Stag Medical Centre

Updated 10 August 2017

The Stag Medical Centre is situated in Rotherham and opened in 1989. This is a purpose-built medical centre which includes minor surgery facilities. There is a branch surgery situated at Rosecourt Surgery, 121 Bawtry Road, Wickersley Rotherham S66 2BL. The practice moved into this development at the beginning of 1994. We visited both sites as part of this inspection.

There are car parks and full access for people with disabilities at both surgeries. Major bus routes serve both surgeries. Patients can access services at both surgeries.

The practice provides Personal Medical Services (PMS) for 11,600 patients in the NHS Rotherham Clinical Commissioning Group (CCG) area. They have a higher than average population in the 50 plus age group and are located in the fourth least deprived area nationally.

The practice provides some enhanced services which include dementia and learning disability services.

There are seven GP partners, four female and three male. There are five practice nurses, including two specialist practitioner practice nurses and four health care assistants.

A practice manager, assistant manager, secretary, administration staff and teams of receptionists are also employed.

The practice is used for teaching medical students and for further education and familiarisation of general practice work for doctors.

The practice is open as between 8.00am and 6.30pm, Monday to Friday.

Consultations are held at the Stag from 8.30am to 12.30pm and 3.30pm to 5.45pm, Monday to Friday and at Rose Court from 8.30am to 12.30pm and 3.30pm to 5.30pm Monday to Thursday and 8.30am to 12.30pm on Fridays.

All the doctors have consultations at both surgeries on a rota system.

Updated 10 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stag Medical Centre on 25 April 2016. The overall rating for the practice was Good but with Requires Improvement for safety. The full comprehensive report on the April 2016 inspection can be found by selecting the ‘all reports’ link for Stag Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 27 June 2017 to confirm that the practice had taken action to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 25 April 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as Good.

The practice had taken action to meet the legal requirements. Our key findings were as follows:

• The practice had improved systems to manage health and safety. Health and safety risk assessments for the premises including a fire risk assessment had been completed. Fire drills had been completed and work had been completed to ensure blinds in the practice met Department of Health guidance.

• Checks of the defibrillator had been undertaken to meet relevant guidance.

• Systems had been improved to ensure blank prescription forms and pads were securely stored in line with relevant guidance.

• Systems to improve the management of infection, prevention and control (IPC) had been improved including records of the cleaning had been implemented and completed and staff had received IPC training. Annual IPC audits to monitor standards had been undertaken.

The practice had also taken action in areas recommended for improvement:

• Systems had been implemented to review actions taken in response to significant events to check these had been implemented appropriately and had been effective.

• Procedures for recording the actions taken in response to medical alerts had been improved and implemented.

• Training had been provided for staff who were undertaking chaperone duties.

• Arrangements for monitoring the temperature of the vaccine fridge in relation to the provision of thermometers had been reviewed and improved in line with relevant guidance.

• Procedures for obtaining written consent from patients prior to minor surgical procedures and contraceptive implants had been reviewed. New consent forms had been developed and implemented.The practice had also introduced a World Health Organisation (WHO) check list for surgical procedures to assist clinicians to ensure all the appropriate records were completed and information had been provided to the patient. Completed documents were stored on the patient record.

• Access to the practice by telephone and to a named GP had been reviewed. Since the last inspection the practice had commenced the Productive General Practice programme. (Productive General Practice is a programme from the NHS Institute which aims to support general practices in realising internal efficiencies, while maintaining quality of care and releasing time to spend on more value added activities.) The practice had used this system to review their appointment system. An audit had showed 93% of appointments were given to patients as per the patients request. The data had enabled the practice to review staffing requirements and in response to the information provided had employed an advanced nurse practitioner to improve access to appointments. The practice had also had a new telephone system in November 2016 which provided more lines and a call waiting system. This system enabled the practice to monitor call waiting times and discontinued calls. The practice was in the process of reviewing the data from this information to identify if any further improvements could be made.

• Information about the complaints procedure was displayed in the practice to ensure access for patients.

However, there were also areas of practice where the provider needs to make improvements. The provider should:

• Secure the clinical waste bins stored in the car park so they cannot be moved by the general public.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 27 June 2016

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

• Nursing staff had lead roles in long term condition management and patients at risk of hospital admission were identified as a priority.
• The practice had two specialist nurses who had been trained to enable them to provide specialist services for patients with long term conditions. This included interpreting spirometry, initiation of insulin, and in-house near patient testing for those patients on warfarin and initiation of warfarin for patients with atrial fibrillation.
• Performance for diabetes related indicators was 95% which was 12% better than the CCG average and 4% above the national average.
• Longer appointments and home visits were available when needed.
• All these 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 hosted a diabetes education and self-management for ongoing and newly diagnosed (DESMOND) delivered by a diabetic specialist nurse. This is a patient centered education programme for patients with Type 2 diabetes diagnosed within the previous 12 months.
• The practice also hosted the health trainer programme which helped and supported patients to make healthy lifestyle changes. Equipment such as a blood pressure machine and weighing scales were provided in the waiting areas for patients use.

Updated 27 June 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 had a high number of accident and emergency attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• The practice’s uptake for the cervical screening programme was 78%, which was comparable to the CCG average of 76% and the national average of 74%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 27 June 2016

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.

Updated 27 June 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 improve access.
• 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.

Updated 27 June 2016

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

• Performance for mental health related indicators was 98% which was 8% better than the CCG average and 6% better than the national averages.
• 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. Staff had completed dementia friends training.
• The practice hosted an in house service, improving access to psychological treatment service (IAPT), and this included two well-being practitioners and two counsellors.
• The PPG members told us they were working with a representative of the local Rotary Club to raise the profile of Admiral Nurses to enable a better service for patients and families living with dementia in the practice and Rotherham area. They were also visiting local businesses to encourage them to become dementia friendly organisations.

Updated 27 June 2016

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 with a learning disability.
• 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.
• 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.