Moorland Medical Centre

Updated 25 July 2017

Moorland Medical Practice is registered with the Care Quality Commission (CQC) as a partnership provider in Leek, North Staffordshire. The practice holds a General Medical Services (GMS) contract with NHS England. A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract.

The practice area is one of low deprivation when compared with the national and local Clinical Commissioning Group (CCG) area. At the time of our inspection the practice had 8,861 patients. There is a higher proportion of older patients registered with the practice when compared with the national practice average. For example, 22% of the practice population are over 65 years old compared with the national average of 17% and 10% of the practice population are over 75 years old compared with the national average of 8%. The percentage of patients with a long-standing health condition is 69% which is higher than the local CCG average of 57% and the national average of 53%. These statistics could mean an increased demand for GP services.

The practice is open between 8am and 6pm Monday to Friday except Thursdays when it closes at 5pm. Appointments are from 8am to 12.30pm every morning and 2pm to 5.20pm daily. It provides extended opening hours between 6.30pm and 8.45pm on Mondays. Patients can book appointments up to six weeks in advance. The practice does not routinely provide an out-of-hours service to their own patients but patients are directed to the out of hours service, Staffordshire Doctors Urgent Care when the practice is closed.

The practice staffing comprises of:

• Five GP partners (three female and two male)

• Three female GP Registrars

• Three female advanced nurse practitioners

• Four female practice nurses

• A care home nurse practitioner

• Two female health care assistants

• A practice manager

• A team of administrative and ancillary staff working a range of hours.

The practice provides a number of specialist clinics and services. For example long term condition management including asthma, diabetes and high blood pressure. It also offers services for family planning, childhood immunisations, smoking cessation, travel vaccinations, antenatal and postnatal care. The practice is a training practice for GP registrars and medical students to gain experience and higher qualifications in general practice and family medicine.

Updated 25 July 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Moorland Medical Centre on 28 November 2016. The overall rating for the practice was good with requires improvement in providing safe services. The full comprehensive report on the 28 November 2016 inspection can be found by selecting the ‘all reports’ link for Moorland Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 10 July 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in the regulation that we identified in our previous inspection on 28 November 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.

Our key findings were as follows:

• Appropriate recruitment checks had been carried out for all staff including locum GPs.

• Non-clinical staff who chaperoned had received appropriate training and a Disclosure and Barring Service (DBS) check.

• Formal systems for reviewing patients prescribed a high risk medicine had been implemented.

• Risk assessments had been completed to identify which emergency medicines should be held at the practice.

We also saw the provider had implemented the best practice recommendation we previously made in relation to providing a well-led service:

• Policies and the business continuity plan had been dated so staff knew which version to refer to for guidance.

However, there was an area of practice where the provider needs to make improvements.

The provider should:

• Obtain recent photographic proof of identity of all members of staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 January 2017

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

• Performance for diabetes in all five related indicators was in line with the Clinical Commissioning Group (CCG) and national averages. For example, the percentage of patients with diabetes, on the register, whose last measured total cholesterol was within recognised limits was 84% which was higher than the CCG and national averages of 80%.

• The percentage of patients with chronic obstructive pulmonary disease (COPD) who had had a review in the preceding 12 months was 65%. This was below the CCG average of 89% and the national average of 90% however the practice had taken action to improve this.

• Longer appointments and home visits were available when needed.

• All these patients had 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.

• Health care assistants and practice nurses provided home visits for housebound patients with long term conditions.

• The practice had a Home Blood Pressure Monitoring system in place and a blood pressure monitoring machine in the waiting room.

• There was Responsive Home Care Service for housebound patients that provided such services as flu immunisations, foot checks and blood testing.

Updated 23 January 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. Immunisation rates were high for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way.

• The practice’s uptake for the cervical screening programme was 80%, which was comparable to the Clinical Commissioning Group (CCG) and national averages of 82%.

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

• The practice held six weekly meetings with the health visitors and school nurses where they discussed any safeguarding concerns.

• The practice had an effective system in place to follow up children who failed to attend for their immunisations.

• There were information links on the practice’s website providing parents and young patients with support with issues such as bullying and bed wetting.

Updated 23 January 2017

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

• The practice had a specialised team that provided care to frail older patients. The team included a care home nurse practitioner, GPs, a data quality co-ordinator, practice nurses and a health care assistant.

• The practice provided dedicated weekly ward rounds to their nursing, residential and warden controlled homes.

• Individual care plans were in place for older patients most at risk.

• Bi-monthly Integrated Local Care Team (ILCT) meetings were held at the practice where patients’ needs were discussed by health and social care professionals.

Updated 23 January 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 reflects the needs for this age group.

• The practice offered extended opening hours between 6.30pm and 8.45pm on Mondays.

Updated 23 January 2017

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

• The percentage of patients with a diagnosed mental health condition who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months was 62%. This was below the CCG and national averages of 89% however their exception reporting rate was 5%. This was lower than the CCG average of 10% and the national average of 13% meaning more patients had been included. The practice had taken action to make improvements in this area.

• Seventy-eight per cent of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. This was below the CCG average of 87% and the national average of 84%.

• 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.

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

• The practice provided weekly wards rounds at three local mental health hospitals.

• The practice had been piloting weekly support from a community psychiatric nurse to discuss patients experiencing poor mental health.

Updated 23 January 2017

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 carers and 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.

• The practice had identified 2% of their patients as carers and policies and procedures in place to support them.

• The practice held regular meetings with the ILCT & palliative care team to address the needs of vulnerable patients.

• The practice had identified their 4% most vulnerable patients. Through the use of care plans, home visits and education of care home staff, a care home nurse practitioner supported many of these patients who were living in care homes to avoid unplanned hospital admissions.

• The practice provided a substance misuse prescribing service for patients with drug related problems.