Highgate Medical Centre

Updated 28 April 2017

Dr Mayur Lakhani is a sole clinical partner working with sessional GPs who is based in Highgate Medical Centre in Sileby, a village north west of Leicester. There is a local population of about 8,500 which will increase as up to 1000 new homes are built over the next five years. Sileby is an area with private housing alongside some pockets of social deprivation. The practice has 3585 patients. Almost 10% of its patients are aged 75 and over, and approximately 22% are aged under 18.

The practice occupies single-storey purpose-built accommodation which it hopes to refurbish in the near future to improve disability access with automatic doors and generally update the premises.

Dr Lakhani is the senior GP and works six sessions and the extended access hours each week. There are two long term sessional GPs, one male and one female who between them work five sessions a week. A female GP provides additional sessions as required. Another male GP works in the practice for approximately one session each month providing a minor surgery service. There are two female nurse practitioners who are also prescribers who provide minor illness and urgent care, as well as managing long-term conditions which includes care planning. There is also a female phlebotomist. The clinical team is supported by a practice manager, and other support staff, whose roles include a patient coordinator and an end of life care coordinator. The practice is a teaching practice which has medical students on placement.

The practice is open between 8am and 6pm Monday to Friday with the exception of Thursday when it closes at 1pm. On this afternoon and between 6 and 6.30pm the practice had a contract with Primecare whose telephone number is provided by the answerphone message and on the practice’s website. Extended hours appointments are available on Monday from 7.15am and on Wednesday and Friday from 7.30am.

Out of hours services are provided by DHU (Derbyshire Health United).

Updated 28 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Mayur Lakhani on 7 September 2016. 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.
• Risks to patients were assessed and well managed.
• 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.
• The practice consistently received very good patient feedback about the quality of care given to patients, for example in the national GP survey.

• We saw examples where the practice had considered the communication needs of vulnerable patients ie a system was in place to provide sign language CBT to patients where needed.

• 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.
• Urgent appointments were made available for vulnerable patients and unwell children even where the sessions were fully booked.
• The practice had adequate facilities and equipment.
• There was a clear leadership structure and staff felt supported by 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 28 April 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. The practice had identified 3% of its patients in this category

• The practice's performance for diabetes management was similar to or higher than national averages, for example, the practice scored 86% for the QOF indicator relating to blood sugar control management for diabetic patients compared to the local average of 83% and national average of 78%.

• Longer appointments and home visits were available when needed. The practice kept a register of patients who were housebound.

• All patients had a named GP and 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.

• The practice also encouraged supported self-management for many conditions with factsheets, information on the web-site and community events for example, one for patients with arthritis which was supported by a local community group for people with joint problems.

Updated 28 April 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 referred some vulnerable families to the Leicestershire Supporting Families Service to help them access appropriate support.

• Immunisation rates were above the national standard for childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

• The practice’s web-site had a link to a site supporting teenage health.

• Data showed 93% of eligible women had received a cervical screening test compared with the local average of 83% and national average of 81%.

• Appointments were available outside of school hours and the premises were suitable for children and babies. Young children who were ill were always seen and the practice used a sepsis screening tool to help identify this condition.

• The lead GP had a Diploma in Child Health and had recently done a presentation to local GPs about allergies in children related to cow’s milk.

• The practice offered 24 hour and 6 week baby checks with 20 minute appointments.

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

Updated 28 April 2017

The practice is rated as good 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.

• The practice’s approach was to undertake frailty assessments, dementia screening and an integrated approach to include where needed end of life planning and a multi-agency approach.

• The practice had identified those older patients at risk of hospital admission and had developed care planning which identified key health problems and their on-going management. Special notes were included on records for out of hour’s services to avoid unnecessary or inappropriate hospital admissions.

Updated 28 April 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 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 reflected the needs for this age group.

• Early morning appointments could be pre-booked 3 days a week and bookable telephone consultations were available.

• The practice was doing a trial of an online consultation service called AskmyGP for non-emergency advice and problems. Patients completed a questionnaire and received advice by email or telephone, for example, to pick up a prescription or book an appointment.

• The practice offered a travel vaccination service. Patients could fill in an on-line questionnaire to help identify what vaccinations they needed and when.

Updated 28 April 2017

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

• 92% of patients living with dementia had a face-to-face care review in the previous 12 months, compared with the local average of 87% and national average of 84%.

• 94% of patients with severe mental health problems had a comprehensive agreed care plan documented in their records compared with the local average of 94% and national average of 89%. Alerts on their records meant that they were routinely offered longer appointments.

• 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 which included appropriate end of life care plans.

• The practice had told patients experiencing poor mental health and where appropriate their carers about how to access various support groups and voluntary organisations.

• 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. For example, they were routinely offered longer appointments.

Updated 28 April 2017

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 carers, people with a learning disability, people who were housebound and those with alcohol or substance misuse problems.

• The practice offered longer appointments for patients including those with serious mental health issues and those with a learning disability.

• Administrative staff had put alerts on to patient records to ensure that patients received assistance, for example, if they could not see the screen in reception asking them to go in to their appointment.

• 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 Citizens Advice Bureau provided a weekly session at the practice for patients to get advice and assistance with a wide range of problems.

• The practice had identified 98 (2.7%) of its patients who had caring responsibilities. They were offered a referral to a local support service for a carer assessment, and given information about local authority services such as First Contact, which could offer practical assistance with a variety of housing and other matters There was also information available in the waiting area and on the website.

• A member of the administrative team was the practice co-ordinator for end of life care. They were the first contact for patients and their families and liaised with community based services and offered support to families after bereavement. They also maintained the practice’s register of patients identified as having caring responsibilities.

• The practice carried out regular audits into its provision of end of life care. The most recent audit had identified that 78% of patients who had died had been on the end of life care register for at least two weeks and that 73% of them had died in their preferred place of care.

• The practice kept a register of patients on the autistic spectrum and followed guidelines on being an autism friendly practice.

• 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.