Archived: The Grange Family Health Centre

Updated 19 March 2015

Holywell Medical Group has a patient population of approximately 24,000. The practice serves a mixed area, with some areas having a high level of unemployment and social deprivation.

There are five branches comprising; The Grange Family Health Centre, Stubbing Road, Chesterfield, Derbyshire S40 2HP; Rectory Road Medical Centre, Rectory Road, Staveley, Chesterfield, Derbyshire S43 3UZ; Holywell House, Holywell Street, Chesterfield, Derbyshire, S41 7SD; The Medical Centre, Station Road, Barrow Hill, Chesterfield, Derbyshire S43 2PG; and Inkersall Family Health Centre, Attlee Road, Inkersall, Chesterfield, Derbyshire S43 3HB.

The service is provided by five partner GPs and six salaried GPs. In addition there are three nurse practitioners, eight practice nurses, one assistant practitioner and seven healthcare assistants, plus a full team of administrative and reception staff. Local community health teams support the GPs in provision of maternity and health visiting services. The practice has a mixture of GPs of different genders; with seven female GPs and four male GPs. At the time of our inspection all of the nursing staff were female.

The practice has a General Medical Services (GMS) contract with NHS England. This is a contract for the practice to deliver primary care services to the local community or communities.

We previously inspected this GP practice on 17 September 2013 and 25 March 2014. At both inspections we identified concerns and areas of non-compliance with the regulations. Following the inspection on 17 September 2014 compliance actions were set in respect of respecting and involving people who use services; care and welfare of people using services; safety and suitability of premises, and assessing and monitoring the quality of service provision. Both reports can be viewed at www.cqc.org.uk/location/1-586376190/reports.

During this inspection we visited the branches at The Grange Family Health Centre and Rectory Road, Staveley.

The practice has opted out of the requirement to provide GP consultations when the practice is closed. The out-of-hours service is provided by Derbyshire Health United Out-of-Hours Service, which is accessible via the 111 telephone number.

Updated 19 March 2015

Letter from the Chief Inspector of General Practice

We inspected Holywell Medical Group on 14 October 2014. There are five branch surgeries that comprise Holywell Medical Group, however on this occasion we only visited two; The Grange Family Health Centre (the main practice) and Rectory Road Medical Centre. This was a comprehensive inspection.

Our overall rating for Holywell was that the practice is good.

We have set a compliance action related to the management of medicines which has made the rating for ‘safe’ as requires improvement. All other areas of the practice which we inspected are rated as good.

Our key findings were as follows:

• Patients at The practice were clinically assessed and care and treatment was provided in line with best practice. We found the care and treatment offered to patients to be compassionate and delivered to meet patient’s needs.
• The practice had taken steps to improve and address issues that had been highlighted in previous Care Quality Commission (CQC) inspection reports. However, we were not assured that all of the steps taken were robust and sustainable, as some systems relied on individuals rather than a practice based approach.
• Access to the service had improved, although some patients still reported difficulty making an appointment. There were plans to introduce a new telephone system to help address this problem.
• Our observations and comments received from patients suggested that staff treated patients with respect, kindness and compassion.

However, there were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Secure the small controlled drugs safe container at Rectory Road in line with the Royal Pharmaceutical Society guidelines and ensure that the number of controlled drugs on the premises tally with the record of receipt and disposal.
• Ensure clinical waste bags are stored in line with recognised guidance.

Additionally the provider should:

• Review the needs of working patients in respect of the practice’s opening times to ensure patients who work can access to the service at convenient times for them to avoid the risk of them not being seen when they need to be.

Identify what steps the practice would take in response to patient feedback from the patient participation group survey.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 March 2015

The practice is rated good for the population group of people with long-term conditions.

Patients with long-term conditions were kept under review, and there were systems for making referrals to other care agencies when required.

Where patients with long-term conditions were taking medication, the practice offered a regular medication review.

The practice website offered advice and information about a number of long-term conditions and how to live with them.

Data we saw indicated the practice performed as well or better to other practices locally and nationally in respect of how they monitored the health and wellbeing of patients with long term conditions.

Updated 19 March 2015

The practice is rated good for the population group of families, children and young people.

The practice worked closely with midwives and offered pre and post natal services to new mothers. The practice ran childhood vaccination and immunisation clinics and offered advice about contraception, including emergency contraception. Patients and staff we spoke with told us the needs of this patient group were catered for and met well.

The practice website offered advice and information to mothers and young children. This included sections on women’s health aged 18 to 39 years, children’s sleep and on teenage boys and girls aged 15 to 18 years.

Updated 19 March 2015

The practice is rated good for the population group of older people.

Every patient over the age of 75 had a named GP. All patients aged 75 and above had been sent a letter informing them who their lead GP was. The practice had considered what kind of information older patients may need and had this available in the waiting room and on the practice website. Older patients we spoke with told us their needs were being met.

The practice had signed up to an enhanced contract whereby each care home had a named GP and link nurse at the practice. The practice had identified 200 patients who were living in care homes, the majority being older people. By having a named GP and link nurse these patients received continuity of care.

The practice told us older patients were offered same day appointments or a home visit where applicable. If none were available, the patient’s call would be triaged by a GP. Two older patients we spoke with told us they had been offered a same day appointment.

Updated 19 March 2015

The practice is rated as requires improvement for working age people (including those recently retired and students.

The practice website indicated that the practice was open between 8am and 6pm. Several patients who worked during the day told us it was not easy to get an appointment without taking time off work to do so. Access to services remained an issue for patients wanting appointments outside the normal working day. The practice was aware of this and had a plan to improve telephone access. This had not been implemented at the time of our inspection.

Patients aged 40 and over were offered health checks. There was information available in the waiting area that would particularly relate to patients in this age group, for example about smoking cessation and weight loss. The practice website had information about getting fit and staying healthy particularly aimed at patients in this population group.

Updated 19 March 2015

The practice is rated good for the population group of people experiencing poor mental health.

The practice had a lead member of staff for mental health who told us that referrals for more complex situations were made to other specialist services such as Community Mental Health Teams (CMHT). The practice met with members of the CMHT at monthly meetings to discuss how people’s mental health and other needs could be understood and met. They were aware of the importance of identifying any possible safeguarding risks to individuals and within families.

The practice held a register of all patients at the practice who had a diagnosed mental health condition. Regular physical health checks were offered and there was recognition that people with mental health needs may have a higher risk of certain physical health conditions. There was a choice of three services for referral to Improving Access to Psychological Therapies (IAPT) services.

There were leaflets about memory issues and dementia available for patients in the waiting room.

Updated 19 March 2015

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

The practice had several patients registered who were considered to be vulnerable. This included people with a learning disability and homeless people sleeping rough in the town. Homeless people sleeping rough in Chesterfield who were seen at the practice were given the practice address to enable them to register.

We saw examples of where staff tried to accommodate the preferences of patients with a learning disability when they made appointments. The staff demonstrated their understanding of the Mental Capacity Act (2005) in that they correctly assumed that each patient had capacity unless there was evidence to indicate otherwise which would be assessed.