenings until 8pm and Saturday mornings until 12.30pm.
• 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 offered “RU Clear” screening which is a confidential sexual health screening service and included emergency contraception.

Updated 2 June 2016

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

• The practice offered counselling and CBT services and had good links with mental health services and crisis teams.
• Staff were trained to recognise mental health presentations and enable access to support services.

• Patients with mental health issues had care plans and where required access to drug and alcohol services within the practice.
• The practice was the lowest prescriber of benzodiazepines in the Heywood, Middleton and Rochdale CCG.

• The practice was able to provide evidence that the number of patients on the focussed care list with mental health issues had reduced by 10% after working with the focussed care worker and counsellor.

• 100% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is above the national average of 84%

• 95% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in their record in the preceding 12 months which was above the national average of 88%.
• 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 patients were offered and receiving services available to them such as referrals to memory clinics for assessment and care.
• 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.

Updated 2 June 2016

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

• The practice staff included a focussed care worker who provided social and medical care to its patients in need of this support. The practice were able to provide evidence that a number of households had become substance free and that they had assisted women leaving domestic violence situations. Some patients who had received this care spoke with us and told us of their experiences of the support given to them and the dramatic difference it had made to their lives.

• The practice held a register of patients living in vulnerable circumstances including homeless people, military veterans, refugees, travellers and those with a learning disability.
• Patients of no fixed abode were able to use the surgery address to register with the practice.
• The practice offered longer appointments for patients with a learning disability. For patients attending the focussed care worker, joint appointments with a learning disability practitioner were also offered.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff 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.