Wolstanton Medical Centre

Updated 7 July 2016

Wolstanton Medical Practice is registered with the Care Quality Commission (CQC) as a partnership provider in Newcastle, North Staffordshire. The practice holds a General Medical Services (GMS) contract with NHS England. 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 area is one of low deprivation when compared with the national and local Clinical Commissioning Group (CCG) area. At the time of our inspection the practice had 11216 patients, with a practice age distribution comparable to the national and CCG area in all age groups. The percentage of patients with a long-standing health condition is 48% which is comparable with the local CCG and national averages. The practice has been at its present site since 1967 and has access suitable for disabled patients. The practice is a training practice for GP registrars and medical students to gain experience, knowledge and higher qualifications in general practice and family medicine.

The practice staffing comprises of:

• Four GP partners (three male and one female) providing three whole time equivalent (WTE)

• Four female salaried GPs (1.6 WTE)

• A GP Registrar (one WTE)

• Two female advanced nurse practitioners ( 1.87 WTE)

• Four female practice nurses including a specialist complex needs nurse and a health care support worker (three WTE)

• A practice manager (one WTE)

• An assistant practice manager (one WTE)

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

The practice is open from 8am - 6pm Monday to Friday. Appointments can be booked up to seven days in advance and are by appointment only. GP appointments are from 8.30am to 10.30am and 11.15am to 12.30pm every morning and 3pm to 5pm or 4pm to 6pm daily. Practice nurse appointments are from 8.45am to 12.30pm and 2pm to 6pm. Extended surgery hours are offered every Saturday morning between 8am -11am. The practice has opted out of providing cover to patients in the out-of-hours period. During this time services are provided by Staffordshire Doctors Urgent Care. Patients are directed to this service by a message on the telephone answering machine and information on the practice’s website.

Updated 7 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wolstanton Medical Centre on 1 June 2016. Overall the practice is rated as outstanding.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• The practice used innovative and proactive methods to improve patient outcomes. They worked with other local providers to share best practice. For example, the cleansing of non-surgical wounds with tap water rather than sterile water. A report had been presented to the local Clinical Commissioning Group (CCG) highlighting the benefits to patients and the health economy to influence and change local practices.

• Feedback from patients about their care was consistently positive.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. For example, the practice provided a shared care maintenance programme for patients with opioid addiction.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, the practice had added three additional telephone lines to reduce the waiting time for the telephone to be answered.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result.

• The practice had a clear vision which had quality and compassion as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed.

• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw three areas of outstanding practice:

• The practice went beyond the scope of normal support and development of their staff. For example, three GPs had been supported to study for a Doctor of Philosophy (a doctorate degree awarded by universities) and an Advanced Nurse Practitioner (ANP) had been supported by the practice to take on leadership roles within and outside of the practice.

• Patients over 75 years old were provided with a questionnaire to identify any medical or social needs. Seven hundred and seventy-nine questionnaires had been sent out to patients of which 701 were returned. Of these, 221 patients had identified needs and were assessed by the complex needs nurse and appropriate care and referrals were made to support these patients.

• The practice was not only proactive in managing, monitoring and improving outcomes for its own patients but it shared its learning locally and nationally within primary care. It did this by contributing to reports to the CCG such as the benefits to the health economy through the use of tap water rather than sterile water in the cleansing of non-surgical wounds. They had also published their research in recognised medical journals, for example, the diagnosis of Addison’s disease (a rare, chronic disorder in which insufficient steroid hormones are produced).

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

• Ensure there is a system in place to record and monitor all prescription pads received into the practice.

• Ensure blank prescription forms are stored securely in locked rooms at all times.

• Ensure regular fire drills are carried out.

• Ensure that targeted services are in place to support carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 July 2016

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

• Performance for diabetes related indicators was comparable with the national average.For example, the percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was within normal limits was 82% compared with the Clinical Commissioning Group (CCG) average of 80% and national average of 81%. There was a practice exception reporting rate of 8% for patients with diabetes which was lower than the average CCG rate of 10% and the national average rate of 12% meaning a higher than average rate of patients had been included.

• 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 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 offered enhanced anticoagulation drug monitoring (drugs that prevent blood clotting) and made changes to medications where required.

• There were systems in place to monitor the prescribing and use of high risk drugs.

The practice was proactive in sharing local learning with the wider national primary care setting. For example, it had published research articles in national medical journals regarding the diagnosis of Addison’s disease (a rare, chronic disorder in which insufficient steroid hormones are produced) and the management of gout.

Updated 7 July 2016

The practice is rated as outstanding 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 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.

• The practice’s uptake for the cervical screening programme was 82% which was comparable with the national average of 82%. There was a robust practice policy in place supporting this service which helped to support their low exception reporting rate of 1.9% (CCG average of 5.3% and national average of 6.3%) meaning a higher than average rate of patients had been included.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives and health visitors.

• Children who were at risk were discussed at monthly disciplinary practice meetings.

The practice was proactive in sharing local learning with the wider national primary care setting. For example, it had published research articles in national medical journals regarding women’s health and the early diagnosis of cancer.

Updated 7 July 2016

The practice is rated as outstanding 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.

• All patients over the age of 75 years had a named GP.

Patients over 75 years old were provided with a questionnaire to identify any medical or social needs. Seven hundred and seventy-nine questionnaires had been sent out of which 701 were returned. Of these, 221 patients had identified needs and were assessed by the complex needs nurse and appropriate care and referrals were made to support these patients.

Updated 7 July 2016

The practice is rated as outstanding 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 was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

• Patients could request prescriptions on line or by using the Patient Access smartphone app.

• The practice offered extended practice hours every Saturday morning between 8am -11am. Telephone consultations were also available during the working day.

The practice offered NHS health checks for patients aged 40-74 years.

Updated 7 July 2016

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

• The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was 91% compared with the CCG and national averages of 84%.

• The percentage of patients with a diagnosed mental health condition who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months was 97% which was higher than the CCG average of 87% and the national average of 88%.

• 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 told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Patients with known drug misuse issues had a named GP. The practice provided a shared care opioid maintenance programme for patients with opioid addiction.

Updated 7 July 2016

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

• The practice had identified 43 patients with a learning disability and 31 of these patients had attended for an annual review to assess their needs and had been provided with a personalised care plan.

• The practice regularly worked with other health care professionals in the management of vulnerable patients.

• The 2% most vulnerable patients registered with the practice who attended the A&E department or were admitted to hospital, were contacted by the practice’s complex needs nurse to ensure a responsive discharge home. Their care and further needs were discussed at monthly unplanned admissions meetings held at the 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.

The practice could identify 115 patients as carers (1.02% of the practice list). Written information was available to direct carers to the various avenues of support available to them. Staff opportunistically supported carers but targeted services to support this vulnerable group of patients were not in place.