Archived: SSAFA Southglade Health Centre Also known as SSAFA Care CIC

Updated 8 August 2016

SSAFA Southglade Health Centre provides primary medical services to approximately 2,200 patients through an alternative provider medical services (APMS) contract. The practice is located in the Bestwood area of Nottingham, approximately four miles from the city centre. It is run by SSAFA Care Community Interest Company which is part of the SSAFA charity, providers of health and social care to the armed forces and their families.

The premises were newly built in 2012 when the practice was formed, and they are shared with other local community health services including a pharmacy. They are located within Southglade Park alongside council owned services such as the leisure centre, community access centre and Sure Start Children’s Centre.

The level of deprivation within the practice population is above the national average. The practice is in the first most deprived decile meaning that it has a higher proportion of people living there who are classed as deprived than most areas. Data shows number of younger people aged below 40 years registered at the practice is significantly higher than the national average, and the proportion of 40 to 85+ year olds is significantly lower than national averages.

The practice team comprises of three GPs; (two females and one male) employed as long term locum doctors, a practice nurse, a health care assistant, a group practice manager, a practice administrator, the administrative/reception team, a premises officer and a cleaner.

The practice is open between 8am and 6.30pm Monday to Friday. Appointment times start at 8am and the latest appointment offered at 6pm daily. The practice does not provide the extended hours service.

When the surgery is closed, patients are advised to dial NHS 111 and they will be put through to the out of hours service which is provided by Nottingham Emergency Medical Services.

Updated 8 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at SSAFA Southglade Health Centre on 24 May 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 and near misses, and we saw evidence that learning was applied.

• The practice usedproactive methods to improve patient outcomes, working with other local providers to share best practice. For example, education courses were offered to patients with long term conditions such as diabetes and working with the local diabetes specialist nurse to improve the wellbeing of patients.

• Feedback from patients about their care was consistently positive. Data from the GP survey was consistently high and this included confidence in care provided by GPs, where 94% of patients surveyed said they had confidence and trust in the last GP they saw or spoke to.

• The practice planned and co-ordinated patient care with the wider multi-disciplinary team to plan and deliver effective and responsive care to keep vulnerable patients safe.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients. There were regular patient surveys undertaken, and patients were currently invited to form a patient participation group as another means of engaging patients.
• The practice actively reviewed complaints to see if there were any recurrent themes, and identified issues where learning could be applied to improve patient experiences in the future.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

• The practice had strong and visible clinical and managerial leadership and governance arrangements, and staff told us that they were well-supported and felt valued by the management.

However, the areas where the provider should make improvements are:

• Ensure safe patient care by identifying risk and doing all that is possible to mitigate this bydeveloping a system for the management of MHRA alerts in the practice so there is clear log of receipt and actions taken.

• Encourage the identification and recording of patients who are carers and offer them appropriate health and wellbeing support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 August 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. They worked collaboratively with a community specialist diabetes nurse on their more complex patients with a diabetes diagnosis to improve outcomes for the patients.

• The practice achieved 95% on QOF in 2014/15. This was in line with the CCG average of 92% and the national average of 95%. The practice told us they their QOF performance had improved to 97% for 2015/16 but this data was not yet verified and published, The practice staff  attributed their success to their recall system for people with long term conditions. A structured annual review was carried out 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.

• There were a large number of leaflets providing education and self-care advice and patients were directed to online resources. The practice actively encouraged patient education sessions for patients with conditions such as diabetes, such as a type 2 diabetes insulin course. There were self-management plans for patients with asthma. A specialist diabetes nurse visited the practice quarterly to review complex patients and provide support to the clinicians.

• The practice promoted self-referral to services such as podiatry, physiotherapy and psychological therapies, whose clinics were offered in the practice premises.

• QOF achievement on indicators for diabetes was consistently above CCG averages. For example, the percentage of patients with diabetes, on the register who had their blood pressure taken within the preceding 12 months was 82%, compared to a CCG average of 74% and national average of 78%.

• QOF achievement on indicators for atrial fibrillation and chronic obstructive pulmonary disease were broadly in line with national averages. The practice achieved 100% on atrial fibrillation, compared to a national average of 99%.

• Longer appointments and home visits were available and offered when needed.

Updated 8 August 2016

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

• The practice worked closely with midwives, health visitors and family nurses attached to the practice. 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 Accident and Emergency (A&E) attendances.

• The practice held meetings every six weeks with the health visitor, and also reviewed any children on a child protection plan at their clinical meetings.

• Immunisation rates were above the CCG averages for standard childhood immunisations. Vaccination rates for five year olds ranged from 94% to 98%, compared to the CCG average of 87% to 95%. The practice attributed their success to good customer care provided to patients; they built rapport so that patients were happy to comply with appointments and notify the practice in advance if they were unable to attend.

• Appointments were available outside of school hours with urgent appointments available on the day for children and babies.

• Joint appointments with the GP and practice nurse were offered for the eight week post-natal check. This allowed mothers and babies to have their post-natal check, baby check and first immunisation done in one visit.

• The practice offered a full range of family planning services including fitting of intra-uterine devices (coil) and contraceptive implant fitting.

• The premises were suitable for children and babies. Baby changing facilities were available and the practice accommodated mothers who wished to breastfeed.

Updated 8 August 2016

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

• The practice had a significantly lower elderly population with approximately 5% aged over 65 years, compared to a national average of 17%. They offered proactive, personalised care to meet the needs of the older people in their population.

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

• Feedback from a care home where all residents are registered with the practice indicated that a named GP carried out review visits and responded to urgent requests when needed to ensure continuity of care. They told us the GPs worked effectively with multi-disciplinary teams including district nurses, dieticians and local mental health teams to ensure patient needs were met and referrals to other services were made promptly.

• There was evidence of close partnership working with the pharmacy in arranging flu vaccinations for residents in a care home. Communication relating to prescriptions for residents was seamless between the care home, practice and pharmacy with a clear audit process in place. Practice supplied data which showed 539 patients were eligible for flu vaccinations in 2015-2016 and 402 were given vaccinations. This represents approximately 75% of eligible patients.

Updated 8 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. This included access to telephone appointments, and the availability of early morning appointments from 8am on weekday mornings.

• Appointments with the health care assistant were available from 8am.

• The practice was proactive in offering online services such as online prescription requests, appointments, and accessing medical records to view test results.

• There was a full range of health promotion and screening information in the practice that reflects the needs for this age group. Self-referral was encouraged for accessing psychological services, podiatry and physiotherapy.

• The practice’s uptake for cervical screening for eligible patients was 93%, which was significantly higher than the CCG average of 82% and the national average of 82%. They attributed their success to their reception staff’s active recall and follow up system.

• Breast and bowel cancer screening data was broadly in line with CCG and national averages. For example, the proportion of patients who were screened for bowel cancer within six months of invitation was 50%, compared with a CCG average of 50% and a national average of 55%.

Updated 8 August 2016

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

• Practice supplied data which showed that in 2015 - 2016, 87% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months.

• 83% of patients diagnosed with mental health conditions had their care reviewed in a face to face meeting in the last 12 months.

• 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, for example Wellness in Mind, Talking Therapies and Alzheimer’s Society.

• 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.

• There were counselling clinics by Let’s Talk Wellbeing on Wednesdays and Thursdays held at the practice.

Updated 8 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 homeless people, travellers and 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. For example, the practice coordinated with the respiratory team and district nursing team for a housebound patient recently registered with the practice . This ensured the patient had the appropriate support and continuity of care following their change of registered practice.

• 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.

• Staff told us they were aware of how to access interpreting and text talk services for their patients with hearing impairment and an interpreter could be arranged for those who could not speak in English through Language Line translation service.

• The practice’s computer system alerted GPs if a patient was also a carer. However, the practice had only identified 3 patients as carers (0.13% of the practice list).