Higherland Surgery

Updated 9 March 2017

Higherland Surgery is registered with the Care Quality Commission (CQC) as a partnership provider in Newcastle Under Lyme, Staffordshire. At the time of our inspection, the practice had 4,191 patients. The practice has a slightly higher percentage of older people than the national average for example, 22% patients are over 65 years old (17% nationally) and 4% patients are over 85 years (2.3% nationally). These statistics could mean an increased demand for GP services. The practice provides GP services to two care homes with 28 patients registered at the practice and routinely visits these homes every Tuesday morning. The practice provides GP services to a local travelling community of around 31 patients.

The practice is open between 8am and 6pm Monday to Friday with the exception of Thursday when the practice is open from 8am to 1pm. On Thursday afternoons the practice hold training sessions and meetings for staff and medical students. The practice offers extended hours on a Monday from 6pm to 8pm. As members of North Staffordshire Federation, patients have access to a Hub that provides appointments every Saturday from 9am to 4pm (with plans to extend the hours to include Sundays and evenings). The practice does not routinely provide an out-of-hours service to their own patients but patients are directed to NHS 111, the out of hours service when the practice is closed. Patients can book appointments in advance through the practice on-line appointment system.

The practice staff work a variety of full and part time hours, staffing comprises of:

• Three GP Partners (two female and one male) providing 1.80 whole time equivalent hours (WTE).

• One GP Registrar providing one WTE hours.

• One Practice Nurse providing 0.6 WTE hours.

• Two healthcare assistants providing 1.24 WTE hours.

• One practice manager, an assistant practice manager and an office manager, providing 1.43 WTE managerial hours.

• Three senior receptionists and three receptionists providing 6.05 WTE hours.

• A cleaner providing 10 hours per week.

The practice holds 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. They also provide some Directed Enhanced Services, for example, they identify patients who are at high risk of avoidable unplanned admissions. The practice provides a number of services, for example long-term condition management including asthma, diabetes and high blood pressure. The practice offers NHS health checks and smoking cessation advice and support.

Updated 9 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Higherland Surgery on 19 January 2017. 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.
• 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.
• Practice staff reviewed the needs of its local population to secure improvements to services where these were identified.
• 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 GP and there was continuity of care, with urgent appointments available the same day.
• The practice offered extended opening hours between 6pm and 8pm on a Monday. As members of North Staffordshire Federation, patients had access to a local Hub service that provided appointments every Saturday from 9am to 4pm (with plans to extend the hours to include Sundays and evenings).
• The practice provided an ‘endoscope-i’ service. This provided a mobile image enabling a video or still photograph, for example of the ear, which the GP used to discuss any identified concerns or need for referral with the secondary care specialists in Ear Nose and Throat. On occasion reducing the need for patients to attend hospital.
• 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 the 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 March 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 rates for all of the diabetes related indicators were comparable to local and national averages. For example, 83% of patients with diabetes had received a recent blood test to indicate their longer-term diabetic control was below the highest accepted level, compared with the CCG and national average of 78%.

• The percentage of patients with chronic obstructive pulmonary disease (COPD) who had had a review in the preceding 12 months was 94%; this was higher than the CCG average of 92%, and national average of 90%. The practice exception reporting rate was 4%. This was lower than the CCG average of 12% and the national average of 11.5% meaning more patients had been included.

• Longer appointments and home visits were available when needed.

• All these patients had 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.

Updated 9 March 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.

• The practice’s uptake for the cervical screening programme was 83%, which was slightly higher than the CCG average of 82% and national average of 81%.

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

• The practice had an effective system in place to follow up children who failed to attend for their immunisations.

• A community midwife attended the practice on a weekly basis.

• The practice offered a family planning service, contraceptive and a sexual health service, this included contraceptive implants and coils.

• One of the GPs at the practice had a speciality in Genito-Urinary Medicine and the practice provided chlamydia screening and ‘C card’ scheme facilities. (C-Card schemes are an effective way to help young adults take responsibility for their sexual health; providing them with easy access to free contraception, education about sexual health and wellbeing, and are an opportunity to signpost to related services).

Updated 9 March 2017

The practice is rated as good for the care of older people.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice provided a named accountable GP for patients aged over 75 years with urgent appointments available the same day.

• Patients had access to telephone appointments with the GP if requested.

• Care plans were in place and agreed for those patients identified as being at high risk of admission / re-admission.

• Home visits were available for older patients and patients who had clinical needs, which resulted in difficulty attending the practice.

• The practice provided a routine weekly ward round to their patients in two local care homes.

Updated 9 March 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, 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.

• The practice offered extended opening hours between 6pm and 8pm on a Monday and as members of North Staffordshire Federation, patients had access to a local Hub service that provided appointments every Saturday from 9am to 4pm (with plans to extend the hours to include Sundays and evenings).

• Access to telephone consultations with the GP.

• Appointments could be pre booked online as well as book on the day appointments. An Electronic Prescribing Service was available to patients.

Updated 9 March 2017

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

• Performance for mental health related indicators showed for example, the percentage of patients with a diagnosed mental health condition who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months was 91%. This was higher than the CCG average (89%) and national average 90%. The practice exception reporting rate was 17.5%. This was higher than the CCG average of 10% and the national average of 13% meaning fewer patients had been included.

• 81% of patients diagnosed with dementia had had their care reviewed in a face-to-face meeting in the last 12 months, which was slightly lower than the CCG average of 87% and the national average of84%.

• 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.

Updated 9 March 2017

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 carers and those with a learning disability. The practice provided carer support, sign posting, information packs and completed a carer’s register.

• 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.

• The practice provided GP services to a local travelling community of around 31 patients.

• 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.