Stapenhill Medical Centre

Updated 18 September 2017

Stapenhill Medical Centre is part of the NHS East Staffordshire Clinical Commissioning Group. The total practice patient population is 9,750. The age profile of patients is broadly in line with national averages. Stapenhill Medical Centre is located within easy reach of Burton on Trent town centre in Staffordshire and there is a rural branch surgery with a dispensary in the village of Rosliston providing services to 1,800 patients. The premises at both sites are purpose built buildings owned by the partners.

The staff team comprises of six GP partners (5 male, 1 female), one salaried GP (female) and two GP trainees (one male, one female). The GPs overall provide 53 clinical sessions per week, the GP trainees provide 15 combined sessions per week and the advanced nurse practitioner, who is also a prescriber, works six sessions per week. The provider has been an approved GP training practice since 2006.

The practice is open each weekday from 8am to 6pm and is open on a Saturday morning from 8am to 12.30pm. The branch practice is open from 8am to 12.30pm Monday to Friday. The practice has opted out of providing cover to patients outside of normal working hours. This service is provided by Staffordshire Doctors Urgent care.

There are 29 permanent staff in total, working a mixture of full and part time hours. Staff at the practice also includes: a practice manager, an assistant practice manager, an administrator and a patient services team leader, two practice nurses, two healthcare assistants and a dispenser, one medical secretary and eight 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 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. It also provides a number of Directed Enhanced Services, for example extended hours access is available.

Updated 18 September 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Stapenhill Medical Centre on 23 August 2016. The overall rating for the practice was requires improvement, with the safe and well led key questions being rated as requires improvement. The practice was rated as good for the key questions of effective, caring and responsive. We found two breaches of the legal requirements and as a result we issued requirement notices in relation to:

• Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Good Governance.
• Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Safe Care and Treatment.

The full comprehensive report from the inspection on the 23 August 2016 can be found by selecting the ‘all reports’ link for Stapenhill Medical Centre on our website at www.cqc.org.uk

We carried out an announced comprehensive inspection at Stapenhill Medical Centre on 14 August 2017. Overall the practice is now rated as Good.

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. Processes introduced since our last inspection demonstrated that learning was now shared and any resultant changes to systems and procedures implemented.
• 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.
• Risks to patients and staff were comprehensively assessed.
• Appropriate recruitment checks had been completed.
• Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Information about services and how to complain was available and easy to understand.
• 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.
• Patients said they found it easy to make an appointment with a named or preferred GP and urgent appointments were available the same day.

The areas where the practice should make improvements are:

• Consider extending the template used for recording receipt external alerts to include the nursing team.

• Improve the systems for monitoring uncollected prescriptions and for tracking the use of prescription pads and forms.
• Carry out a risk assessment to establish which medicines should be carried as routine when performing home visits.
• Explore how the high exception reporting for annual reviews of patients on the mental health register and patients with learning disabilities could be reduced.
• Formalise and document the support from GPs provided to the nurse prescribers.
• Review the system for recording verbal complaints to allow themes and trends to be identified.
• Explore how the practice could be proactive in capturing patient feedback.
• Consider further improvements to the governance framework to include regular internal meetings for the nursing team.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 September 2017

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.
• Patients with long-term conditions were included on the practice frailest 2% at risk register and had an admission avoidance care plan in place. The practice had systems in place to identify patients with chronic or life limiting conditions to alert the out-of-hours service and provide information to enable continuity of care.
• Patients on the at risk register were offered same day access.
• 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 18 September 2017

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.
• 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 meetings.
• The practice provided a contraception and sexual health service including chlamydia screening. One of the nursing team specialised in sexual health.
• 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 82%, which was comparable to the local CCG average of 83% and national average of 81%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 18 September 2017

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, the branch surgery was based in a rural area inhabited by a high number of elderly patients, blood sampling was provided to reduce the need for these patients to travel to the main surgery or hospital.
• The practice was responsive to the needs of older people, and offered home visits throughout the day and urgent appointments for those with enhanced needs.
• Elderly patients identified at higher risk of hospital admission were placed on an ‘at risk’ register and had an admission avoidance care plan in place, which highlighted their needs and wishes and was regularly reviewed. All admissions of patients on this register were discussed to see if their admissions were avoidable.
• Same day access was available to all patients on the at risk register.
• The practice held monthly meetings with their local community healthcare team.
• The GPs and advanced nurse practitioner provided home visits to care home patients and had completed additional training in order to complete advanced care planning for these patients.

Updated 18 September 2017

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. All patients requesting same day help were offered a telephone consultation, if no appointment was available, and following that, a face-to-face appointment if required.
• 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. Appointments and prescriptions could be booked online. A telephone language translation service was available for patients with limited English.
• The practice provided an extended hours service on a Saturday morning.
• Patients in the 40 to 74 age groups were offered NHS health checks through a locally commissioned service.

Updated 18 September 2017

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 80%, which was comparable with the local CCG average of 75% and national average of 76%.
• Clinical staff had received training in the Mental Capacity Act and used this when assessing patients. The practice carried out advance care planning with carers for patients with dementia.
• Performance for poor mental health indicators was higher than the national average. For example, 96% of eligible patients with severe poor mental health had a recent comprehensive care plan in place compared with the national average of 89%. However, although there was a patient recall system in place, 56% of patients had been excluded.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. One of the GPs was the appointed lead for patients on the dementia and mental health registers.
• 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 18 September 2017

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.
• The practice held a register of patients living in vulnerable circumstances including those with a learning disability. The practice included carers on their frail and vulnerable patients at risk register.
• The practice offered longer appointments for patients with a learning disability and those 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 palliative care register were reviewed at monthly multidisciplinary meetings held.
• Patients with learning disabilities were recorded on a register and there was a patient recall system that invited them to attend for an annual health check. However, only 16 out of 39 annual health checks had been completed in 2016/17.