Archived: Malling Health @ Stoke Aldermoor

Updated 1 February 2017

Malling Health @ Stoke Aldermoor is situated on Aldermoor Lane, Coventry CV3 1BN. The surgery was established in June 2009. It is located approximately two miles to the east of Coventry city centre.

The practice premises are leased from NHS Properties. The single storey building has disabled access and parking for patients is available. The practice is accessible by public transport. The practice is part of the Integrated Medical Holdings (IMH) parent organisation. Clinical staff and the practice manager are shared with a sister practice, Malling Health @ Foleshill Coventry CV6 6 5ND. Patient lists for the two practices are separate, and non-clinical staff for the practices are not shared.

Malling Health@ Stoke Aldermoor currently has 3,063 registered patients. Approximately 45% of their patient group is of white British origin, with approximately 35% being of Asian or other mixed race origin. The practice provides Alternative Primary Medical Services (APMS) under a contract with NHS England. They offer enhanced services such as childhood and flu vaccinations.

The practice is staffed by three salaried GPs, two male and one female. At the time of our inspection one of the part time GPs had resigned, and the practice were actively recruiting to a 30 hour salaried GP post to cover the practice and their sister practice. A female clinical lead employed by IMH provides clinical guidance and support to the team of GPs. There are two female practice nurses. One female health care assistant (HCA) is shared by a number of the IMH practices and offers short sessions at the practice. The clinical team is supported by a practice manager and a range of administrative and reception staff.

Information published by Public Health England rates the level of deprivation within the practice population group at two, on a scale of one to ten. Level one represents the highest levels of deprivation, and level ten the lowest. People living in more deprived areas tend to have greater need of NHS services.

The age/sex profile of the practice shows a significantly higher than average percentage of men and women in the 25 to 34 year age group, and a significantly higher number of children aged 0 to four years.

The practice is open between 8am and 6.30pm Monday to Friday. Extended hours surgeries are available between 6.30pm and 9.30pm at a choice of four locations, delivered via a local GP Alliance under a locally agreed information sharing agreement.

Practice nurses offer access to appointments for management of a range of chronic diseases such as asthma and diabetes. Childhood immunisations are also provided.

Out of hours care is provided by City of Coventry Out of Hours Service, which is accessed by calling the NHS 111 service.

Updated 1 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Malling Health@Stoke Aldermoor on 10 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.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff had the skills, knowledge and experience to deliver effective care and treatment. Staff told us due to recent and pending staff resignations, workloads were high which increased pressure on staff.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. A complaints leaflet was available on request, but details on how to complain were not included in the practice leaflet.
• Some patients told us they found the appointment system difficult. Same day appointments were available. Patients were able to make use of an extended hours scheme to access same day appointments between 6.30pm and 9.30pm. This service was delivered via a local GP alliance.
• The practice premises were leased from NHS Properties. We saw there was need for refurbishment in some areas. The practice showed us an improvement action plan which evidenced that NHS Properties had been approached to effect these improvements.
• The practice was part of Integrated Medical Holdings (IMH) organisation. Clinical staff and the practice manager worked across Malling Health @Stoke Aldermoor and their sister practice Malling Health@Foleshill.
• IMH had a clear leadership structure and governance framework. Staff told us they had little contact with senior managers from the organisation. However they told us they felt supported by the practice manager and senior GP in the practice.
• The practice told us they had endeavoured to establish a patient participation group (PPG). At the time of our visit this had not been achieved. They told us they found it difficult to engage patients in the process. They received patient feedback via the NHS Friends and Family test, as well as via a suggestion box in the waiting area, and by carrying out internal patient satisfaction surveys.
• The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider should make improvement are:

• Review their appointment system to enhance patient experience of access to same day appointments.

• Continue with a programme of recruitment of clinical staff to augment the clinical team.

• Continue to engage with patients to establish and develop a patient participation group.

• Take steps to improve patient’s awareness of the practice’s complaints process.

• Continue to carry out or at least comprehensively risk assess the need for enhanced disclosure and barring service (DBS) checks for all staff acting in the role of chaperone.

• Develop systems to improve the identification of those patients acting as unpaid carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 February 2017

The practice is rated as good for the care of people with long-term conditions.

• There had been recent changes in the nursing team which had meant some reliance on locum practice nurse hours. At the time of our visit two new practice nurses had been recently appointed who would undertake lead roles in chronic disease management.

• 96% of patients with diabetes, on the register, had a blood pressure recording which was within normal limits completed in the preceding 12 months, compared to the CCG and national average of 91%.

• Longer appointments and home visits were available when needed.

• All these patients had a care plan in place and had been allocated a named GP.

• Regular reviews, including a medicines review were carried out by practice nurses to check the health and medicines needs of people with long term conditions were being met.

• The practice team liaised with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 1 February 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 accident and emergency (A&E) attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• 85% of patients with asthma had an asthma review completed in the preceding 12 months, compared to the CCG and national average of 76%.

• Patients told us that children and young people were treated in an age-appropriate way and staff described examples from practice to demonstrate this.

• 97% of eligible women had received a cervical screening test in the preceding five years, compared to the CCG and national average of 81%.

• Appointments were available outside of school hours. Baby changing facilities were available and a room could be made available for women wishing to breast feed their babies.

• The practice held monthly meetings to which health visitors, school nurses and midwives were invited. We saw minutes from meetings to evidence information sharing and updating.

Updated 1 February 2017

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

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

• The practice was responsible for four care homes for older people. One of the GPs carried out a weekly ‘ward round’ to monitor the health and care needs for this group of people. Following the inspection we sought feedback from one of the care homes who told us the practice provided a caring and responsive service to their residents.

• Home visits were available when required.

• The practice had identified their 2% of patients at higher risk of unplanned admission to hospital, and each of these patients had a care plan in place which was regularly reviewed.

• The practice worked with the end of life and palliative care teams to co-ordinate care for this group of patients.

Updated 1 February 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 acknowledged and the practice had adjusted the services it offered to ensure these were as accessible and flexible as possible.

• The practice offered online services to book appointments or order repeat prescriptions. We saw evidence that 194 patients were fully registered for online services, although an additional 1269 patients had partially registered, and were requiring patient activation.

• The practice provided a text messaging service to remind patients of their appointment times, to reduce the number of appointments being missed by patients.

• We saw that the patient waiting area contained health promotion information reflecting the needs of this age group.

• The practice was open between 8am – 6.30pm Monday to Friday. Patients were also able to access extended hours appointments between 6.30pm and 9.30pm delivered at a choice of four sites via a local GP Alliance.

Updated 1 February 2017

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

• 100% of patients with schizophrenia or other psychoses had their alcohol consumption recorded in the preceding 12 months compared to the CCG and national average of 89%.
• 92% of patients diagnosed with dementia had had their care reviewed at a face to face meeting in the last 12 months compared to the CCG average of 81% and the national average of 84%.

• The practice worked with multidisciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia. Staff were able to accurately describe their responsibilities in relation to mental capacity issues for patients.

• Following the inspection we sought feedback from a specialist dementia care home for which the practice had responsibility. They told us the GPs had provided a responsive and appropriate service to those people who were experiencing mental capacity difficulties.

• The practice hosted an ‘Improving Access to Psychological Therapies’ (IAPT) clinic. Those patients who were experiencing emotional or psychological difficulties were able to receive support from these sessions.

Updated 1 February 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 those with a learning disability.

• The practice offered longer appointments for patients when needed.

• The practice worked with multidisciplinary teams in the case management of vulnerable people.

• The practice gave vulnerable patients information about how to access relevant support groups and voluntary organisations.

• Staff gave examples from practice which demonstrated they 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. Contact numbers for local safeguarding teams and safeguarding policies were displayed in consultation rooms and were available on the practice computer system.

• The practice hosted a weekly drop in session run by the local carers’ charity. At the time of our visit only 13 people had been identified as unpaid carers. The practice told us they were actively trying to identify carers. They asked newly registered patients if they were being cared for or were acting as a carer due to poor health or disability. We saw the practice had a notice board in the patient waiting area dedicated to carers.