Warwick Gates Family Health Centre

Updated 28 January 2016

Warwick Gates Family Health Centre is located in Heathcote, an area of Warwick, in South Warwickshire. Warwick Gates Family Health Centre has five GPs (two males and three females) operating from a modern, purpose built building in Heathcote. The practice provides primary medical services to patients in a fairly affluent, urban area and has significantly larger number of working age patients and lower numbers of older patients compared to the national average.

The GPs are supported by a practice manager, two practice nurses, a health care assistant (HCA), and administrative and reception staff. There were 6736 patients registered with the practice at the time of the inspection.

The practice has a General Medical Services (GMS) contract with NHS England. The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities.

Warwick Gates Family Health Centre is an approved training practice for doctors who wish to be become GPs. A trainee GP is a qualified doctor who is training to become a GP through a period of working and training in a practice. Only approved training practices can employ trainee GPs and the practice must have at least one approved GP trainer.

The practice is open between from 8am to 6.30pm Monday to Friday each week. The practice is closed at weekends. Appointments are available from:

• Monday from 8.30am to 10.30am and 3.50pm to 5.50pm
• Tuesday from 8am to 10.30am and 3.50pm to 5.50pm
• Wednesday from 8.30am to 10.30am and 3pm to 5pm
• Thursdays from 8am to 10.30am and 3.50pm to 5.50pm
• Friday from 8.30am to 10.30am and 3pm to 5pm.

A duty GP is available during opening hours and during the lunchtime period when the practice is closed. Patients who call the practice are given a mobile number to call for the duty GP. Extended hours appointments are available from 7am to 8am on a Tuesday, Wednesday and Friday, and from 6.30pm to 8pm on Wednesday evenings for pre-bookable appointments only.

Home visits are also available for patients who are too ill to attend the practice for appointments. There is also an online service which allows patients to order repeat prescriptions and book appointments. Booking of appointments can also be made up to six weeks in advance.

The practice does not provide an out-of-hours service but has alternative arrangements in place for patients to be seen when the practice is closed. For example, if patients call the practice when it is closed, an answerphone message gives the telephone number they should ring depending on the circumstances. Information on the out-of-hours service (provided by NHS Warwickshire Out Of Hours) is provided to patients and is available on the practice’s website and in the patient practice leaflet.

The practice treats patients of all ages and provides a range of medical services. This includes disease management such as asthma, diabetes and heart disease. Other appointments are available for maternity care and family planning.

Updated 28 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Warwick Gates Family Health Centre on 3 November 2015. The overall rating for this service is good. We found the practice was outstanding for providing services for older patients.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• Information about how to complain was available and easy to understand.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice had a clear vision about providing a quality and caring service in a safe way.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• 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.

We saw several areas of outstanding practice including:

• The practice had engaged in a project with AGE UK to assess and support all high risk elderly patients to identify and address clinical and social need. The practice had a nominated AGE UK care coordinator and an in-house coordinator to support this work. Positive results were achieved for three patients registered with the practice, who as a result of this comprehensive assessment process were found to have undiagnosed conditions. Additionally, the skills developed by practice staff from this project were being applied to all patients including older patients who were not included in this project.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 January 2016

This 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. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medicine 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 quality monitoring data (QOF) for 2014/2015 showed that the percentage of patients with hypertension (high blood pressure) having regular blood pressure tests was 87.73% which was higher than the national average of 83.11%.

Updated 28 January 2016

This practice is rated as good for the care of families, children and young patients. Appointments were available outside of school hours and the premises were suitable for children and babies. The practice provided childhood immunisations and appointments for these could be booked throughout the week to provide flexibility for working families. Last year’s performance was comparable with local and national levels. For example, childhood immunisation rates for the vaccinations given to under two’s ranged from 84.5% to 100% and five year olds from 94.2% to 96.5% which compared with CCG rates of 83.7% to 98.8% and 93.3% to 98.2% respectively.

Appointments were available outside of school hours and the premises were suitable and accessible for children, with changing facilities for babies.

We saw good examples of joint working with midwives, health visitors and district nurses. The practice also offered a number of online services including booking appointments and requesting repeat medicines.

Updated 28 January 2016

This practice 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 and had a range of enhanced services for example, in dementia and end of life care. The practice had low numbers of patients in the over 65 and 75 years population group compared with national averages (over 65 years was 9.5% compared with the national average of 16.7% and over 75 years of age was 3.7% compared with the national average of 7.6%).

Patients over the age of 75 had a named GP and GPs carried out visits to patients’ homes if they were unable to travel to the practice for appointments. The practice had exceeded the national average for providing flu vaccinations to patients over the age of 65. Data for the year 2014/2015 showed that 79.6% of patients had been given their flu vaccination compared with the national rate of 73.24%.

The practice had engaged in a project with AGE UK to assess and support all high risk elderly patients to identify and address clinical and social need. The practice had a nominated AGE UK care coordinator and an in-house coordinator to support this work. Positive results were achieved for three patients registered with the practice who were found to have undiagnosed conditions as a result of this comprehensive assessment process. Additionally, the skills developed by practice staff from this project were being applied to all patients including older patients who were not included in this project.

The practice maintained a register of all patients in need of palliative care and offered home visits and rapid access appointments for those patients with complex healthcare needs. Other professionals and practice staff had access to clear information about patients receiving end of life care so they were able to respond in the event that medical assistance was needed. The practice held regular multidisciplinary integrated care meetings where all patients on the palliative care register were discussed.

Updated 28 January 2016

This practice is rated as good for the care of working age patients (including those recently retired and students). The needs of this population group 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 hours appointments so that patients could access appointments around their working hours.

The practice offered a number of online services, including booking and cancelling appointments and requesting repeat medicines. They also provided a full range of health promotion and screening clinics that reflected the needs of this age group. The practice nurses had oversight for the management of a number of clinical areas, including immunisations, cervical cytology and some long term conditions.

Updated 28 January 2016

This practice is rated as good for the care of patients experiencing poor mental health (including patients with dementia). The practice held a register of patients living in vulnerable circumstances including those patients with dementia. The GPs and the practice nurses understood the importance of considering patients’ ability to consent to care and treatment and dealt with this in accordance with the requirements of the Mental Capacity Act 2005.

The practice invited patients experiencing poor mental health to attend for an annual health check. Longer appointments were arranged for this and patients were seen by the GP they preferred. The annual reviews took into account patients’ circumstances and support networks in addition to their physical health. The percentage of patients diagnosed with dementia whose care had been reviewed for 2014/2015 was 90.91% which was higher than the national rates of 83.82%.

The practice had given patients experiencing poor mental health information about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for patients’ with mental health needs and dementia.

Updated 28 January 2016

This practice 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 patients with a learning disability. For example, the practice had carried out annual health checks and offered longer appointments for patients with a learning disability.

Staff had received training and knew how to recognise signs of abuse in vulnerable adults and children who were considered to be at risk of harm. 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.

Patients were provided with information about how to access various support groups and voluntary organisations. For example, through leaflets, on the information notice board in the waiting area and on the practice’s website.