The Greenway Medical Practice

Updated 16 August 2016

• Drs Scrivings, Cameron, and Majid offers primary care medical services to 8077 patients under a Personal Medical Services (PMS) contract. The practice is known locally as The Greenway Medical Practice.
• Patients living in this area are ranked as sixth on the scale of one to ten for deprivation (more deprived areas tend to have greater need for health services). One per cent of patients are from a black, minority and ethnic background.
• The practice occupies a suite on the first floor in a modern purpose built heath centre opposite Cleckheaton bus station and close to local shops and services.
• It has six consulting rooms, two treatment rooms and a minor surgery suite. The building also houses community dental services, audiometry service, physiotherapy, district nursing, family planning, and other community health services. All childhood immunisations are provided by local community provider Locala.
• In addition to primary medical care, the practice have a weekly minor surgery service and host local alcohol and substance misuse nurses. The practice is the sole provider to a local school and nursing/care home for children, young people and adults with severe and complex physical and mental health needs.
• There are three GP partners (one male and two female), two salaried GPs (one male and one female), a male GP registrar, 2 female nurse practitioners, three female practice nurses (two of whom are independent prescribers), two female healthcare assistants, a female phlebotomist and a team of administrative staff.
• Greenway Medical Practice is a training practice. They are able to accommodate GP registrars on placement. There was a GP registrar on placement at the time of the inspection.

• The practice is open between 8am and 6.30pm Monday to Friday. Appointments are from 8am to 12.30pm every morning and 1.30pm to 6.30pm daily. The practice offers extended hours clinics on alternate Wednesdays and Thursday mornings from 7.30am and on Tuesdays and alternate Wednesdays evenings until 7.30pm.
• When the practice is closed out-of-hours services are provided by Local Care Direct, which can be accessed via the surgery telephone number or by calling the NHS 111 service.

Updated 16 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Scrivings, Cameron,and Majid on 31 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.
• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Practice specific protocols were developed in response to NICE 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.
• The practice operated a demand led system. All patients making an appointment were assessed by a clinician and seen in accordance with their need.
• Data showed that patient satisfaction feedback was better than local and national averages for the majority of questions. Patients said they found it easy to make an appointments, 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 management. The practice proactively sought feedback from staff and patients, which it acted on.
• 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.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Ensure there are systems and processes in place for notifiying clinical staff of Patient Safety Alerts.
• Ensure all fridges have two thermometers, one of which is a maximum/minimum thermometer independent of mains power.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 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. The healthcare assistants supported the nursing team to review and support patients with long term conditions.
• 71% of patients with diabetes, on the register, with a record of a foot examination and risk classification which was lower than the national average of 88%.
• 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.
• We saw practice specific protocols were developed in response to NICE guidance to carry out reviews of patients with long term conditions.
• GPs and practice nurses used e-consultations with the diabetic, respiratory and cardiology consultants at the local hospital to discuss and plan individual cases.
• The practice worked with and referred patients to the clinical care co-ordinator who supported patients at higher risk of hospital admission.
• A health trainer visited the practice once per week. They helped patients with both physical and mental conditions. The practice referred patients directly and encouraged self referral.

Updated 16 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.
• The practice’s uptake for the cervical screening programme was 86%, which was better than the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Sick children were prioritised and seen immediately if necessary. Appointment flexibility allowed children to be seen after school, or when parents were home from work.
• The practice actively promoted seasonal vaccines to the appropriate groups offering clinics outside school/work hours.
• All women were contacted in the immediate post-natal period. They were able to book six week checks for them and their baby.
• Staff promoted and referred to the recently launched local mental health helpline for young people.
• The practice offered contraceptive advice and chlamydia screening.
• Parents could access online services for their children up to the age of 11. Assessments were made for patients between the ages of 11 and 16 to determine whether they were able to access their own record.
• We noted from minutes of multidisciplinary meetings that there was good c ommunication between the practice and the midwives, health visitors and schools nurses.

Updated 16 August 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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified an on-going issue for patients over the age of 75 who were taking more than 10 medications. They used computer software commissioned by the CCG in order to assist them in the process of the managing these medications more effectively.
• Staff worked closely with community providers to co-ordinate care for elderly housebound patients with long-term conditions. For example, the district nurses and care co-ordinator.
• A lead clinician oversaw and implemented the avoidable unplanned admissions enhanced service. These patients had priority access to services.
• The practice actively promoted vaccine uptake in this group. Monthly clinics were offered for shingles and pneumococcal vaccinations. Data showed uptake rates were high. For example, 78% of people aged over 65 were vaccinated for flu which was better than the national average of 73%.

Updated 16 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.
• Extended hours slots were available several days during the week, ranging from 7.30am to 7.50pm, with doctors as well as nurses. Health care assistants offered appointments from 8.10am.
• The practice’s system allowed patients to consult by telephone at a time that suited them. Patients told us they could always speak with a clinician the same day.
• Saturday morning drop-in clinics were offered annually for those requiring seasonal flu vaccination.
• The practice used text messaging to send appointments, reminders and selected test results.
• 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 16 August 2016

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

• 78% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the preceding 12 months, which was below the national average of 84%. The practice were working with the local Dementia Action Alliance to improve services for patients with dementia.
• The practice developed their own practice guidance for staff and used regionally developed care-planning templates for patients with mental health.
• 100% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in the record, in the preceding 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.
• Several members of staff had received ‘Dementia Friends’ training. They were working towards becoming a dementia friendly practice.
• There was a system to ensure that patients with depression attended for their initial follow-up review.
• Staff recognized the need for early intervention and self care. They promoted and referred patients to local mental health and counselling services, including the recently launched local mental health helpline for young people.
• 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 16 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.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• They offered a range of shared-care addiction clinics within the practice, with specialist workers in drug, alcohol and benzodiazepine services visiting weekly.
• The practice registered and supported patients from a local male bail hostel.
• The practice were the sole provider of primary care services to a local school and care home for children and young adults with severe physical and mental health needs. They offered a weekly telephone clinic. They met regularly with clinical and managerial staff from the home.
• The practice had a register of carers and ensured they were offered seasonal vaccines. They offered carers’ health checks and support from al local carer support organisation, ‘Carers Count’.
• 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.