Hollinswood and Priorslee Medical Practice

Updated 7 August 2017

Hollinswood and Priorslee Medical Practice is registered with the Care Quality Commission (CQC) as a partnership provider in Telford, Shrophsire.

The practice has a General Medical Services contract with NHS England to provide medical services to approximately 6,100 patients. It provides Directed Enhanced Services, such as childhood vaccinations and immunisations and minor surgery. The practice area is one of average deprivation when compared with the national and local Clinical Commissioning Group (CCG) area. The practice population has a higher number of younger patients; 25% are under 18 years old (national average 21%) with only 10% being over the age of 65 years, where the national average is 17%.

The practice operates from three sites. The main site is The Surgery, with branch sites at Priorslee and Holliwell. The sites are as follows:

• The Surgery, Downemead, Hollinswood, Telford, TF3 2EW
• Priorslee Surgery , Glen Cottage, Priorslee, Telford, TF2 9NW
• Holliwell, Deercote, Hollinswood, Telford, TF3 2BH

We visited all three sites as part of this inspection. The Hollinswood and Holliwell sites are within walking distance of each other and Priorslee is approximately five minutes away by car.

The practice has two full time GPs (both male), one part time Advanced Nurse Practitioner and two practice nurses (working 20 hours per week each). They are supported by a practice manager, a deputy practice manager and administrative / reception staff. All three sites are open every day from 8.30am to 6pm except Wednesdays when the main practice closes at 3pm, and the Holliwell branch site closes at 1.30pm and Thursdays when the Priorslee branch site closes at 1pm. The practice offers extended hours between 6.30pm and 8pm on Tuesdays at the main site and on Wednesdays at the Priorslee branch site.

The practice does not provide an out-of-hours service to its own patients but has alternative arrangements for patients to be seen when the practice is closed through Shropshire Doctors Co-operative Limited (Shropdoc), a GP out-of-hours service provider.

We carried out an announced comprehensive inspection at Hollinswood and Priorslee Medical Practice on 4 February 2016. The overall rating for the practice was Good, with the Well Led domain being rated as Requires Improvement. We found one breach of a legal requirement and as a result we issued a requirement notice in relation to:

• Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Good Governance.

The full comprehensive report on the 6 February 2016 can be found by selecting the ‘all reports’ link for Hollinswood and Priorslee Medical Practice on our website at www.cqc.org.uk.

Updated 7 August 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Hollinswood and Priorslee Medical Practice on 4 February 2016. The overall rating for the practice was Good, with the Well Led key question being rated as Requires Improvement. We found one breach of a legal requirement and as a result we issued a requirement notice in relation to:

• Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Good Governance.

The full comprehensive report from the inspection on the 4 February 2016 can be found by selecting the ‘all reports’ link for Hollinswood and Priorslee Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection on 6 July 2017. Overall the practice is now 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 improvements had been made to the system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• 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 showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available.
• Patients commented that there were challenges around making appointments. Patients said they did not always know which site to attend for their appointment and were unaware of the availability of extended hours appointments two evenings a week.
• 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

However, there were areas of practice where the provider should make improvements.

The provider should:

• Formalise and record clinical supervision which takes place between the nurse practitioner and GP.
• Obtain a Disclosure and Barring Service (DBS) check pertaining to the current employment for the Advanced Nurse Practitioner.
• Consider obtaining portable oxygen cylinders or a means of transporting the current cylinders around the building.
• Ensure all staff are up to date with their required training.
• Ensure that staff have access up to date policies that have been reviewed.
• Review the GP survey results and identify action to improve patient satisfaction scores for consultations and interaction with the GPs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 August 2017

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

• The GPs had special interests in diabetes, cardiology and respiratory medicine.
• Performance for diabetes related indicators was similar or above the Clinical Commissioning Group (CCG) and national averages. For example, the percentage of patients on the diabetes register, in whom a specific blood test to get an overall picture of what a patients average blood sugar levels had been over a period of time was recorded as 88% compared with the CCG average of 75% and national average of 78%.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• There was a system to recall patients for a structured annual review to check their health and medicines needs were being met. The practice had a structured system for inviting patients for their review or identifying patients who did not attend.
• For those patients with the most complex needs, the GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 7 August 2017

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

• From the sample of documented examples we reviewed we found there were systems to identify and follow up children living in disadvantaged circumstances and who were at risk.
• Systems were in place to follow up children who did not attend out patients appointments.
• Immunisation rates were high for all standard childhood immunisations.
• Priority was given to children for same day or next day appointments.
• 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.

Updated 7 August 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.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

Updated 7 August 2017

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

• 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 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 between 6.30pm and 8pm on Tuesdays at the main site and on Wednesdays at the Priorslee branch site.
• The practice offered all patients aged 40 to 75 years old a health check with the nursing team.

Updated 7 August 2017

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

• The practice carried out advance care planning for patients living with dementia.
• 100% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was above the national average.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia. Patients were invited for an annual review of their physical health needs.
• The percentage of patients experiencing specific mental health conditions with an agreed care plan documented in the preceding 12 months was 94% compared to the local CCG average of 91% and national average of 89%.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The patients had access to a counsellor working from the premises, enabling ease of access.
• The practice proactively managed patients that presented to the emergency department with mental health conditions. When the practice received a notification from the emergency department, crisis team or mental health outreach team, the GPs followed up and reviewed the patient as appropriate.

Updated 7 August 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 a learning disability.
• The practice had identified 29 patients on the learning disability register, who were invited to attend for an annual review.
• 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 regularly 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.