Archived: St Nicholas Health Centre

Updated 11 January 2017

St Nicholas Health Centre provides primary medical services, including minor surgery, to approximately 11,500 patients in Stevenage, Hertfordshire. Services are provided on a General Medical Services (GMS) contract (a nationally agreed contract). St Nicholas Health Centre was purpose built in 1973. A complete refurbishment of the building was carried out in 2012.

The practice serves a higher than average population of those aged between 0 to 19 years and 35 to 49 years, and a lower than average population of those aged from 55 years and over. The population is 85% White British (2011 Census data). The area served is less deprived compared to England as a whole.

The practice has had a high staff turnover and the number of GP Partners has reduced from seven to two over the last two years. The practice has recruited additional nurses and are training nurses in minor illness to increase appointment availability. The practice have been actively attempting to recruit new GPs and has been holding discussions with local practices with a view to having a formal merger in place in the future.

The practice team consists of two GP Partners; one of which is male and one is female. There are two salaried GPs, two former GP partners who hold regular sessions and regular GP locums, four practice nurses, one of which is qualified to prescribe certain medications, and one Health Care Assistant. The non-clinical team consists of a practice business manager, assistant practice manager and a team of administration and reception team staff members.

St Nicholas Health Centre is an approved associate training practice for doctors who are undertaking further training (from four months up to one year depending on where they are in their educational process) to become general practitioners.

The practice is open to patients between 8am and 6:30pm Mondays to Fridays. Appointments with a GP are available from approximately 8.50am to 11.50am and from 2pm to 5pm daily. Emergency appointments are available daily. A telephone consultation service is also available for those who need urgent advice. The practice offers extended opening hours between 7am and 8.30am every Monday and Thursday, and from 8.30am to 12pm one Saturday each month.

Home visits are available to those patients who are unable to attend the surgery and the Out of Hours service is provided by Hertfordshire Urgent Care and can be accessed via the NHS 111 service. Information about this is available in the practice, on the practice website and on the practice telephone line.

Updated 11 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Nicholas Health Centre on 20 July 2016. Overall the practice is rated as requires improvement.

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. However, there was no evidence of learning and communication with staff in relation to reporting incidents and concerns.
• Not all governance structures, systems and processes were effective and enabled the provider to identify, assess and mitigate risks to patients, staff and others.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Patient comments highlighted that they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Improvements were made to the quality of care as a result of complaints and concerns. However, information about how to complain was not easily available.
• Patient comments highlighted that they found it easy to make an appointment with urgent appointments available the same day.
• There was a clear leadership structure and staff felt supported by management.
• The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider must make improvements are:

• Introduce systems to alert the practice of emerging risks such as in infection control, arrangements to deal with emergencies, fire safety, control of substances hazardous to health, significant events, staff appraisal, supervision and training.

• Ensure an accessible and effective system is in place so that patients are appropriately informed regarding how to make a complaint, including the recording of verbal complaints.

• Implement the actions required for the completion and effective management of all of the risks identified in the Legionella risk assessment.

• Ensure an appropriate system is in place for the safe monitoring of prescriptions.

• Ensure all clinical staff receive vaccinations in line with current national guidance and an effective system is in place to maintain a record of staff vaccinations.

The areas where the provider should make improvements are:

• Carry out a review of the practice policies to ensure they are practice specific and meet current legislation and guidance.

• Continue to monitor the results from the National GP Patient Survey and establish an action plan for areas which are identified as requiring improvement.

• Review the services available to patients who are hard of hearing or do not have English as their first language.

• Engage with the virtual Patient Participation Group in the delivery of the services provided.

• Ensure appropriate recruitment checks are completed for all non-clinical staff and an effective system is in place for the required checks to be undertaken prior to employment.

Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 October 2016

The practice is rated as inadequate for providing safe services and requires improvement for providing responsive and well-led services. The issues identified as inadequate and requiring improvement affected all patients including this population group.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The practice had developed personal health plans for patients with diabetes, one of the nurses had a lead role in managing diabetes and the practice worked closely with the local diabetic consultant who carried out an annual review of patients with diabetes.
• Performance for diabetes related indicators was above the CCG and national average. The practice had achieved 94% of the total number of points available, compared to the local and national average of 89%.
• 77% of patients diagnosed with asthma, on the register, had received an asthma review in the last 12 months which was comparable to the local and national average of 75%.
• Longer appointments and home visits were available when needed.
• All patients with a long-term condition 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.

Updated 10 October 2016

The practice is rated as inadequate for providing safe services and requires improvement for providing responsive and well-led services. The issues identified as inadequate and requiring improvement affected all patients including this population group.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and identified as being at possible 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.
• The practice’s uptake for the cervical screening programme was 81%, which was comparable to the CCG average of 83% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The senior nurse prescriber held minor illness clinics on a daily basis.
• The practice offered a range of family planning services. Baby vaccination clinics and ante-natal clinics were held at the practice on a regular basis. A community midwife held a clinic at the practice on a weekly basis.

Updated 10 October 2016

The practice is rated as inadequate for providing safe services and requires improvement for providing responsive and well-led services. The issues identified as inadequate and requiring improvement affected all patients including this population group.

• The practice offered proactive, personalised care to meet the needs of the older people in its population, this included enhanced services for avoiding unplanned admissions to hospital and end of life care.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments when required.
• The practice worked closely with a multidisciplinary rapid response service in place to support older people and others with long term or complex conditions to remain at home rather than going into hospital or residential care.
• The practice offered a health check for all patients aged 75 or over.
• A named GP carried out a weekly visit to a local care home for continuity of care. We spoke to the home manager who told us that the practice would respond to issues and that there was a good relationship with clinical staff.

Updated 10 October 2016

The practice is rated as inadequate for providing safe services and requires improvement for providing responsive and well-led services. The issues identified as inadequate and requiring improvement affected all patients including this population group.

• 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 provided a health check to all new patients and carried out routine NHS health checks for patients aged 40-74 years.
• Data showed 74% of female patients aged 50 to 70 years had been screened for breast cancer in the last three years compared to 72% locally and nationally.
• The practice was proactive in offering on line services such as appointment booking, an appointment reminder text messaging service and repeat prescriptions, as well as a full range of health promotion and screening that reflects the needs of this age group.
• A health and wellbeing specialist from the local public health team held a weekly session at the practice and provided information, advice about diet management and provided motivational and behavioural support. Patients were also signposted to local services.
• Extended opening times were available two mornings each week and during one Saturday each month.
• The practice told us that they would be providing an electronic prescribing service (EPS) in July 2016. EPS enables GPs to send prescriptions electronically to a pharmacy of the patient’s choice.

Updated 10 October 2016

The practice is rated as inadequate for providing safe services and requires improvement for providing responsive and well-led services. The issues identified as inadequate and requiring improvement affected all patients including this population group.

• 85% of patients diagnosed with dementia had their care reviewed in a face to face meeting in 2014/2015, which was comparable to the local average of 86% and national average of 84%.
• The practice held a register of patients experiencing poor mental health and offered regular reviews and same day contact.
• The practice referred patients to the Improving Access to Psychological Therapies service (IAPT) and encouraged patients to self-refer.
• Performance for mental health related indicators was better than the CCG and national average. The practice had achieved 100% of the total number of points available compared to 96% locally and 93% nationally.
• 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 A&E where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• The practice had doctors with a special interest in mental health and the practice worked closely with the community psychiatric nurse (CPN) and child and adolescent mental health services (CAMHs).

Updated 10 October 2016

The practice is rated as inadequate for providing safe services and requires improvement for providing responsive and well-led services. The issues identified as inadequate and requiring improvement affected all patients including this population group.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability and had completed 16 health checks out of 38 patients on the learning disability register since April 2016.
• It offered longer appointments and annual health checks for people with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• Vulnerable patients had been told how to access various support groups and voluntary organisations.
• The practice maintained a list which highlighted vulnerable patients to all staff. Practice staff provided flexible and additional support services to these patients.
• The practice had developed shared care services and worked alongside local community drug services and charities in place to support people with addictions.
• The practice had close links to a local women’s resource centre which provided support to vulnerable women.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. However, not all of the staff members had completed safeguarding training. Staff members 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.