The Nile Practice

Updated 7 September 2017

The Nile Practice is registered with the Care Quality Commission (CQC) as partnership provider in Cheslyn Hay, Staffordshire. The practice is part of the NHS Cannock Chase Clinical Commissioning Group. 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. At the time of our inspection the practice had approximately 9,500 patients.

The practice operates from three sites. The main site is The Nile Practice – Cheslyn Hay, with branch sites in Cannock and Hednesford. The practice sites are located as follows:

• The Nile Practice – Cheslyn Hay, High Street, Cheslyn Hay, Walsall, WS6 7AE
• The Nile Practice – Cannock, Old Penkridge Road, Cannock, Staffordshire, WS11 1HX
• The Nile Practice – Hednesford Valley Health Centre, Station Road, Hednesford, Cannock, WS12 4DH

The staffing consists of:

• Three GP partner (two male and one female) and one female salaried GP (from August 2017).
• Two GP registrars (one male and one female).
• Three practice nurses, one part time healthcare assistant and three part time phlebotomists.
• A practice manager, a reception manager, reception staff and medical secretaries.

The main Cheslyn Hay site is open between 8am and 6.30pm Monday to Friday. The Cannock site is open between 8am and 6.30pm every day except on Thursdays when they close at 1pm. The Hednesford Valley Health Centre site is open between 8am and 6.30pm every day except Wednesdays when they close at 1pm. Extended hours appointments are available between 6.30pm and 7.30pm on Tuesdays at all three sites. The practice does not routinely provide an out-of-hours service to their own patients but patients were directed to the out of hours service, via the NHS 111 service when the practice is closed.

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 child health developmental checks and immunisations, travel vaccinations and NHS health checks. The practice is an accredited training practice for final year medical students and GP Registrars.

Updated 7 September 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at The Nile Practice on 1 November 2016. The overall rating for the practice was Good with the Safe domain being rated as Requires Improvement. We found one breach of a legal requirement and as a result we issued a requirement notice in relation to:

• Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Safe Care and Treatment.

The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for The Nile Practice on our website at www.cqc.org.uk.

The Nile Practice merged with Dr A Yi’s practice in April 2017. An announced comprehensive inspection at Dr A Yi was previously carried out on 15 January 2016. The overall rating for the practice was good with the safe domain being rated as Requires Improvement. We found two breaches of a legal requirements and as a result we issued requirement notices in relation to:

• Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Safe Care and Treatment.
• Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Fit and Proper Persons Employed

The full comprehensive report on the 15 January 2016 inspection can be found by selecting the ‘all reports’ link for Dr A Yi on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection on 18 July 2017. Overall the practice remains rated as good with the safe domain being rated as Requires Improvement.

Our key findings were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff demonstrated that they understood their responsibilities although not all staff were up to date with training on safeguarding children and vulnerable adults relevant to their role.
• Staff were aware of current evidence based guidance. Clinical staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey were very positive and showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available.
• Patients we spoke with said they were able to get an appointment when they needed one, with urgent appointments 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 proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements

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

The provider should:

• Ensure that all staff complete training as required by the practice. Proactively promote the range of appointments available to patients, in particular the pre-bookable and extended hours appointments.
• Consider including information about the patient reference group on the practice website.
• Ensure that practice meetings are held on a regular basis.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 September 2017

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

• The GP partners had lead roles for long term conditions and worked closely with the relevant practice nurse.
• Performance for diabetes related indicators was similar or above the Clinical Commissioning Group (CCG) and national averages. For example, the percentage of patients on the diabetes register, in whom a specific blood test to get an overall picture of what a patients average blood sugar levels had been over a period of time was recorded as 85% compared with the CCG and the national average of 78%.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• There was a system to recall patients for a structured annual review to check their health and medicines needs were being met. The practice had a structured system for inviting patients for their review or identifying patients who did not attend.
• For those patients with the most complex needs, the GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 7 September 2017

The practice is rated as good for the care of families, children and young people.

• We found there were systems to identify and follow up children living in disadvantaged circumstances and who were at risk.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives and health visitors to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

Updated 7 September 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.
• The practice followed up older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

Updated 7 September 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• 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 needs of these populations 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 extended hours on Tuesdays from 6.30pm until 7.30pm at all three sites for working patients who could not attend during normal opening hours.
• The practice offered all patients aged 40 to 75 years old a health check with the nursing team.

Updated 7 September 2017

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

• The practice carried out advance care planning for patients living with dementia.
• 93% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was above the national average.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia. Patients were invited for an annual review of their physical health needs.
• The percentage of patients experiencing specific mental health conditions with an agreed care plan documented in the preceding 12 months was 90% which was comparable to the Clinical Commissioning Group and national average.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

Updated 7 September 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 those with a learning disability.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.