Archived: Dr McGowan and Partners

Updated 2 August 2016

Dr McGowan and Partners is registered with the CQC as a partnership provider. The provider operates two practices within the NHS Stoke on Trent Clinical Commissioning Group (CCG) area. This inspection focussed solely on the services provided from Moorcroft Medical Centre.

The practice operates out of purpose built premises close to Hanley city centre. The practice has patients from all age groups receiving care and treatment, although of note there are more patients aged over 65 when compared with local and national levels:

• 20% of patients are aged 65 and over compared to the clinical commissioning group and national averages of 17%.

• The practice area is more deprived when compared with both local and national averages.

• Income deprivation for older people is worse within the practice area (27% of patients meet this threshold compared to the CCG average of 20% and national average of 16%).

• The practice has identified more patients with long-term conditions than local and national averages.

These factors can influence the demand for health services on a general practice.

At the time of our inspection the practice had a stable list size of around 8,000 patients.

Staff work at both practices run by the provider. Although as a guide the following staff are normally based at Moorcroft Medical Centre :

• Six GPs (two female and four male).

• Two female advanced nurse practitioners.

• A male prescribing pharmacist.

• Three practice nurses (two female, one male) and one female healthcare assistant.

• The administrative team is led by a managing partner, practice manager and other managers totalling over 30 staff.

The practice have their opening times displayed within the premises and detailed on their website:

• The reception is open 7:30am to 6pm Monday, Wednesday and Friday, 7:30am to 7:45pm on Tuesday and 7:30am to 1pm on Thursday.

• Telephone access for routine appointments and queries is on Monday, Wednesday and Friday 8am to 12pm then 2pm to 6pm, Tuesday 8am to 11:30am then 2:30pm to 6pm and Thursday 8am to 1pm. Outside of these hours each weekday patients can telephone an alternative telephone number for urgent assistance.

• In line with local arrangements the practice closes at 1pm each Thursday. Patients can access assistance at this time and the out-of-hours service by telephoning the practice telephone number from where their call is transferred to the local out-of-hours provider.

The practice has opted out of providing out-of-hours services to their patients, these services are provided by Staffordshire Doctors Urgent Care.

Updated 2 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr McGowan and Partners on 15 June 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.
• The practice took the opportunities available to them to improve the range of services available to patients.
• Staff were experienced, engaged, confident and well trained for their role.
• Risks to patients were thoroughly 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 easy to make an appointment with a named GP and there was continuity of care, with urgent appointments 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 provider was aware of and complied with the requirements of the duty of candour.

We saw an outstanding feature of the practice:

The practice had taken action following patient and staff feedback about high patient demand for appointments. A GP provided daily cover as a ‘floor walker’ each morning. This was to directly support staff to flow patients to the most suitable appointment for their needs. Patients had the benefit of, when appropriate, being able to talk with the GP directly to discuss their issue. The practice was able to demonstrate that the GP was able to resolve around 75% of issues at the time of the call. Previously this would have resulted in an on the day appointment being taken. Commonly the GP was dealing with in excess of 20 patient contacts each morning as a floor walker.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 August 2016

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

• There was a team approach to reviewing the care needs of patients with long-term conditions.

• The practice had recruited a clinical pharmacist on a full time basis in 2014 with a primary focus on improving the outcomes for patients with long-term conditions including Chronic Obstructive Pulmonary Disease (COPD).

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and 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 August 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.

• 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.

• 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 and health visitors.

Updated 2 August 2016

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

• Demographically the practice had more patients aged over 65 years of age than other local practices. Data showed that 20% of patients were aged 65 and over, compared to the clinical commissioning group and national averages of 17%.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• The practice reviewed all unplanned admissions to hospital, although closely focused on those aged over 65. An advanced nurse practitioner assessed the circumstances for admission and when necessary contacted patients to establish if any additional support or intervention was required.

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

Updated 2 August 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.

• Appointments were available from 7:30am each morning and one evening each week.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 2 August 2016

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

• 92% of patients with dementia had a face to face review of their condition in the last 12 months. This was higher than the clinical commissioning group (CCG) average of 85% and national average of 84%. Clinical exception reporting was 3% compared to the CCG and national averages of 8%.

• 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.

• The practice had told 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.

Updated 2 August 2016

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 a learning disability.

• 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.

• 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.