The Health Care Surgery

Updated 3 October 2017

The Health Care Surgery is situated in a purpose built building in North Sheffield. Car parking and disabled access is provided. The practice provides General Medical Services (GMS) for 4,858 patients in the NHS Sheffield Clinical Commissioning Group (CCG) area. Enhanced services are provided and included those for patients living with dementia and a learning disability. The practice catchment area is classed as within the group of the first most deprived areas in England. The age profile of the practice population is similar to other GP practices in the Sheffield Clinical Commissioning Group (CCG) area with a slightly higher population of patients who are under 14 years of age.

There are four female GP partners, one female male salaried GP, three practice nurses and a health care assistant. They are supported by a practice manager and an administration team.

The practice is open 8.15am to 12:30pm and 1.30pm to 6pm each day except for Thursdays when they are open until 12 noon. Phone lines are closed between 12:30pm and 1:30pm for the lunch hour. The surgery runs a drop-in service for all weekday morning appointments. Patients are asked to present to the surgery desk before 9.30am to register their name. If the clinic is very busy and running over normal capacity, the practice runs an additional acute service. For example, anyone booking in once capacity is reached may be asked to return to the surgery later the same day, after a specific time, and will be seen by the first available GP. The surgery runs an appointment system every weekday afternoon except Thursdays.

Appointments between 3pm and 5.30pm are bookable from 8:30am the same day. These can be made over the front desk or via the telephone. The surgery is open on Saturdays from 8.30am until 10.30 am for pre-booked appointments only. These appointments are only for patients in full-time employment who are unable to attend weekday surgeries.

The practice is also open 8am-10pm Mon-Fri and 10-6 Sat-Sun as part of the NHS Sheffield Clinical Commissioning Group (CCG) Extended Access Scheme. The extended hours scheme consists of GP and practice nurse appointments which are accessed by the practice patient population and those patients registered at surrounding practices. Patients are directed to use at the GP collaborative service or the NHS 111 service when practice is closed.

The practice participates in the training of doctors who wish to make their careers in general practice. They are also involved in training medical and nursing students.

Updated 3 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Health Care Surgery on 10 August 2016. The overall rating for the practice was good with requires improvement for the ‘safe’ domain. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for The Health Care Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 4 September 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulation that we identified in our previous inspection on 10 August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• We saw evidence that recruitment checks such as DBS where required for the role, and references were being obtained prior to employment.
• We saw records which identified the immunisation status of all staff members.
• The practice had reviewed their governance systems and provided evidence that action had been taken in response to medical alerts.

• The practice had reviewed their governance systems and provided a matrix of evidence that staff training had been completed.
• The procedures to implement improvements identified in the infection prevention and control audit had been reviewed and updated.
• NHS protect guidance and governance arrangements had been implemented relating to the storage for blank prescription forms.
• A risk assessment for the provision regarding the availability of paediatric pads for the defibrillator had been carried out.
• Resuscitation Council guidance (2015) and arrangements for checking the working condition of emergency equipment were in place.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 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.

• The practice had achieved 100% in all areas related to the care and treatment of patients with long term conditions and its results were higher than CCG and national averages. For example; performance for diabetes related indicators was 100% which was 10% higher than the CCG and the national averages.

• 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 ensured patients were monitored according to their clinical need by completing a monthly report to review if patients with long term conditions or prescribed high risk medicines had received appropriate investigations and reviews.

Updated 21 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. 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 87%, which was comparable to the CCG average of 89% and national average of 81%.

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

• The practice supported young mothers by linking with local organisations and assisting those in need with essential equipment.

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

Updated 21 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.

• The practice had implemented monthly reviews of all patients over 75yrs who had not been seen for over six months.

Updated 21 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.

• The practice offered walk-in clinics every morning Monday to Friday. The surgery was open on Saturdays from 8.30am until10.30 am for patients in full-time employment who were unable to attend weekday surgeries.

• 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 21 September 2016

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

• 88% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the CCG average of 87%.

• Performance for mental health related indicators was 100% which was 6% higher than the CCG average and 7% higher than the national average.

• 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 living 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 those living with dementia.

Updated 21 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 those with a learning disability.

• The practice offered flexible appointments available at quieter times of day 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.

• 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 reviewed all patient deaths and where the deceased patient had been a carer they ensured the cared for were supported appropriately and staff maintained contact until they were assured the person had all the support they needed.