Archived: Henley Green Medical Centre

Updated 6 December 2017

Henley Green Medical Centre provides care and treatment to approximately 4,600 patients from the Henley Green area of Coventry. The practice is part of the NHS Coventry and Rugby Clinical Commissioning Group (CCG) and operates on a General Medical Services (GMS) contract. The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities.

The practice provides services from the following address, which we visited during this inspection:

Henley Green Medical Centre

Henley Road

Coventry

CV2 1AB

The surgery is located in a purpose built building which was erected in 1989. All reception and consultation rooms are fully accessible for patients with mobility issues. An on-site car park is available and on-street parking is also available nearby. Since our January 2017 inspection, the practice has developed plans to extend the practice building and a planning application was due to be decided shortly after our inspection in September 2017.

The surgery is open from 8am to 6.30pm on a Monday, Tuesday, Wednesday and Friday (appointments from 8.30am to midday then 3pm to 6pm) and from 8am to 1.30pm on a Thursday (appointments from 8.30am to midday). The service for patients requiring urgent medical attention out-of-hours and on a Thursday afternoon is provided by West Midlands Ambulance Service/Coventry and Warwickshire Partnership Trust through the NHS 111 service.

Extended hours appointments are available in conjunction with other local practices within the GP Alliance from 6.30pm until 9.45pm on weekdays and from 10am to 4pm on Saturdays and 10am to 2pm on Sundays. This offers appointments with GPs and a practice nurse.

Henley Green Medical Centre offers a range of services and clinic appointments including long term condition reviews, smoking cessation, family planning, childhood health and ante and post-natal services. The practice also offers minor surgery, spirometry and phlebotomy services.

The practice consists of:

• Three GP partners (two male and one female)

• Two salaried GPs (female)

• Two practice nurses (both female)

• Two healthcare assistants (female)

• Non-clinical members of staff including a practice manager, medical secretary, prescription clerks, an IT assistant, receptionists, a scanner and a summariser.

The practice has been a training practice since 2014 and involved in the training of qualified doctors interested in pursuing a career as a GP. The practice has also been accredited with the Primary Care Research Network (PCRN) as a ‘research ready’ practice since 2011. This means that the practice is actively involved in clinical research and their patients are able to participate in clinical trials should they wish to do so.

Since our January 2017 inspection, the practice had merged with another local practice, The Crossley Practice. This was operated as a branch surgery and patients could obtain appointments at either practice. The Crossley Practice had migrated to the same computer system used by Henley Green Medical Centre. It is envisaged that the merged practices would continue to deliver services from both sites until the proposed expansion and refurbishment of Henley Green Medical Centre was completed which would not be before 2018.

Additionally, since our January 2017 inspection, the practice has joined the local GP Federation, a group of practices who work together to improve healthcare within the local area.

Updated 6 December 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection of Henley Green Medical Centre on 10 January 2017. The practice was rated as requires improvement overall, with safe rated as inadequate. The full comprehensive report on the January 2017 inspection can be found by selecting the ‘all reports’ link for Henley Green Medical Centre on our website at www.cqc.org.uk.

This inspection was a follow up comprehensive inspection carried out on 26 September 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 10 January 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice is now rated as Good.

Our key findings were as follows:

• The practice had carried out necessary training to enable staff to carry out the duties they are employed to perform safely and effectively.

• Appropriate pre-employment checks were completed for all staff employed by the practice in line with their recruitment policy.

• Risks to the health and safety of staff and service users receiving care and treatment were assessed and effectively managed.

• Staff who acted as a chaperone had received a Disclosure and Barring Service (DBS) check and appropriate training.

• The practice had an effective programme of quality improvement activity including clinical audit.

• There was an effective system in place to enable the practice to ensure that appropriate action had been taken in relation to patient safety alerts.

• Staff had been briefed on the existence of the practice business continuity plan, business continuity arrangements and their responsibilities in relation to this.

• The practice had reviewed the decision that GPs do not carry a range of emergency medicines for use in acute situations when on home visits and had undertaken a risk assessment in relation to this. The practice will review this every three months.

• Staff had received Hepatitis B immunisation boosters.

• The practice had continued to improve the arrangements in place to monitor patients being prescribed high risk medicines and had changed the re-authorisation of these from every six months to every three months.

• The practice had encouraged patients to engage with national cancer screening programmes, especially in relation to screening for breast cancer and had signed up to take part in a Coventry-wide initiative due to take place in 2017.

• An additional GP partner had been appointed and this had enabled lead roles and governance to become more clearly defined.

• The practice had joined the local GP federation, a group of practices who worked together to improve healthcare with the locality.

However there was an area of practice where the provider should make improvements:

• The practice should continue to closely monitor data for the cervical screening programme and identify ways to increase patient take up when possible.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 6 December 2017

The provider had resolved the concerns identified at our inspection on 10 January 2017 which applied to everyone within this population group. The population group rating has been updated to reflect this. The practice is now rated as good for the care of people with long-term conditions.

• Patients had a named GP and a review every six to 12 months to monitor their condition and ensure they received correct medicines. The frequency of the review depended on the severity of the patient’s condition.

• The practice’s computer system was used to flag when patients were due for review. At the time of our previous inspection, the practice had moved towards offering patients with multiple long term conditions one fully comprehensive review whenever possible. This system had successfully continued.

• QOF data for 2016/17 provided by the practice showed that they had achieved mixed outcomes in relation to the conditions commonly associated with this population group. For example the practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with chronic kidney disease, depression and epilepsy but had scored below local and national averages for chronic obstructive pulmonary disease, diabetes, hypertension and secondary prevention of coronary heart disease. However, the data for 2016/17 showed patient outcomes had improved from the previous year (2015/16) with an overall attainment of 95%. This was above the 91.3% achieved for 2015/16 compared to the local CCG average of 94.5% and national average of 95.4%. The practice had introduced additional patient recall for those with long-term conditions to follow-up those who failed to attend for reviews to reduce exception reporting.

• Nursing staff had received appropriate training in chronic disease management, for example asthma and diabetes.

• Longer appointments and home visits were available when needed.

Updated 6 December 2017

The provider had resolved the concerns identified at our inspection on 10 January 2017 which applied to everyone within this population group. The population group rating has been updated to reflect this.

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

• Systems were in place to identify children and young people who might be at risk, for example, those who had a high number of A&E attendances.

• Data available for 2015/16 showed that the practice childhood immunisation rates for the vaccinations given to two year olds were above the national average resulting in the practice scoring 97% compared to the national average of 91%. For five year olds this ranged from 90% to 100% (compared to CCG range of 95% to 99% and national range of 88% to 949%).

• A total of 81% of eligible patients had received cervical screening in the last 12 months. This was in-line with the national average of 81%.

• There were appointments outside of school hours and the practice building was suitable for children and babies.

• Family planning services were available and all the practice nurses were trained to carry out contraceptive pill checks.

Updated 6 December 2017

The provider had resolved the concerns identified at our inspection on 10 January 2017 which applied to everyone within this population group. The population group rating has been updated to reflect this. The practice is now rated as good for the care of older people.

• Older patients were given personalised care which reflected their needs.

• Care plans were in place with the most vulnerable older patients and used with multi-disciplinary teams to reduce unplanned hospital admissions. These patients had an alert placed on their patient records to ensure clinical staff were aware.

• Over the last 12 months all patients aged 75 and over had been invited for a health check. This included blood tests, fracture assessment, frailty assessment, and checks for depression and dementia. From those checks, the practice identified patients who needed further investigation and referred them appropriately.

• Nationally reported Quality and Outcomes Framework (QOF) data for 2016/17 showed the practice had achieved good outcomes for conditions commonly found amongst older people. For example, the practice had obtained 100% of the points available to them for providing recommended care and treatment for patients experiencing atrial fibrillation, heart failure and osteoporosis and for those requiring palliative care.

• Home visits were offered to patients who could not reach the practice.

• Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people.

Updated 6 December 2017

The provider had resolved the concerns identified at our inspection on 10 January 2017 which applied to everyone within this population group. The population group rating has been updated to reflect this.

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

• The practice ensured it provided services to meet the needs of the working age population, For example, extended hours appointments were available during evenings and weekends through the local GP Federation.

• Telephone consultations were available for patients who were unable to reach the practice during the day.

• A full range of services appropriate to this age group was offered, including travel vaccinations.

Updated 6 December 2017

The provider had resolved the concerns identified at our inspection on 10 January 2017 which applied to everyone within this population group. The population group rating has been updated to reflect this.

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

• QOF data for 2016/17 showed 80

• The practice worked with multi-disciplinary teams to provide appropriate care for patients with poor mental health. This included patients with dementia.

• Patients were able to access on site counselling and cognitive behavioural therapy services provided by the local Improving Access to Psychological Therapies (IAPT) team.

• The lead GP was in the process of undertaking a primary care diploma in mental health.

• Patients were signposted to appropriate local and national support groups.

• Staff demonstrated a good working knowledge of how to support patients with mental health needs and dementia.

Updated 6 December 2017

The provider had resolved the concerns identified at our inspection on 10 January 2017 which applied to everyone within this population group. The population group rating has been updated to reflect this.

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

• The practice supported vulnerable patients to access various support groups and voluntary organisations.

• There was a register of vulnerable patients including those with a learning disability.

• Longer appointments were available for patients with a learning disability.

• The practice worked with other health care professionals to provide care to vulnerable patients, for example, the district nursing team.

• Staff could recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities to share appropriate information, record safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.