Hill Top Surgery

Updated 16 November 2016

Hope Citadel Healthcare CIC is also known as Hill Top Surgery. It is located in a purpose built health centre in the Fitton Hill area of Oldham. It is a single storey building, fully accessible to the disabled or those with mobility difficulties, and there is a large car park at the practice.

The practice is part of an organisation, Hope Citadel Healthcare Community Interest Company. Five GPs work at the practice, four males and a female GP who attends one day a week from another practice within the organisation. A female GP had recently left to take on a new post and the practice was in the process of recruiting another permanent female GP. There are two practice nurses, two healthcare assistants, two counsellors and a focussed care practitioner. The focussed care practitioner is a nurse who looks at the holistic needs of patients, liaising with other services to ensure the best outcomes for patients. There is also a practice manager and reception and administrative staff.

The practice is open:

Monday 8am – 7pm

Tuesday 8am – 8pm

Wednesday 8am – 8pm

Thursday 8am – 7pm

Friday 8am – 6.30pm

Saturday 9am – 1pm.

The practice has an Alternative Provider Medical Services (APMS) contract with NHS England. It is a member of NHS Oldham clinical commissioning group (CCG). It was opened in 2009 with no patients and at the time of our inspection 3838 patients were registered.

There is a much higher than average proportion of patients in the 0-14 and 20-34 age range, and a much lower than average proportion of patients over the age of 65. There is a higher than average proportion of patients with a long term health condition (75% compared to the local average of 56% and the national average of 54%).

Life expectancy is lower than average. The average life expectancy for males is 73, compared to the CCG average of 76 and national average of 79, and the female life expectancy is 77, compared to the CCG average of 81 and the national average of 83. The practice is in an area of high deprivation.

The practice is a training practice.

The practice has opted out of providing out-of-hours services to their patients. This service is provided by a registered out of hours provider, Go-to-doc Ltd.

Updated 16 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hope Citadel Healthcare CIC on 23 September 2016. Overall the practice is rated as outstanding.

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. All opportunities for learning from internal and external incidents were maximised.

• Feedback from patients about their care was positive.

• The practice implemented suggestions for improvements as a consequence of feedback from patients and from the patient participation group (PPG).
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice held several community groups on their premises and was actively involved in running most of them.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• The practice encouraged their staff to develop and progress. For example reception staff had been trained to be team leaders and practice managers within the organisation and the healthcare assistant had recently been accepted into medical school.

We saw several areas of outstanding practice including:

• The practice was instrumental in setting up various social and community groups to suit the needs of their patient population. The importance of social interaction, and the high cost of joining social groups potentially making them unaffordable for patients had been recognised. The practice carried out evaluations of the groups and found patients found them very beneficial. Groups included:

  • BLISS (Believe Love Inspire Self-worth Support), for young isolated mothers, initiated by reception staff. An evaluation had been carried out and outcomes had been positive for patients attending. A counsellor from the practice attended the group once a month.

  • Mucky Monkeys; a group for young children and their parents, initiated by The Salvation Army and run by a members of the reception staff.

  • Inspire; a social group for older patients and the retired.

  • Hill Top Growers; a gardening group initially set up for diabetic patients but all patients could join in. This encouraged healthy eating and exercise.

  • Healthy Lifestyles; a group where weight could be monitored and patients could join in with group walks and exercise.

• The practice was closely involved in a community café, The Brew, based across the road from them. Patients living in social isolation were supported to attend the café, and where patients were looking to learn new skills or start work they arranged for them to have work experience in the café. This gave them experience, confidence, and the opportunity for a reference for when applying for jobs.

• The practice employed a focussed care practitioner. The focussed care practitioner looked after the holistic needs of patients who were referred by the GP. Needs were wide-ranging and included family issues, alcoholism, sexual exploitation and sleep problems. The focussed care practitioner saw patients on a regular basis when this was needed and put plans in place involving other organisations, such as the job centre or housing department, to ensure individual needs were met. There was regular evaluation of this service with evidence available of progression made by patients seeing the focussed care practitioner. We spoke with two patients who told us how seeing the focussed care practitioner had had a positive impact on their lives.

• The practice employed in-house counsellors so they were easily accessible to patients. Staff were also actively encouraged to use the counselling service if they felt it was required.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 November 2016

The practice is rated as outstanding 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 92%. This was above the CCG average of 82% and the national average of 89%.

• The practice held a gardening group (Hill Top Growers) that had been set up for patients with diabetes. This encouraged healthy eating and exercise, and all patients were now able to join in.

• All patients with long term conditions were invited for a review of their condition at least annually. Reviews were monitored and patients were telephoned if they did not attend.

• 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, there was a named GP who worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 16 November 2016

The practice is rated as outstanding 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. Additional safeguarding training had been provided and policies reviewed following the publication of the independent inquiry into child sexual exploitation in Rotherham.

• 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 above the CCG average of 82% and the national average of 82%. Text reminders were used to encourage patients to keep their appointments, and nurses telephoned patients who did not attend their appointment to encourage them to re-book.

• Appointments were available outside of school hours and the premises were suitable for children and babies. The practice had regard to the social needs of their patients. For example, eight week baby checks with the nurse and GP were coordinated to make it more relaxed for the mother and ensure the baby was only changed once to avoid extra expense of nappies.

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

Updated 16 November 2016

The practice is rated as outstanding 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.

• A GP visited a large local nursing home each week for a walk around to meet the needs of patients without visit requests becoming urgent.

• The practice had a high take up rate of flu vaccinations for the over 65 age group.

• The practice ran a weekly social club (Inspire) mainly for older or retired patients.

Updated 16 November 2016

The practice is rated as outstanding 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.

• The practice had social media accounts so information could easily be accessed by patients.

• The practice had extended opening four evenings a week and it was also open on Saturday mornings.

• The practice had recognised that some patients wishing to find work did not have relevant experience or references. The worked closely with a community café to arrange work experience for patients who would then have an employer to approach for a reference if required.

Updated 16 November 2016

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

• Performance for mental health related indicators was 97%. This was above the CCG average of 92% and the national average of 93%.

• 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.

• The practice employed an in-house counsellor who attended for two days each week.

• 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 dementia.

Updated 16 November 2016

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

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• 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 ran various social groups and these were beneficial to patients whose circumstances may make them vulnerable.