Shipley Medical Centre Also known as Affinity Care

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Overall, we found that the practice provided effective care and treatment. At the last inspection of the service in December 2022 the provider was rated requires improvement for effective care and treatment. Issues identified included low uptake of childhood immunisations and cervical screening, issues with the review and management of long-term conditions, and lapses in staff appraisals. This assessment showed that steps had been taken to make improvement in these areas. New processes had been put in place to increase both cervical screening and child immunisations and some progress had been noted in take-up. Searches undertaken on the provider’s clinical system demonstrated long-term conditions were being well managed, and appraisal processes were in place for staff. The provider also had in place measures for the effective monitoring and reporting of key performance indicators via their Quality and Safety Group, and undertook effective clinical supervision of staff.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patient feedback from the 2024 National GP Patient Survey indicated that patient satisfaction with how the practice worked with them to assess their needs was generally in line with local and national averages. For example, 83% of respondents reported that the healthcare professional they saw or spoke to was good at listening to them at their last general practice appointment compared to the local average of 86% and the national average of 87%. Feedback from a representative of the patient participation group confirmed that they were regularly called for health reviews. We were told that GPs and other clinical staff worked with them to understand their treatment.

Leaders, managers and staff told us that processes were in place to assess patient needs. For example, they explained to us their process for reviewing patients with a learning disability. This included monitoring their learning disability register, and calling patients in for regular reviews. To support this process, we were informed that the provider had appointed a dedicated learning disability coordinator, and a GP partner who acted as a learning disability lead. Data supplied to us from the practice showed that 98 learning disability patients (78%) of 126 learning disability patients had received a review and health check in the previous 12 months. Staff told us that they had access to assessment tools, such as those for dementia and frailty. When we spoke with staff, they confirmed to us they were aware of how to deal with and escalate actions to support deteriorating patients.

The provider had processes and systems in place to assess patient needs. This included care navigation and initial triage. Clinical staff had access to assessment tools such as those for mental health conditions, and dementia. The provider had developed complex care health teams which supported housebound and/or otherwise vulnerable patients such as those approaching end of life, or patients accommodated in residential care settings. These teams supported the delivery of ongoing and anticipatory care, and included reviews, monitoring and direct care and treatment. Patients that had additional needs had these identified clearly on their patient record, which allowed staff to make adjustments to better meet their requirements. Furthermore, the provider held registers of patients with specific needs and used this for care planning. This included palliative care, and learning disability patients, and those who were carers. For example, Shipley Medical Centre had identified 985 patients as carers and was able to use this to target additional support. The provider had systems to record and manage advanced care planning and end of life decisions and we saw during our remote searches that Recommended Summary Plan for Emergency Care Treatment (ReSPECT) documentation had been completed in line with requirements.

We saw no indication of concern in this area.

Leaders told us that processes were in place which kept clinicians up to date with current evidence-based practice. For example, clinical leads within the Quality and Safety Group reviewed new NICE guidance, this was then sent to all clinicians and discussed at regular protected learning time sessions. We saw evidence in the minutes of the Quality and Safety Group that issues such as medicines and long-term conditions were standing items for discussion. Personal development was also encouraged, and staff we spoke with told us they had access to learning opportunities which sought to improve patient care, and felt free to raise additional training and development needs with the provider. The provider told us that they used audits to assess that care was delivered in line with required standards.

The provider had systems and processes to keep clinicians up to date with current evidence-based practice. This included the review of new or revised guidance, and the dissemination of this to staff. We saw that clinical supervision and audit was used to assess compliance with standards, and when identified drive improvement. Recent audits included 2-week cancer referrals, and patients with coeliac disease. Our review of the remote clinical searches of patient records showed that patients were being effectively and safely managed. We saw that staff appraisal progress was monitored, and that appraisals were generally up to date for staff.

We received positive feedback from a member of the patient participation group regarding how the provider engaged with them and kept them informed about developments in their care and treatment.

Feedback we received from leaders, managers and staff informed us of other services the practice worked closely with. This included community and secondary care services, mental health services, social care, and voluntary sector organisations. For example, they told us how they worked with social services and health visitors regarding safeguarding vulnerable adults and children.

We received no feedback from partners and stakeholders regarding how the provider worked with others. Therefore, we had no concerns in this area.

The practice delivered or hosted various services in-house. This included dementia and spirometry clinics, minor surgery, and abdominal aortic aneurysm screening (a check which showed if there was a bulge or swelling in the aorta, the main blood vessel that runs from the heart). It also delivered a young persons contact service, which was used to support referred young patients aged 11 to 18 (up to 25 for those patients with a learning difficulty). This used a multidisciplinary approach and brought together a wide group of health and care professionals including specialist nurses, and youth workers, and had additional support of Child and Adolescent Mental Health Services, drug and alcohol, and sexual health workers. It delivered care via face-to-face clinics and drop-in sessions, and was available across all Affinity Care sites. The provider had developed a segmented model of care which included 2 complex heath care teams who undertook the management of care for some of the most vulnerable and/or housebound members of the practice population. Activities of these teams included home visits, and visits to residential care facilities, as well as coordinating care with other stakeholders. The home visiting team was housed at Shipley Health Centre.

We saw no indication of concern in this area.

When we spoke with staff at all levels within the organisation, we found that they were committed to supporting, encouraging and enabling patients to live healthier lives. They explained how they recognised the challenges they faced regarding some areas that they were underperforming in such as cervical screening and child immunisations and told us how they sought to work with individuals and families to improve uptake. For example, if a parent was reticent to have their child immunised, they offered them time with a nurse to discuss this further. Leaders and managers told us they had good links with other organisations to help promote healthy lifestyles via their Community Partnership. This was composed of all the Affinity Care practices, along with representatives from social care, community care and the voluntary sector. An example, of activities delivered has included running NHS health checks, and other health checks in settings such as places of worship and local community centres. In the previous 12 months we heard that 937 patients had received an NHS health check.

We saw that the provider was involved in a wide number of activities to support population health. They and other stakeholders worked as part of a Community Partnership to work collaboratively and to support healthier lives. Activities included community health checks, and diverting funding to support work in respect of hypertension by purchasing self-testing and home-testing machines after recognising local need. We also saw that they had processes to fund other partners to deliver community services. For example, they had funded a local voluntary and community sector provider to deliver tier 1 (more complex) social prescribing support. The provider also supported the delivery of collocated services, and we saw that services such as alcohol and drugs workers, district nurses, and community midwives were hosted within the practice.

Patient feedback from the 2024 National GP Patient Survey indicated that the majority of respondents were satisfied with how their needs were supported. For example, 69% reported that they have had enough support from local services or organisations in the last 12 months to help manage their long-term conditions or illnesses. This aligned with local and national averages of 68%. Feedback from a representative of the patient participation group confirmed that they were regularly called for health reviews, and that health promotion information and advice was readily available at the practice or via the website.

Feedback from staff and leaders was positive about monitoring and improving outcomes. We were informed that following our last inspection in late 2022, that the provider had established ongoing schedules of audits and reviews under their Quality and Safety Group. Senior leaders informed us that this quality management process helped them to track and monitor performance, and service critical areas such as safeguarding, and learning events. Leaders and staff explained to us they had recognised areas of underperformance, and had put in measures to tackle these. This included focusing actions to encourage patients to attend for screening and preventative measures such as cervical cancer screening, and childhood immunisations.

The provider had developed and adopted effective clinical governance and reporting procedures across all Affinity Care locations. They had established a Quality and Safety Group which was attended by clinical leaders from the organisation, each of whom had responsibility for a key area of activity and the outcomes associated with this area of work. This included safeguarding, complaints, medication reviews prescribing, long-term conditions, medicines monitoring and usage, cytology and vaccinations and immunisations. Performance was monitored using a report and red, amber, green (RAG) rating system. The group met quarterly and reported directly to the Board of Directors for Affinity Care. September 2024 was the first month since June 2023 where all indicators were either rated green or amber. Underlying this reporting and monitoring mechanism we saw that the provider had in place effective systems of recalling patients, undertaking reviews, and managing medicines and patient safety. As part of the assessment, we conducted a series of remote clinical searches to assess the practices procedures for the management of patients with long-term conditions. We found that the management of patients with long-term conditions which included asthma, chronic kidney disease, and diabetes was good. The provider had sought to improve processes for encouraging patients to attend for cervical screening and childhood immunisations. This included offering appointments at a time to suit the patient/parent, and appointing dedicated staff to engage with patients. Non-attenders for screening and immunisation were escalated to the clinical meeting for discussion and escalation to other parties, for example health visitors.

Our review of the remote clinical searches of patient records showed the practice worked with patients to monitor and improve outcomes. We saw that regular reviews were undertaken for those patients with long-term conditions. These reviews carried appropriate detail. We saw that the provider was able to further support patients by signposting and referring them on for additional lifestyle advice. Registers were held which ensured monitoring of specific groups, such as palliative care patients and learning disabilities patients, were managed. Information published by Office for Health Improvement and Disparities showed the latest data (June 2023) for cervical screening as achieving an uptake of 72%, which was below the national target of 80%. This figure was though above the figure of 71% which we saw at our last inspection in late 2022. During this assessment the provider shared with us a report which indicated via unverified data, that they were achieving a screening rate of over 80%. This had been achieved through a combination of enhanced patient engagement, improved call and recall processes, and greater flexibility on accessing screening. Child immunisation data for the provider showed that it had narrowly failed to achieve 4 out of 5 child immunisation minimum targets, with figures ranging from 86-89% compared to the minimum target of 90%. Again, the provider had recognised this, and had put in place measures to improve uptake. This included discussing with reticent parents the need for vaccinations, dedicating a telephone line to book vaccinations, and appointing a coordinator to manage child immunisations processes. Unverified in year data supplied to us by the provider indicated progress in this area. For example, it showed that 91% of children under 5 years had received 2 doses of measles, mumps and rubella (MMR) vaccinations.

We saw no indication of any concern in this area.

Staff we spoke with were able to give examples of how consent was considered, sought and recorded (where appropriate). They had a good understanding of considerations which needed to be made for children and young people, those with limitations to mental capacity, and the vulnerable, elderly, or those whose first language was not English. Staff also outlined how they obtained verbal consent prior to referring to other services.

We saw that the provider had processes in place to manage consent. We saw that staff had received training regarding the mental capacity of patients, which enabled them to effectively assess the patient’s ability to give consent. The provider used inferred consent for most procedures, however they also required specific written consent when undertaking certain more complex, personal, or invasive treatments. Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) and Recommended Summary Plan for Emergency Care Treatment (ReSPECT) documentation was examined as part of our assessment. We did not identify any issues with the completion of these, this included recording the input of patients and/or carers in decisions.