Archived: The Practice Drayton Road

Updated 27 January 2017

The Practice Drayton Road is located in Longton, Stoke on Trent and is registered with the CQC as an organisation. The practice holds a Personal Medical Services (PMS) contract with NHS England. A PMS contract is a locally agreed alternative to the standard General Medical Services (GMS) contract used when services are agreed locally with a practice, which may include additional services beyond the standard contract.

The practice is located in a single storey building and is leased and managed by Chilvers and McCrea Limited (The Practice Group) who have 48 GP practices including four walk-in centres. The practice is situated within Longton Health Centre and has a private car park. The building is accessible and has facilities for patients with a physical disability.

The clinical team consists of one locum GP giving one whole time equivalent (WTE), an advanced nurse practitioner and one practice nurse (1.22 WTE) plus a health care assistant (0.43 WTE). The clinical team is supported by a practice manager, two administrators and two receptionists. Staff are supported by a team of regional and national staff including a regional nurse manager, a business manager, area lead GP and a Human Resources (HR) business partner. This is in addition to teams from other departments within the organisation to include clinical and information governance, legal and finance.

The practice serves a population of 3,268 patients comprising of 1,596 female patients and 1,668 male patients. The practice age distribution is broadly comparable to England averages with the exception of fewer patients aged 35-44 years and 74 years upwards but more patients under the age of 10 years. The practice population has lower levels of unemployment (2.4%) compared to the local average of 7.8% and the national average of 5.4%. The percentage of patients with a long-standing health condition is 57% which is the same as the CCG and higher than the England average of 54%.

The practice is open between 8am and 6.30pm Monday to Friday except Thursdays when it closes at 1pm. The practice offers extended hours on a Monday evening from 6.30pm to 8pm. If patients require an urgent appointment, they are asked to contact the practice from 8am. Patients can book routine appointments 12 weeks in advance in person, by telephone or on-line. Home visits are available to patients with complex needs or who are unable to attend the practice.

• GP appointments are available in the mornings from 8.30am to 11.30am and from 4pm to 6pm except Thursday afternoon when the practice closed at 1pm. Appointments with a practice nurse are available from 9am to 6pm on a Monday, Tuesday and a Wednesday. Appointments with an Advanced Nurse Practitioner (ANP) are available on Tuesday and Thursdays from 9am to 11.30am, Wednesdays from 10am to 11.30am and 3pm to 6pm and on Fridays from 3pm to 6pm. Telephone consultations are also available with the ANP on Wednesdays from 9am to 10am.

The practice does not provide an out-of-hours service to their patients. When the practice is closed patients are directed to the out-of-hours service, Staffordshire Doctors Urgent Care. The nearest hospital is the University Hospital of North Midlands.

Updated 27 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Practice Drayton Road on 28 September 2016. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. We saw the practice had acted on significant events. However, the practice had not shared outcomes with all staff or carried out an annual analysis of incidents or in depth to identify any common trends, maximise learning and help mitigate further errors.

• Most patients said they found it easy to make an appointment with urgent appointments available on the same day.

• Patients’ needs were assessed and care was planned and delivered in line with current evidence based guidance.

• Information about how to complain was available but not readily accessible. The practice responded quickly to issues raised.

• The practice had good facilities and was equipped to treat patients and meet their needs.

• There was a staffing structure in place and staff were aware of their own roles and responsibilities.

• An advanced nurse practitioner had been recruited to mitigate the challenges in recruiting a permanent GP and improve access of appointments. Data showed that some patient clinical outcomes were below local and national averages.

• The practice proactively sought feedback from staff and patients, which it acted on.

• The practice had a patient participation group and had implemented suggestions for improvements and had made changes to the way it delivered services as a consequence of feedback.

• Staff held quarterly meetings with healthcare professionals involved in the care of the patients.

• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Carry out a regular analysis of significant events to identify any common trends, maximise learning and help mitigate further errors.

• Implement an effective system that details the actions taken in response to alerts issued by external agencies, for example from the Medicines and Healthcare products Regulatory Agency (MHRA).

The provider should:

• Implement an effective programme of continuous a clinical audit.

• Ensure the practice complaints procedure is accessible to patients.

• Ensure all staff are made aware of the safeguarding lead and are made aware of the contact details for the local safeguarding teams for children and adults.

• Carry out an annual review of complaints to identify any common themes and trends.

• Consider expanding the practice emergency medicines to include anti-histamine medicine or carry out a risk assessment as to why this is not required.

• Explore lower the average satisfaction levels in the national GP patient survey and consider ways to improve people’s experiences of the service received.

• Ensure all staff are made aware of vulnerable patients on the computer system and the clinical code used to identify them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 January 2017

The practice is rated as requires improvement for the care of people with long-term conditions. The provider is rated as requires improvement for safe, effective and well led as well as overall. The provider is rated as good for caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• Clinics were available to address the needs of patients with long-term conditions such as asthma, diabetes and hypertension.

• Performance for diabetes related indicators were comparable to the Clinical Commissioning Group (CCG) and the national average.

• Longer appointments were available when needed.

• Patients were offered an annual review with the practice nurse or GP depending on their condition or preference to check their health and medicine needs were being met. They were provided with a self-management plan and referred to the community support services if required to deliver a multidisciplinary package of care.

• Systems were in place to monitor patients discharged from hospital and to review their medicine and their health needs.

Updated 27 January 2017

The practice is rated as requires improvement for the care of families, children and young people. The provider is rated as requires improvement for safe, effective and well led as well as overall. The provider is rated as good for caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 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 shared the building with other professionals including the health visitor and liaised with them on a weekly basis regarding concerns about children and their families.

• Young children had access to same day appointments using the protected emergency appointment system. Appointments were available outside of school hours.

• Immunisation rates were comparable to local averages for all standard childhood immunisations. Clinics were well attended. Any child that failed to attend their appointment was followed up with a telephone call by the practice nurse and a letter reminding them of the importance if immunisation. The health visitor was informed of persistent non-attenders.

• The practice’s uptake for the cervical screening programme was 81%, which was comparable to the CCG average 80% and the national averages of 82%. Their exception reporting rate was 5%, which was lower than the CCG and national averages of 6%.

Updated 27 January 2017

The practice is rated as requires improvement for the care of older people. The provider is rated as requires improvement for safe, effective, well led as well as overall. The provider is rated as good for caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice offered personalised care to meet the needs of the older people in its population.

• The practice provided annual flu, pneumonia, and shingles vaccinations.

• The practice made courtesy calls to patients aged 75 and over every eight to ten weeks to check on their health and welfare.

• The practice had a call and recall system to ensure older people attended their appointments when necessary.

• Same day appointments and home visits were available for older patients with enhanced needs.

• The practice worked in partnership with other healthcare professionals in meeting the needs of older people with complex needs.

Updated 27 January 2017

The practice is rated as requires improvement for the care of working age people (including those recently retired and students). The provider is rated as requires improvement for safe, effective and well led as well as overall. The provider is rated as good for caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The needs of the working age population, those recently retired and students had been identified. The practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. For example, the practice had changed the morning GP appointments to start at 8.30 am and offered extended hours on a Monday evening until 8pm to allow flexibility for patients. The practice had monitored the patients that made use of the extended hours service and identified 92% of users were of working age.

• A range of online services were available, including booking and cancelling appointments, prescriptions and access to health medical records.

• NHS Health checks were available for patients aged 40 to 74 in addition to new patient health checks and health promotion material.

Updated 27 January 2017

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). The provider is rated as requires improvement for safe, effective and well led as well as overall. The provider is rated as good for caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 46% of patients experiencing poor mental health had a comprehensive, agreed care plan in place compared with the Clinical Commissioning Group (CCG) average of 86% and the national average of 88%. The practice performance in this area had improved in 2015/16 was 84% and the clinical exception rate was 3%.
• 86% 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 85% and the national average of 84%.
• Patients experiencing poor mental health were told how to access various support groups and voluntary organisations.

• Longer appointments were available to allow sufficient time to deal with patients with complex issues.

Updated 27 January 2017

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. The provider is rated as requires improvement for safe, effective and well led as well as overall. The provider is rated as good for caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice worked with other health care professionals in the case management of vulnerable patients. They held a register of vulnerable patients so that they were clearly identified to staff on the practice computer system.

• 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 with the exception of one clinician.

• The practice held a carers’ register and information was available to direct carers to avenues of support available to them.

• The practice offered longer appointments for patients with a learning disability and those with complex needs. Care plans were in place and reviews had been scheduled for a number of people with a learning disability in a local care home.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.