The Yoxall Practice

Updated 8 August 2017

Yoxall Health Centre is part of the NHS East Staffordshire Clinical Commissioning Group. The total practice patient population is 4,948. The age profile of patients shows a higher than average percentage of elderly patients, 28% are aged 65 and over compared to the national average of 17%. Yoxall Health Centre is a rural practice located close to Burton on Trent in Staffordshire. The premises is a purpose built building owned by the partners and a retired ex-partner.

The staff team comprises of two GP partners (one male, one female) and one salaried GP (female). The GPs work a combined total of 22 clinical sessions per week. The provider has a dispensary within the premises and employs a practice pharmacist.

The practice is open each weekday from 8am to 6pm. Extended hours are offered on a Monday evening between 6.30pm and 9pm. The practice has opted out of providing cover to patients outside of normal working hours. Staffordshire Doctors Urgent Care provides these out-of-hours services.

In addition to the partners there are 15 permanent staff in total, working a mixture of full and part times hours. Staff at the practice include:

• A practice manager, a deputy practice manager and a finance officer.

• An advanced nurse practitioner, a healthcare assistant and four dispensers.

• A medical secretary and four reception/administration support staff.

The practice provides long-term condition management including asthma and diabetes. It also offers child immunisations, minor surgery and travel vaccinations. The practice offers NHS health checks and smoking cessation advice and support. The practice has a General Medical Services (GMS) contract with NHS England. This is a contract for the practice to deliver General Medical Services to the local community or communities. They also provide a number of Directed Enhanced Services (DES) that include offering extended hours access, minor surgery and the childhood vaccinations and immunisation scheme.

Updated 8 August 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection of The Yoxall Practice on 5 September 2016. The overall rating for the practice was good with requires improvement for providing a safe service. The full comprehensive report on the 5 September 2016 inspection can be found by selecting the ‘all reports’ link for The Yoxall Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 6 July 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations identified at our previous inspection on 5 September 2016. This report covers our findings in relation to those requirements.

Our key findings were as follows:

• The provider had implemented an effective system to manage the safe care of patients on high risk medicines.
• Effective checking systems were in place to ensure that emergency procedures are tested and emergency equipment is maintained and fit for use.
• Clinical staff completed annual refresher courses in basic life support training and non-clinical staff were required to complete the same refresher course bi-annually.
• Actions identified as required in the infection prevention control audits had been completed or planned.
• Learning from significant events had been shared with appropriate staff, and following review, resultant action taken. There had been a significant increase in the number of events recorded.
• The provider had implemented an effective system to monitor the use of prescription pads and forms.
• The provider had risk assessed the process of taking repeat medication requests by telephone. Individual cases were reviewed where the cessation of this service may result in a detrimental impact on an individual’s care.
• Audits had been carried out to ensure nationally recognised clinical guidelines are followed.
• The practice had adopted a proactive approach in identifying patients who also act as carers. This included the appointment of a carers’ lead and liaison with the local secondary school to help identify young carers.
• Verbal complaints had been recorded to enable trends to be identified and the wider practice team were involved with reviewing complaints.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 October 2016

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

• GPs and 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 patients with a long term condition 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.
• The practice held a list of patients who required palliative care and their GP acted as the lead. The gold standards framework was used for the coordination of end of life care. The practice provided eligible patients with anticipatory medicines as indicated by their long-term condition or end of life needs.

Updated 28 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 when compared to local and national averages.
• The practice held regular clinical meetings where children at risk, child welfare concerns and safeguarding issues were discussed to ensure awareness and vigilance. The practice had a system in place to highlight patients of concern, as well as those who were considered at risk and these were discussed at clinical multi-disciplinary team meetings.
• The practice provided a contraception and sexual health service that included chlamydia screening.
• 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.
• The practice’s uptake for the cervical screening programme was 83%, which was the same as the local CCG average and above the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 28 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. For example, a designated GP carried out visits to a local nursing home every two weeks, and to a local care home every four weeks.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Elderly patients with complex needs or at greater risk of an admission to hospital had written care plans that were regularly reviewed.
• The practice held six weekly meetings with their local community healthcare team.

Updated 28 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 provided telephone consultations with a GP, a nurse or a healthcare assistant.
• 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. Appointments could be booked and repeat prescription requests made online.
• The practice provided an extended hours service on a Monday evening.
• The practice provided NHS health checks to those in the over 40 to 74 age groups.

Updated 28 October 2016

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

• Patients diagnosed with dementia who had received a face-to-face review in the preceding 12 months was 77%, which was lower than the local CCG average of 86% and national average, 84%.
• Clinical staff had received training in the Mental Capacity Act and used this when assessing appropriate patients. The practice carried out advance care planning with their carers for patients with dementia.
• The indicators of performance for patients experiencing poor mental health were higher than the national averages. For example, 100% of eligible patients with severe poor mental health had a recent comprehensive care plan in place compared with the national average of 88%. The exception rate was 44%, which was above the CCG average of 12% and national average of 13%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• 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.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

Updated 28 October 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• We found that the practice enabled all patients to access their GP services and assisted those with hearing and sight difficulties. A telephone language translation service was available for patients with limited English.
• The practice held a register of patients living in vulnerable circumstances including those with a learning disability. The practice’s frail and vulnerable patient register included carers.
• The practice provided care to three residential homes that housed vulnerable children and adults. Same day appointments were provided if needed and the provider liaised with the staff at the homes to ensure consultations were carried out where the patients felt secure and comfortable.
• The practice offered longer appointments for patients with a learning disability and with complex needs.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients and 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.
• All patients on the practice’s palliative care register were reviewed at a six weekly multidisciplinary meeting.