Page Hall Medical Centre

Updated 11 October 2016

Page Hall Medical Centre is located in a purpose built health centre in inner city Sheffield and accepts patients from within a one mile radius of Page Hall, covering Firvale, Northern General Hospital, Crabtree Estate, Earl Marshall, Wensley Estate and Firth Park (as far as Hucklow Road).

Public Health England data shows the practice population has a higher than average number of patients aged 0 to 45 year olds compared to the England average. Practice data confirmed 83% of the practice population were of ethnic minority and the practice had audited that 32% of all consultations require the use of an interpreter. The practice catchment area has been identified as one of the first most deprived areas nationally.

The practice provides Primary Medical Services (PMS) under a contract with NHS England for 7351 patients in the NHS Sheffield Clinical Commissioning Group (CCG) area. It also offers a range of enhanced services such as childhood vaccination and immunisations.

Page Hall Medical Centre has three GP partners (two female, one male), four salaried GPs (three female, one male), one GP registrar, five practice nurses (three of whom are nurse prescribers), two healthcare assistants, a practice manager and an experienced team of reception and administration staff. The practice is a teaching and training practice for medical students.

The practice is open 8.15am to 6pm Monday to Friday with the exception of Thursdays when the practice closes at 12.30pm. The GP Collaborative provides cover when the practice is closed on a Thursday afternoon. Extended hours are offered 9am to 12 noon on a Saturday morning. Morning and afternoon appointments are offered daily Monday to Friday with the exception of Thursday afternoon when there are no afternoon appointments.

When the practice is closed between 6.30pm and 8am patients are directed to contact the NHS 111 service. The Sheffield GP Collaborative provides cover when the practice is closed between 8am and 6.30pm. For example, at lunchtime. Patients are informed of this when they telephone the practice number.

Updated 11 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Page Hall Medical Centre on 26 July 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it difficult at times to make a routine appointment although urgent appointments were available the sameday through the nurse telephone triage system.
• 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 and complied with the requirements of the duty of candour.

We saw areas of outstanding practice:

• The practice had set up a working group with the local schools to look at attendance issues contributed to by minor illnesses. The practice had arranged to have self help leaflets translated into Slovak to assist patients. The practice had worked with school nursing teams to support pupils where there were specific concerns.
• The GPs told us they had agreed to complete death certificates during out of hours periods to facilitate and support patients whose religion required the burial to take place as soon as possible after death.
• The practice had developed a new patient registration appointment system with interpreters on site which offered an enhanced level of screening and opportunistic vaccination as well as orientation to the NHS for new migrants. The GP told us this had uncovered an exceptionally high prevalence of hepatitis B in some communities and the practice had implemented a contact tracing and hepatitis B vaccination programme for their own patients. The GP told us this had been recognised by Public Health England and had triggered a national enhanced service to offer patients who may be vulnerable the Hepatitis B vaccination.

The area where the provider should make improvement is:

• Maintain a complete record of the immunity status of clinical staff as specified in the national Green Book (immunisations against infectious disease) guidance for healthcare staff.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 11 October 2016

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

• Nursing staff had lead roles in long term condition management and patients at risk of hospital admission were identified as a priority.
• Longer appointments and home visits were available when needed.
• Patient information was available in pictoral form to assist with consultations for patients who were unable to read or write and we saw an example of the one used for patients who had asthma.
• All these patients had a named GP and a structured annual review to check their health and medicines needs  were being met. The practice had developed a recall system to fall on the patient’s birthday, to include an appointment with the healthcare assistant, practice nurse and GP over the month to review all their medical conditions.
• 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. For example, the diabetologist held regular clinical meetings at the practice to discuss patients with complex diabetic needs.

Updated 11 October 2016

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

• 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.
• Staff told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• Data showed 96% of women eligible for a cervical screening test had received one in the previous five years compared to the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice had set up a working group with the local schools to look at attendance issues contributed to by minor illnesses. The practice had arranged to have self help leaflets translated into Slovak to assist patients. The practice had worked with school nursing teams to support pupils where there were specific concerns. 
• We saw positive examples of joint working with midwives, health visitors and school nurses. The practice held monthly safeguarding meetings with health visitors and midwives at the practice.

Updated 11 October 2016

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

• 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 home visits and urgent appointments for those with enhanced needs.
• The practice provided medical care and weekly routine GP visits to patients who resided in a local care home.
• The practice signposted patients to a local community organisation who ran social groups for the elderly in the area.
• The percentage of patients aged 65 or over who received a seasonal flu vaccination was 75%, higher than the national average of 73%.

Updated 11 October 2016

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

• 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 appointments on a Saturday morning 9am to 12 noon at the practice and weekend and evening appointments at a local practice through the Sheffield satellite clinical scheme.
• 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 11 October 2016

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

• Of those patients diagnosed with dementia, 95% had received a face to face review of their care in the last 12 months, which is higher than the national average of 84%.
• Of those patients diagnosed with a mental health condition, 87% had a comprehensive care plan reviewed in the last 12 months, which is comparable to the national average of 88%.
• The practice regularly worked with multidisciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had advised patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• 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.
• The practice hosted Improving Access to Psychological Therapies Programme (IAPT), a counselling service to support patients’ needs.

Updated 11 October 2016

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 including those with a learning disability.
• The practice looked after the medical care of patients who resided in a local housing complex for people with learning difficulties and had a named GP for these patients.
• Practice data had identified that 83% of the practice population were of ethnic minority background and 32% of clinical consultations required an interpreter. The practice had access to interpreter services, both face to face and on the telephone and also employed their own bilingual receptionists to assist patients at the front desk and when booking appointments.
• The GP told us the practice would record in patients' records if a patient was unable to read or write to alert staff that they may require assistance. Staff told us they would interpret NHS letters for patients who were unable to read or write and we observed the practice nurse assist a patient during our inspection. Practice data showed 25% of the practice list were considered to be in this category.
• 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 informed vulnerable patients about how to access various support groups and voluntary organisations. For example, a chronic pain support group.
• The practice had developed a new patient registration appointment system with interpreters on site which offered an enhanced level of screening and opportunistic vaccination as well as orientation to the NHS for new migrants. The GP told us this had uncovered an exceptionally high prevalence of hepatitis B in some communities and the practice had implemented a contact tracing and hepatitis B vaccination programme for their own patients. The GP told us this had been recognised by Public Health England and had triggered a national enhanced service to offer patients who may be vulnerable the Hepatitis B vaccination.
• The GPs told us they had agreed to complete death certificates during out of hours periods to facilitate and support patients whose religion required the burial to take place as soon as possible after death.
• 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.