Orchard Croft Medical Centre

Updated 7 November 2016

The practice operates from a main surgery which is located at Orchard Croft Medical Centre, Cluntergate, Horbury, Wakefield, West Yorkshire WF4 5BY; it also delivers services from Netherton Branch Surgery, Netherton Place, Netherton, Wakefield WF4 4LS. The practice serves a patient population of around 11,650 patients and is a member of NHS Wakefield Clinical Commissioning Group.

The main surgery is situated in purpose built premises which opened around 30 years ago. The surgery is located over two floors and is accessible for those with a physical disability. There is parking available on the site for patients. The branch surgery is also located in a purpose built premises which is accessible to those with a disability and there is parking available adjacent to the building.

The practice population age profile shows that it is above both the CCG and England averages for those aged over 65 years old (20% compared to the CCG average of 18% and England average of 17%). Average life expectancy for the practice population is 80 years for males and 83 years for females (CCG average is 77 years and 81 years and the England average is 79 years and 83 years respectively). The practice population is predominantly White British.

The practice provides services under the terms of the General Medical Services (GMS) contract. In addition the practice offers a range of enhanced local services including those in relation to:

• Childhood vaccination and immunisation

• Influenza and Pneumococcal immunisation

• Rotavirus and Shingles immunisation

• Extended hours access

• Dementia support

• Risk profiling and case management

• Support to reduce unplanned admissions

• Improving patient online access

• Minor surgery

• Patient participation

As well as these enhanced services the practice also offers additional services such as those supporting long term conditions management including asthma, diabetes, heart disease and hypertension, and physiotherapy.

Attached to the practice or closely working with the practice is a team of community health professionals that includes health visitors, midwives, members of the district nursing team and health trainers.

The practice has five GP partners (two male, three female), two salaried GPs (one male, one female), one GP registrar (female). In addition there is one advanced nurse practitioner, five nurses and two health care assistants (all female). Clinical staff are supported by a practice manager, an assistant practice manager, a data manager and an administration and reception team. In addition the practice also has the services of pharmacists and physiotherapists on site.

The practice appointments include:

• On the day appointments

• Pre-bookable appointments

• Telephone consultations

• Telephone triage where patients could speak to a GP or nurse to ask advice and if identified obtain an appointment

Appointments can be made in person, via the telephone or online.

The practice is open between:

Orchard Croft Medical Centre 8am and 6.30pm Monday to Friday and 8am to 11am on Saturday.

Netherton Branch Surgery 8am to 1pm and 2pm to 6pm on a Wednesday and 8am to 1pm on a Friday.

Additionally the practice works with other local GPs to offer appointments from 6.30pm to 8pm Monday to Friday and from 9am to 3pm on a Saturday and Sunday. This service is delivered from premises approximately 2.5 miles from the main Orchard Croft Medical Centre.

Orchard Croft Medical Centre is accredited as a training practice, and also acts as a teaching practice for a local university. It therefore hosts and supports GP trainees and third year medical students.

Out of hours care is provided by Local Care Direct Limited and is accessed via the practice telephone number or patients can contact NHS 111.

Updated 7 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Orchard Croft Medical Centre and Netherton branch surgery on 21 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 an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.

• Data showed patient outcomes were at or above average compared to the national average.

• 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.
• 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.
• There was continuity of care, with urgent appointments available the same day.
• The practice had recognised some low patient satisfaction with regard to access and had put in place measures such as increasing the numbers of telephone lines to improve this.

• There was evidence of appraisals and personal development plans for all staff.

• The practice had developed their own advice and resources to support staff such as an advice note containing simple information to improve prescribing and medicines optimisation.

• 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 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.

There was an area of outstanding practice:

• In 2016 the practice had begun to offer atrial fibrillation screening. From 1 April 2016 399 patients have been screened and identified 16 patients who needed further investigation. Of these patients, six were identified as suffering from atrial fibrillation and had received effective follow up care.

There were areas where the provider should make improvements:

• Review and address the areas of concern which had not been actioned in relation to the Infection Prevention and Control (IPC) audit which had been carried out at the Netherton branch surgery in July 2015.

• Review the clinical waste storage arrangements at the Netherton branch surgery. At the time of inspection the bulk waste bin was outside the practice awaiting collection. The bin lid was not secured due to a missing lock and therefore the clinical waste stored inside was open to the public.

• Review the immunity status of staff in relation to measles, mumps, rubella and chickenpox in order to assure themselves that their staff are adequately protected in line with the latest guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 November 2016

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 such as diabetes and pain management. The practice kept registers of patients with long term conditions and used these to effectively manage treatment packages which included structured examinations, the development of personalised care plans and regular reviews.
• The practice offered online consultations with secondary care specialist consultants. (An online consultation is a mechanism that enables primary care providers such as GPs to obtain specialist input into a patient's care and treatment without requiring the patient to attend a face-to-face visit, by using IT based communication links and data sharing).

• The practice delivered dedicated diabetic clinics in conjunction with a local secondary care consultant and nurse. The practice also offered specialist care management for diabetes and enhanced services such as insulin initiation in-house. Performance in relation to diabetes was above local and national averages, for example 96% of patients on the diabetes register had a record of a foot examination and risk classification having been carried out in the previous 12 months, compared to a Clinical Commissioning Group (CCG) average of 89% and a national average of 88%.

• There was a designated area on the practice website which specifically gave information to patients in respect to cardiology.

• Longer appointments and home visits were available when these were needed by patients.

• 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 had begun to offer atrial fibrillation screening (atrial fibrillation is an abnormal heart rhythm characterized by rapid and irregular beating and the condition is associated with an increased risk of heart failure, dementia, and stroke). From 1 April 2016 399 patients had been screened and this had identified 16 patients who needed further investigation and of these patients six had some form of atrial fibrillation detected. These patients have all received further support and investigation, for example, three patients have received anticoagulant medication (anticoagulants are used to to prevent heart attacks, strokes, and blood clots) and one is awaiting a referral to an anticoagulation clinic. The patients have also received education with regard to diagnosis, treatment and management as well as having received anticoagulation counselling.  A partner from the practice with a specialist interest  in cardiology had developed atrial fibrillation screening guidelines which have been adopted by the Wakefield cardiology network.    

Updated 7 November 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. Monthly meetings were held with health visitors to discuss safeguarding issues.

• Childhood immunisation rates for the vaccinations given were above CCG and national averages.

• We were told by the practice that children and young people were treated in an age-appropriate way and were recognised as individuals.

• The practice provided a full range of family planning services and had recall systems in place to support patients in receipt of these services. In addition staff had received c-card training (the c-card programme aims to give improved access to contraceptives to young people).

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

• The practice had a system in place to contact new mothers to arrange six week mother and baby checks.

Updated 7 November 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, this included offering housebound patients home visits by GPs and a member of the nursing team.

• The practice delivered care to 58 patients who lived in three residential/nursing homes. This care involved weekly visits to the homes where care needs would be met and reviews carried out.

• The practice hosted an Abdominal Aortic Aneurysm (AAA) screening programme for male patients over 65 years of age (AAA isa swelling of the aorta, the main blood vessel that leads away from the heart, down through the abdomen to the rest of the body). In 2015/2016 74 patients were screened and two aneurysms were detected. These two patients were followed up by the programme coordinators and received necessary secondary care support.

• Annual flu, pneumococcal and shingles vaccination programmes were delivered by the practice; these included vaccinations administered at dedicated weekend clinics.

• The practice delivered an avoiding unplanned admissions service which provided proactive care management for patients who had complex needs and were at risk of an unplanned hospital admission. At the time of inspection the practice had 194 patients (around 2% of the practice list) on their avoiding unplanned admissions register.

• The practice offered electronic prescribing, sending prescriptions direct to the patient’s pharmacy of choice. This made the prescribing and dispensing process more efficient and convenient for patients.

Updated 7 November 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. For example, the practice offered extended hours access on a Saturday morning 8am to 11am with a GP and a nurse and patients were able to make appointments, request prescriptions and view their medical records online.

• Telephone consultations were available with GPs and nurses.

• The practice was proactive in offering a full range of health promotion and screening that reflects the needs for this age group. This included referrals to other health partners such as health trainers and hosting clinics for patients with mental health issues

• The practice participated in the Measles, Mumps and Rubella and Meningitis C catch up programme for young people.

Updated 7 November 2016

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

• The practice had developed a protocol to alert GPs and nurses should a patient with a firearm certificate develop mental health problems. Letters received from the Police informing the practice that an individual held a firearms certificate were scanned into the patient record and a code added to inform staff of this. This had been used on one occasion and enabled the practice and Police to work together to support a firearms certificate holder who had expressed suicidal thoughts.

• The practice hosted a weekly clinic with a local provider for patients from their own and other practices that had mental health issues. Patients could self-refer for an appointment at this clinic or could attend on a drop-in basis.

• Templates used for NHS health checks and over 75s health checks contained a dementia screening tool.

• Annual dementia reviews were carried out with patients on the dementia register and appointments dates were sent in writing to patients to help them remember when these reviews were due. Additional support was offered to patients with dementia when they attended the surgery.

• 94% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive and agreed care plan documented; this was above the local CCG average of 89% and the national average of 88%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. In addition the practice regularly monitored the records of patients with mental health issues to ensure checks and reviews had taken place.

• The practice carried out advance care planning for patients with dementia.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 7 November 2016

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

• The practice held registers of patients living in vulnerable circumstances including those with a learning disability.

• The practice offered longer appointments for patients with specific needs such as the frail elderly with complex needs.

• 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.

• A member of staff had received level one training in British Sign Language.

• Flags on patient’s notes alerted staff when a patient had a hearing impairment and may need extra support.