Archived: Carfax Health Enterprise CIC Also known as Carfax NHS Medical Centre

Updated 3 March 2016

Carfax Health Enterprise is located in the centre of Swindon, it provides both a GP practice service and a walk in centre. It is near both the bus and train stations. It shares the Swindon Health Centre with a range of other health services including another GP practice. The premises are dated and all services are due to move to a larger purpose built health centre, nearby, in 2017. There is a car park next to the health centre and public transport links are good.

A total of 75 staff work at the provider across both the walk in centre and GP practice. There are 14 GPs. Thirteen of the GPs work part time and all are salaried GPs. Eight of the GPs are female and six male. A team of 10 nurses and four health care assistants work in the GP practice. The walk in centre is staffed by a team of 11 nurses, four emergency care practitioners and one associate practitioner. The GPs and nurses are supported by an administration and reception team of 28. The walk in centre is a nurse led service. Advice can be sought from the practice GPs when the nurse practitioners and emergency care practitioners require it.

The provider is managed by a board of directors on a not for profit basis. The board comprises a medical director who is a practicing GP, two registered nurses, the managing director, company secretary and director of operations. The board are based at Carfax NHS Medical Centre. The practice and walk in centre opened in 2009. The service is operated under an Alternative Provider Medical Services (APMS) contract (APMS contracts are locally negotiated and are open to both NHS practices and voluntary sector or private providers). Both the GP practice and Walk in Centre were managed under the one contract. The provider is subject to regular monitoring of contract performance by NHS England.

The provider shares the training for qualified doctors wishing to become GPs with another local practice. They also offer placements for nurses in training.

There is a registered practice population of approximately 12,500 patients and the walk in centre achieves over 32,000 patient contacts each year. Patient turnover is above average due to a high density of short term rented accommodation nearby and a significant number of patients arriving from, and departing to, other countries. Services offered from Carfax NHS Medical Centre include; minor illness and minor injury walk in, scheduled appointments for unregistered patients, substance misuse shared care, care of homeless people, needle exchange, appointments for violent patients unable to register elsewhere and Tuberculosis screening for the population of Swindon and North Wiltshire.

The GP practice is open between 8am and 8pm every day of the year. The first appointment is at 8.15am and the last appointment at 7.15pm. The walk in centre is also open every day until 8pm and it opens at 7am on weekdays (except on weekends and Bank Holidays when it opens at 8am).

When both services are closed out of hours (OOH) services are provided by Sequol. Telephone calls to the practice out of hours are automatically transferred to 111. Information about how to contact the out of hours service is on the practice website and in the practice leaflet.

All services are provided from; Carfax NHS Medical Centre, Swindon Health Centre, Carfax Street, Swindon, Wiltshire, SN1 1ED.

Updated 3 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Carfax Health Enterprise (also known as Carfax Medical Centre) on 13 January 2016. Overall the provider is rated as good. Specifically the provider is rated good for delivery of safe, effective, caring and well led services. The provider is rated as requires improvement for delivery of responsive services as some improvements should be made.

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.
• Training and development was supported by management.
• The provider recognised the needs and delivered services appropriately for patients from ethnic minorities and for those with a disability.
• 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.
• Patients said they found it easy to make an appointment with a GP.
• The provider was well equipped to treat patients and meet their needs.
• 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.
• Placements were offered for nurses in training.

The areas where the provider should make improvement are:

• Ensuring patients attending the walk in centre are informed of the standard to be seen and treated within four hours. Also introduce a system of keeping patients informed of the waiting time likely to be experienced.

• To provide an induction loop to assist patients who use hearing aids.

• Seek consent from the patient to share information with a third party lodging a complaint on the patient’s behalf.

• Ensure the virtual patient group is formalised to facilitate structured feedback from patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 March 2016

The practice is rated as good for the care of patients 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 achieved 93% of the national targets for care of patients diagnosed with diabetes.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and were offered 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 or nurse worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 3 March 2016

The provider is rated as good for the care of families, children and young patients.

• 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 patients who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations. This was achieved by aligning the national immunisation programme with that of a number of other countries.

• 87% of patients on the Asthma register had received an annual review compared to the CCG average of 74% and national average of 75%.

• Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives and health visitors.

Updated 3 March 2016

The provider is rated as good for the care of older patients.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population. However, fewer than 5% of the registered patients were aged over 65.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older patients were at or above average. For example the practice had achieved all the targets for treating patients with lung disease.

• The percentage of patients aged 65 or over who received a seasonal flu vaccination was similar to the national average.

Updated 3 March 2016

The provider is rated as good for the care of working-age patients (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 reflects the needs for this age group.

• Appointments were available after 6.30pm every weekday and from 8.15am to 7.15pm on both Saturday and Sunday.

• Patients who had not had the opportunity to book an appointment could be seen at the walk in centre.

Updated 3 March 2016

The provider is rated as good for the care of patients experiencing poor mental health (including patients living with dementia).

• 94% of patients with a severe mental health problem had a care plan compared to 87% CCG average and national average of 86%.

• 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.

• The practice had told patients experiencing poor mental health 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.

• The practice reviewed 93% of patients diagnosed with depression within the target timescale compared to a CCG average of 87% and national average of 85%.

• The practice undertook shared care for patients who were substance misusers and offered a needle exchange scheme.

Updated 3 March 2016

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

• The practice held a register of patients living in vulnerable circumstances including homeless people and those with a learning disability.

• The practice offered services to all homeless people in Swindon.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.

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

• 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.

• The practice offered a service to patients who were unable to register at other practices in the area.