Charlton Medical Centre

Updated 12 January 2018

Charlton Medical Centre is located in Telford, Shropshire and delivers regulated activities from Charlton Medical Centre only. It is part of the NHS Telford and Wrekin Clinical Commissioning Group.

The practice is registered with the Care Quality Commission (CQC) as a partnership provider and holds a General Medical Services (GMS) contract with NHS England and provides a number of enhanced services to include minor surgery. A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract.

The practice treats patients of all ages and provides a range of medical services. There are currently around 14,600 registered patients at the practice.

The practice local area is one of more deprivation when compared with the national average. The practice has 55% of patients with a long-standing health condition compared to the CCG average of 57% and the national average of 53%. The practice has a slightly higher percentage of patients who are children between the age of 0 and 4 years when compared to the CCG and national average. The practice also has a slightly higher percentage of older patients when compared to the CCG average.

The practice staffing comprises of:

• Four full-time partners (males).

• Four salaried GPs (3 females and one male).

• Four practice nurses and a health care assistant.

• One practice manager, one reception manager and one administration manager.

• Fifteen members of administrative staff working a range of hours.

Opening hours are 8.30am till 1.00pm and 2pm until 6.00pm Monday to Friday. The practice doors open at 8.20am ready for morning consultations and at 1.40pm ready for afternoon consultations. GP morning appointments run each day from 8.30am to 12.00pm and from 2.00pm and 5.00pm.

The practice has opted out of providing out of hours cover for their patients. The Shropshire Doctors’ Co-Operative Limited (SHROPDOC) provides the practice out of hour’s service.

Additional information about the practice is available on their website: www.charltonmedicalcentre.nhs.uk

Updated 12 January 2018

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. We previously inspected the service in July 2015 and rated the practice as Good overall with outstanding in providing a responsive service.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Charlton Medical Centre on 20 November 2017 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

• The practice had clear systems to keep patients safe and safeguarded from abuse.

• There were systems in place for identifying, assessing and mitigating risks to the health and safety of patients and staff.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

• The practice had purchased an ultrasound scanner to provide enhanced diagnostic facilities to their patients. The ultrasound scans were carried out by visiting sonographers employed by the local hospital trust.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

• Staff stated they felt respected, supported and valued.

• The practice listened and acted on issues raised by the patient participation group.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw areas of outstanding practice:

• The practice had equipment that tested the C-reactive protein (CRP) in a patient’s blood at the point of consultation. This was used when infection was clinically suspected. Measuring the CRP in a patient’s blood in this way helped to differentiate between viral infections and more serious bacterial infections needing antibiotic prescribing.

• The practice had purchased a digital dermoscope (acts as an aid in the diagnosis of skin lesions). Images were reviewed weekly at the clinical meetings and referrals made to secondary care where needed, leading to timely intervention.

• The practice provided an enhanced service with a view of facilitating pre-diagnosis and support to people with dementia. The practice held a licence for the use of a tablet device application used to test for memory problems independent of language or educational attainment allowing diagnosis of early dementia. Due to this, the practice has seen an increase in the number of patients on the practice’s dementia register from 61 to 92 over the last year.

The areas where the provider should make improvements are:

• The practice should complete a written risk assessment to assess the need to stock medicines for the treatment of seizures as part of their emergency stock.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 October 2015

The practice is rated as good for the care of people with long-term conditions. The practice had 8,354 patients registered 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. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

The practice took a proactive approach to long term conditions (LTCs), reaching maximum points for the last two years on the Quality and Outcomes Framework (QOF). The QOF clinical domain results for the practice (2013 to 2014) were all above the local CCG and national averages. (The QOF clinical domain indicator groups include long term conditions such as diabetes and high blood pressure). Practice statistics demonstrated a generally high prevalence of chronic diseases which they informed us was a result of proactive management and coding of chronic disease historically.

A practice nurse led in diabetes and supported patients through to insulin initiation programmes but without the nurse prescribing element and collaboratively worked with the GPs who then prescribed according to the National Institute for Health and Care Excellence guidelines and best practice, enhancing the care available to diabetic patients within the practice. Any bloods or investigations required were ordered in advance of the review clinics.

The practice had funded enhanced diagnostic services for their patients such as a heel scanner for diagnosis of osteoporosis, clinical photography, dermoscopy (acts as an aid in the diagnosis of skin lesions), sleep apnoea monitors (a sleep disorder characterized by pauses in breathing or instances of shallow or infrequent breathing during sleep). The practice had purchased an ultrasound scanner and this had improved diagnostic access for its patients. The practice together with the local hospital trust now staffed and managed this diagnostic facility from the practice for its patients and for other local practices.

Updated 22 October 2015

The practice is rated as good for the care of families, children and young people. The practice had 2,776 families, children and young people registered. 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 good examples of joint working with midwives, health visitors and school nurses. Staff demonstrated a good understanding and were proactive in safeguarding and protecting children from the risk of harm or abuse. The practice had a clear means of identifying in records those children (together with their parents and siblings) who were subject to a child protection plan and who were in looked after conditions. They had undertaken a review of children at risk and liaised effectively with other agencies and health and social care professionals in minimising risk for those children and ensuring updated records were always available.

Updated 22 October 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. The practice had 845 older patients registered at the practice. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The practice worked with staff at the local residential and nursing care homes where they had registered patients to ensure staff managed the ongoing care needs of these patients. We received positive feedback about the service provided by the practice from the three care homes.

Updated 22 October 2015

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice had 1, 828 patients of working age. 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 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 22 October 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice had 148 patients experiencing poor mental health. Of these patients 93% had a care plan in place and had received an annual physical health check. The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (April 2013 to March 2014) was 92.96% which was higher than the national average of 86.04%.

The practice provided an enhanced service with a view to facilitating timely diagnosis and support for people with dementia. The practice held a license for the use of a tablet device application used to test for memory problems independent of language or educational attainment allowing diagnosis of early dementia. This assisted the patients in providing early dementia diagnosis and in the implementation of care and treat accordingly.

The QOF clinical domain for dementia showed the practice had achieved 100%, all of the 26 points available, 5.1 percentage points above the CCG average and 6.6 above the national average The QOF clinical domain for mental health demonstrated that the practice had achieved 39.21 out of 40 points, which was 8.7 percentage points above the CCG average and 7.6 above the national average. The practice had 56 patients registered as living with dementia and at the time of the inspection 78.5% had an agreed care plan in place. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia. The practice monitored patients with poor mental health according to clinical quality indicators and in line with good practice guidelines.

The practice sign-posted patients experiencing poor mental health to various support groups, and voluntary organisations, and were proactive in helping patients address issues to improve all aspects of their health.

The practice had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for patients with mental health needs and dementia. Cognitive Behaviour Therapy (CBT) counsellors attended the practice each week in order that patients who attended for counselling could be seen in familiar surroundings. The practice visited a local care home that provided support especially for patients who were experiencing poor mental health (including people with dementia). The care home staff told us the GP and practice provided a service that more than met their expectations.

Updated 22 October 2015

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 had 288 patients whose circumstances may make them vulnerable. It had carried out annual health checks for people with a learning disability and all patients had received a follow-up. It offered longer appointments for people with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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.