Clifton House Medical Centre

Updated 5 September 2016

Clifton House Medical Centre is led by a team of four GP partners, including two male GPs and two female GPs. Two practice nurses, a treatment room nurse, a healthcare assistant and a phlebotomist are available daily. This is a teaching practice and supports medical students up to the third year of their qualification. The practice employs locum doctors occasionally to improve capacity. A practice manager, human resources manager, finance manager and assistant practice manager are in post and are supported by a number of teams, including a data quality team, prescription team and receptionists.

The practice has baby changing facilities and promotes a positive environment for breast feeding. Accessible toilets are available and patient wifi access is available in the waiting areas. Patients can check-in using a self-service kiosk, which provides guidance in multiple languages or at the manned reception desk. Clinical rooms are located on two floors and the self-service kiosk directs patients to one of two waiting areas.

A private room is available adjacent to the reception desk, which patients can use to request a confidential discussion with staff.

The practice serves a patient list of 9272 people, including 104 patients who are registered carers and is in an area of high levels of deprivation.

Appointments are from 8am to 6.30pm Monday to Friday.

Sixty six per cent of patients are of working age, compared to the England average of 67%. The practice has a higher number of patients with a long-standing health condition (66%) compared with a national average (54%).

We had not previously carried out an inspection at this practice.

Updated 5 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Clifton House Medical Centre on 25 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. 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.
• Patients said there was continuity of care although problems in making appointments was the main area of concern or complaint.
• 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.
• There was a coherent and robust focus on training and development opportunities for staff, led by a dedicated human resources manager.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw areas of outstanding practice:

• All patients newly diagnosed with diabetes were referred to an ‘expert diabetic clinic’. This service provided patients with individualised support and advice on diet and lifestyle and accompanied each patient on a supermarket trip to help them identify healthy food choices.
• The practice ensured new patients whose first language was not English had an interpreter with them during their first appointment.
• The practice provided an interpreter to parents whose children had received vaccinations outside of the UK. This helped to make sure children did not receive the same vaccine more than once.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 September 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.
• Longer appointments and home visits were available when needed, such as for those with multiple health problems or reduced mobility.
• Each patient was invited to an annual review to make sure the practice was meeting their needs.
• 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.
• A multidisciplinary team of specialists met weekly to coordinate the care and treatment of patients with chronic or terminal conditions.
• The practice followed the Gold Standards Framework to provide individualised care for patients who received palliative care. Bi-monthly meetings attended by a multidisciplinary team assessed the needs of each patient.

Updated 5 September 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.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice proactively offered cervical screening and followed up each patient to ensure they received appropriate follow up care.
• Dedicated information was provided for young people, including signposting to sexual health, domestic violence and drug and alcohol services. The practice offered chlamydia screening to young people and referrals to a nearby sexual health centre.

Updated 5 September 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. This included nurse visits to care homes during flu season to administer flu vaccinations and health checks and a preventative shingles vaccination.
• Patients were offered an annual medication review to ensure their regular prescriptions were appropriate and treatment needs were met.
• Staff monitored patients who were carers for older people and offered them support and care through annual health checks.

Updated 5 September 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 sexual health services and access to drug and alcohol liaison teams.
• 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.
• A dedicated GP was available for implant insertion and removal.
• Access to information was available through the practice website as well as two social media platforms. Prescriptions and appointments could be arranged online.

Updated 5 September 2016

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

• 86% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was better than the national average of 84%.
• 90% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the preceding 12 months. This was better than the national average of 88%.
• 95% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had their alcohol consumption recorded in the preceding 12 months. This was better than the national average of 90%.
• 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.
• 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 5 September 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 and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability, mental health needs or complex co-morbidities.
• The practice regularly worked with other health care professionals, including a crisis team and vulnerable adults team, in the case management of vulnerable patients.
• 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 had undertaken training in how to recognise and respond to cases of suspected modern-day slavery and female genital mutilation.
• Clinical staff always saw patients whose circumstances meant they were unlikely to keep to scheduled appointments, such as patients with alcohol or drug addiction.
• A link worker was in place for carers, who offered rapid one-to-one access to appointments through a dedicated phone line.