Archived: Trinity Medical Centre

Updated 25 April 2017

Trinity Medical Practice, Uttoxeter Road, Blythe Bridge, Stoke-on-Trent, Staffordshire, ST11 9HQ. The practice is a single storey; purpose built property, which is owned by the partner. There is car parking available for patients and it is close to public transport. The practice is a dispensing practice.

The practice has a General Medical Services contract with NHS England and worked closely with the Stoke Clinical Commissioning Group (CCG). The total practice patient population is 4,100 covering patients of all ages. They also provide some Directed Enhanced Services, for example they offer minor surgery and the childhood vaccination and immunisation scheme.  One of the GP's is a GP with a special interest accreditation.  They provide a vasectomy service and extended minor surgical procedures to all practices within the two CCG areas.

The proportion of the practice population in the 65 years and over age group is higher than the England average. The practice scored eight on the deprivation measurement scale, the deprivation scale goes from one to ten, with one being the most deprived. People living in more deprived areas tend to have a greater need for health services.

The staff team comprises three GPs, one GP partner who is male and two female salaried GPs. There are three pratice nurses. The practice is managed and supported by a practice manager, administration, secretarial and reception staff.

The practice is a teaching, training and research practice and is affiliated to Keele University. Each year approximately 12 medical students from both year 3 and 4 have placements for four weeks.

The practice operates a telephone triage system for urgent appointments, through the use of a duty doctor. Face to face appointments are available daily for patients that ring the same day. The practice telephones switch to the out-of-hours provider at 6pm each evening and at weekends and bank holidays. The practice reception was open Mondays 8am to 7pm, Tuesdays and Wednesdays 7.30am to 6.30pm, Thursdays 7.30am to 1pm and Fridays 7.30am to 6.30pm.

Appointments can be booked by walking into the practice, by the telephone and on line. Patients requiring a GP outside of normal working hours are advised to contact the GP out of hour’s service provided by Vocare via the NHS 111 service.

Updated 25 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Trinity Medical Centre on 12 January 2017. Overall the practice is rated as good.

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.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result.
• 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. For example, obtaining a cold water dispenser for the waiting area and installing a ‘please wait’ barrier in front of the reception area to increase confidentiality.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Patients said they found it easy to make an appointment with a named GP and urgent appointments were available the same day.

• 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 supported by management. The practice acted upon feedback from staff and patients.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw areas of outstanding practice:

• The practice had introduce an initiative where by the practice nurse in partnership with the lead GP carried out virtual clinics with professionals from secondary care to review and provide appropriate treatments for patient with complex, unstable long term conditions. The clinics take place without the patient being present but patients were informed of these meetings. The specialist or consultant, GP and nurse met to discuss difficult to manage patients, for example those with diabetes.Prior to the meeting recent blood tests and reviews had been completed. Following the clinic the patients were contacted with an explanation of what had been discussed along with new advice, new prescriptions or changes in medication. As a result of these GPs were able to improve the management of patients and treat them closer to home. his saved costs and time to the patients as well as to the consultant and their team had hospital appointments been carried out.

• Both practice nurses had completed additional fire training so they were able to identify fire risks when they visited patients in their own homes. An example of how this impacted on patients was they gave fire safety advice and were able toassist and sign post patients to the community fire advice team

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 April 2017

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

• GPs and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Patients with COPD, asthma and diabetes were managed by nurse led clinics and GPs. Nationally reported data for 2015/2016 showed that outcomes for patients with long term conditions were good. For example, the percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5mmol/l or less was 85% compared to the national average of 83% and the CCG average of 80%.

• One of the GPs and practice nurse undertook ‘virtual clinics’ for patients with complex diabetes, COPD and asthma. The clinics take place without the patient being present. The specialist or consultant, GP and nurse met to discuss difficult to manage patients for example diabetes. Prior to the meeting recent blood tests and reviews had been completed. Following the clinic the patients was contacted with an explanation of what had been discussed along with new advice, new prescriptions or changes in medication.
• The practice also used ‘Speakset’ for more effective communication with patients at home for consultations. ‘Speakset’ comprised a small box attached to the television, with a switch of a button a call would be put through directly to the practices video link operating in a similar way to skype.

• Longer appointments and home visits were available when needed.

• All these patients had a usual 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.

• Practice nurses visited patients at home to do long term conditions reviews and administer flu vaccinations during the flu season.
• Both practice nurses had completed additional fire training so they are able to identify fire risks when they visit patients in their own homes. An example of how this impacted on patients was the advice given to patients about not store electric blankets folded during the summer months. Also patient were given a card with a Freephone number for the Community Fire Advice Team who visit patients’ and check smoke alarms, carbon monoxide alarms and gave general safety advice.
• The practice provided a room for the podiatrist to conduct weekly clinics. This means that patients are able to receive care closer to home.

• Practice nurses could refer appropriate patients to the Lifestyle Programme where patients could have a lifestyle coach for up to 12 months. (A programme designed to give expert advice to patients who want to lose weight and get fitter)

• The practice offered a ‘telehealth’ service. This enabled the practice to have health monitoring of patients via their mobile phones. Patients were provided with the relevant equipment, such as blood pressure monitor, peak flow meter, thermometer or scales.

Updated 25 April 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 A&E attendances. Uptake rates were high for all standard childhood immunisations.

• The practice had a system of follow up when it had been informed that a child had not attended an appointment with an external agency or alternative care provider.

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

• Weekly immunisation clinics were held along with weekly midwife clinics.

• Immunisation rates for 2015/2016 were comparable to or slightly higher than the local CCG average for all standard childhood immunisations. For example, immunisations given to children aged 12 months, 24 months and five years in the practice ranged from 96% to 100% compared to 95% to 99% for the local CCG area and 81% to 95% for England.

• Nationally reported data from 2015/2016 showed the practice’s uptake for the cervical screening programme was 91% compared to the local CCG average of 83% and national average of 82%. We saw examples of systems in place to promote cervical screening to women throughout the practice.

• The practice offered a range of sexual health services where patients could get advice and treatment, for example contraception. Information and testing kits for sexually transmitted diseases were available in the practice.

• The practice had close, regular links with midwives, health visitors and school nurses.

The practice with the Patient Participation Group were looking at ways to engage and work with younger people.  They had recently written to a local secondary school with a view to holding an education event at the school with the local health education team to look at a cross section of health issues, such as, diet, exercise and sexual health.

Updated 25 April 2017

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

• The practice demographic indicated a higher than average percentage of older people within its registered list.

• The practice offered proactive, personalised care to meet the needs of the older people in its population, including home visits. Patients over the age of 75 had a named GP.

• The practice had assessed the older patients most at risk of unplanned admissions and had developed care plans which were regularly reviewed.

• As part of the unplanned admission scheme the practice offered same day telephone appointments.

• Nationally reported data for 2015/2016 showed that outcomes were good for conditions commonly found in older people. For example, performance for heart failure indicators was 100%; this was 2% above the local CCG average and 2% above the England average.

• Patients aged 75 or over who had co-morbidities were seen in a joint consultation with a practice nurse and the pharmacist.

Updated 25 April 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 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 reflected the needs for this age group.

• Family planning clinics, minor surgery and joint injections were provided at the practice so patients did not have to attend hospital to access these services.

• The practice offered a ‘telehealth’ service.This enabled the practice to have health monitoring of patients via their mobile phones. For example, monitoring patients’ blood pressure.

Updated 25 April 2017

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

• Nationally reported data from 2015/2016 showed 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the previous 12 months, compared to the local CCG average of 84% and the England average of 84%.

• Nationally reported data showed the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in their record in the preceding 12 months was 97%, this was 7% above the local CCG and 8% above the England average.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those 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 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.

Updated 25 April 2017

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

• The practice had a good in depth knowledge of its vulnerable patients.

• Same day medicines delivery was available to housebound patients.

• 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.

• Safeguarding concerns are discussed at the two weekly clinical meetings.

• The practice conducted visits to vulnerable patients living in care homes.These visits were carried out by one of the practice nurses and pharmacist where medicines reviews and health assessments were conducted.

• Type talk was available for patients’ with significant hearing impairment. (Type talk