Archived: High Green Medical Practice - Dr Z Khan Also known as High Green Medical Practice

Updated 14 December 2016

High Green Medical Practice is registered with the Care Quality Commission (CQC) as a single handed GP. The GP has a practice manager/business partner. The practice is located in Nottingham. The practice has good transport links for patients travelling by public transport and parking facilities are available for patients travelling by car. The practice is situated within a joint healthcare facility that houses three GP practices, City Care Homes (an adult support service run by the City Council), phlebotomy and dietary services. The practice is situated on the ground floor of the building and has dedicated rooms that include seven consulting rooms. The building aims to provide a one stop shop for patients. The second floor has treatment rooms for services such as phlebotomy, dental treatment and physiotherapy that the provider could refer patients to. The community team are sited on the third level of the building. There is level access to the building, doors to the building are automated and lifts provide access to each floor. All areas within the practice are accessible by patients who use a wheelchair or parents with a pushchair.

The practice team consists of two partners, one male GP and one female practice manager partner. The partners are supported by two salaried GPS and five regular longstanding locum GPs. The GPs work a combined number of sessions of 48 per week (equal to six whole time equivalent GPs). The clinical team includes a lead practice nurse, an advanced care practitioner and a practice nurse. Clinical staff are supported by an assistant practice manager, two medical secretaries, a reception manager, a senior practice administrator and four administration/reception staff. In addition to the partners, there are a total of 14 staff employed either full or part time hours to meet the needs of patients. The practice is accredited to train GPs and has two whole time equivalent training doctors in post.

The practice is open between 8am and 7pm on a Monday, Wednesday and Friday and between 8am and 8pm on a Tuesday and Thursday. Appointments are available throughout the day through a rolling rota so appointments could be made each week day from 8.30am 6.50pm when closing at 7pm and 7.50pm when closing at 8pm. Extended hours are offered at the practice each week day evening. The practice does not provide an out-of-hours service to its patients but has alternative arrangements for patients to be seen when the practice is closed. Patients are directed to the out of hours service, provided by (Nottingham Emergency Medical Services (NEMS), via the NHS 111 service. The nearest hospital with an A&E unit and a walk in service is Queen’s Medical, Nottingham The nearest walk in centre was the urgent care centre in Nottingham city centre.

The practice has a Personal Medical Services contract with NHS England to provide medical services to approximately 9,400 patients. It provides Direct Enhanced Services (DES), such as the childhood immunisations, extended hours and asthma and diabetic reviews. The Local Enhanced Services (LES) offered included support to care home and care plans for vulnerable adults.

The practice has a high proportion of patients from ethnic minorities, 24.9% are White British compared to the England average of 17.1%. The largest ethnic minorities are South Asian (47.6% of the practice population) and Eastern European (15% of the practice population). The income deprivation affecting children of 33% was higher than the national average of 20%. The level of income deprivation affecting older people of 43% was higher than the national average (16%). The age demographic for the practice patients shows a relatively young group of patients. For example, 29% of patients are under the age of 18 (national average 21%) and 4% of patients are aged 65 and over (national average 17%). The patient group is transient and this migration on people has seen the number of patients joined and those that have left in a 12 month period give a turnover of that has ranged between 12% and 22% in recent years.

Updated 14 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at High Green Medical Practice on 29 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 a system in place for reporting and recording significant events.
• Staff understood their responsibilities to raise concerns and to report incidents and near misses. The practice had a formal system in place for the ongoing monitoring of significant events, incidents and accidents.
• Effective arrangements were in place to ensure that risks to patients and staff were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• The practice had a programme of continuous clinical and internal audit in order to monitor quality and make improvements.
• The practice invested in staff development and training.
• 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 and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it difficult to contact the surgery by telephone especially when trying to make an appointment.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt engaged with and supported by the management.
• The practice proactively sought feedback from staff and patients. Actions were taken as a result of feedback.
• The provider was aware of and complied with the requirements of the duty of candour.

There were areas of practice where the provider should make improvements:

• Consider how the telephone access for patients could be improved.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 December 2016

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

• The practice nurse and advanced care practitioner provided home visits for chronic disease management.
• Patients at increased risk of hospital admission were identified as a priority and had written care plans in place.
• The practice Quality and Outcomes Framework (QOF) for the care of patients with long-term conditions was worse than the local and national average. The most recent published data was for 2014/15 and the practice showed us unpublished data that showed an improvement in the QOF performance that brought the practice into line with local and national averages.
• Longer appointments were available when needed and home visits made to patients who were housebound.
• The GPs and nursing team worked with relevant healthcare professionals to deliver a multidisciplinary package of care to patients with complex needs.
• The practice had an effective call and recall system that was supported by a text reminder service.

Updated 14 December 2016

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 did not attend hospital appointments.
• Immunisation uptake rates for standard childhood immunisations were better than the local CCG and the national averages. For example, childhood immunisation rates for the vaccination of children aged two to five and up to five years of age were consistently between 97% and 99%.
• Children and young people were treated in an age-appropriate way and were recognised as individuals. Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice’s uptake for the cervical screening programme was 87%, which was better than the national average of 82%.
• Extended opening provided early morning and late evening appointments five days a week.

Updated 14 December 2016

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.
• Flexible appointments were available for older patients.
• All patients aged 65 and over were offered a health check including blood tests.
• Patients aged over 75 had been advised on their named, accountable GP.
• The practice engaged with community teams involved in care of the elderly population.
• A dedicated telephone line was provided to local care and nursing homes and the GP carried out regular ward rounds.

Updated 14 December 2016

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 offered extended opening hours each week day.
• The appointment telephone line was accessible to patients who worked during the day.
• 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.
• Extended opening provided early morning appointments and late evening appointments each week day.

Updated 14 December 2016

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

• The practice regularly worked with multi-disciplinary teams in the case management of people who experienced poor mental health, including those with dementia.
• The practice held a register of patients who experienced poor mental health. Clinical data for the year 2016/17 showed that 16 of 25 patients on the practice register who experienced poor mental health had a comprehensive agreed care plan. The provider had planned to complete the remaining nine care plans before April 2017.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. For example, the community mental health team.
• The practice maintained a register of patients diagnosed with dementia. The percentage of patients diagnosed with dementia, whose care had been reviewed in a face to face review in the preceding 12 months was 77%, which was comparable with the national average of 84%.

Updated 14 December 2016

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

• The practice held a register of 35 patients with a learning disability and annual health checks had been carried out on all of these patients.
• The practice had a high prevalence of young patients living in vulnerable circumstances, when identified the practice assisted and supported these patients on an individual basis and the provider had an appointed vulnerable patient lead.
• Staff had been trained 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.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations.

• Patients whose first language was not English were offered a translation service via telephone or with an interpreter present to support consultations. The provider had a policy to provide translators to protect potentially vulnerable family members from using relatives as interpreters.

• The practice signposted patient to local self-help groups, for example; alcohol and substance misuse services.