Upwell Street Surgery

Updated 23 January 2017

Upwell Street Surgery is situated in a deprived area of North Sheffield. The practice provides services for 4,913 patients under the terms of the NHS Personal Medical Services contract. 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 includes a higher proportion of elderly patients in nursing homes than other GP practices in the Sheffield Clinical Commissioning Group (CCG) area; a high number of children (1 one in 3 three) and a transient population with a high turnover of patients (10% each year).

The practice has three GP partners; (two female and one male), three salaried GPs; (all female) and three GP registrars; (2 female and one male), one nurse practitioner, one practice nurse and one healthcare assistant. They are supported by a team of practice management staff and an administration team. The practice is open between 8.40am and 6pm on Monday, Tuesday, Wednesday and Friday and closed on Thursday afternoons. Extended hours are offered on Saturday mornings and evenings through the Hub. Appointments with staff are available at various times throughout the day. Patients requesting same day appointments are triaged over the telephone  and offered a face to face appointment if required. When the practice is closed calls were answered by theout-of-hours service which is accessed via the surgery telephone number or by calling the NHS 111 service.

Updated 23 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Upwell Street s Surgery on 7 December 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 they found it easy to make an appointment with a named GP and there was continuity of care, 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 provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Emergency oxygen should be available on the premises as recommended in Resuscitation Council (UK) guidelines .
• The practice should keep a log of fire drills and all staff should have up to date fire training.
• Administrative staff should hold regular, minuted team briefings.
• The practice had a number of policies and procedures to govern activity although some of these needed a review.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 January 2017

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.
• Performance for diabetes related indicators was above the CCG and national average. For example, the percentage of patient with diabetes, on the register, in whom the last blood test was within normal limits was 85%, CCG average 78% and national average 78%
• 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 had developed an understanding of cultural needs across the practice population.  For example they had developed a Ramadam protocol for patients with diabetes to support them with their diet during this religious period .

Updated 23 January 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.
• 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 comparable to the CCG average of 89% and the national average of 81%.
• 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, health visitors and there was frequent liaison with local schools to ensure that children with increased needs were receiving educational support. 

Updated 23 January 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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice carried out regular medication reviews to avoid polypharmacy (the concurrent use of multiple medications).
• The practice had developed an innovative Frailty Protocol to improve care for patients who were frail due to medical conditions. The protocol included detailed care plans and medication reviews.
• The practice had liaised with the Alzheimers Society to enable patients living with dementia in the community and their carers to receive additional support and signposting.
• The practice employed two salaried GPs to provide daily visits and weekly ward rounds to local nursing homes. All nursing home patients had detailed annual care plans and end of life care plans. The practice had low hospital admission rates, or hospital deaths of nursing home patients in their care.

Updated 23 January 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 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 23 January 2017

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

• 90% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the CCG average of 86% and the national average of 84%.
• Performance for mental health related indicators was similar to the CCG and the national average. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 94%, CCG average 90% and national average 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living 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 and liaised closely with the Alzheimers Society.
• 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 23 January 2017

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

• The practice had a high number (24%) of Roma Slovak patients and provided a range of services for these families living in poverty with complex health and social needs. This included;weekly booked surgeries with interpreters, dedicated new patient checks and 'on' day and ‘walk in’ appointments for those patients without skills to book appointments and Hepatitis B screening. The practice had a h igh awareness of safeguarding issues in this group of patients.
• 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.
• 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 had developed an awareness of Female Genital Mutilation (FGM) issues locally and offered referral for surgery and psychosexual counselling.