Hadwen Health

Updated 16 September 2016

The Hadwen Medical Practice is located in Gloucester. Founded in 1986, the practice occupies a two-storey building with access for people with disabilities. Administrative offices are located on both floors. Prescribing, Information Technology and coding rooms are to be found on the ground floor, along with rooms for consulting and nurse treatment, and a reception area. A pharmacy leases a large space to the rear of the practice.

The Hadwen Medical Practice is one of 85 GP practices in the Gloucestershire Clinical Commissioning Group (CCG) area. The practice population is 98% white, with the largest minority ethnic population (around 1.6%) being Asian or Asian British.

Glevum Way Surgery is the main site of The Hadwen Medical Practice (address: Glevum Way, Gloucester, Gloucestershire GL4 4BL). There are local branch practices at The Wheatway (61 The Wheatway, Abbeydale, Gloucester GL4 5ET), and St Michael’s (St Michael’s Square, Gloucester GL1 1HX). Neither branch practice is more than four miles from the main site.

The branch practices were not inspected at this time. This report relates to the main site at Glevum Way. 80% of the practice’s patients are seen at Glevum Way Surgery.

The Hadwen Medical Practice has around 17,706 registered patients, most of whom live within a two to three mile radius of Glevum Way Surgery. The practice has lower than national average patient populations aged from 20 to 24, and 35 to 39 years of age. The patient populations aged from 0 to 4, and 45 to 49 years of age are higher than the national average. A measure of deprivation in the local area recorded a score of 7, on a scale of 1-10. A lower score indicates a more deprived area.

The practice team consists of eight GP partners (three male, five female) and five salaried GPs (all female). In addition, two nurse practitioners, five nurses, and five health care assistants are employed. The clinicians are supported by a Management Partner (who as the title suggests is both the manager and a partner in the practice), and a team of office assistants, secretaries and receptionists. The practice has a General Medical Services contract with NHS England (a locally agreed contract negotiated between NHS England and the practice).

The Hadwen Medical Practice is a training practice for doctors and currently has a training GP partner and one registrar.

The Hadwen Medical Practice is open from 8am to 6.30pm, from Monday to Friday, and from 8am to 11.30am on Saturday. Telephone contact is from 8.30am to 6pm, from Monday to Friday. A mix of pre-bookable and next day appointments, which can be booked up to two months in advance, were available from 8am to 6.30pm from Monday to Friday, and 8am to 11.30am on Saturday. The practice offered evening (6.30pm to 8pm) extended opening hours on Tuesday and Wednesday. Extended hours appointments are available to pre-book up to two months in advance.

The branch practice at The Wheatway was open from 8.30am to 12.30pm, Monday to Friday; and from 1.30pm to 6pm, Monday to Thursday. Appointments were from 8.30am to 12.30pm Monday to Friday; and from 1.30pm to 6pm on Friday.

The branch practice at St Michael’s Square was open from 8.45am to 12.30pm, on Monday, Tuesday, Wednesday and Friday; and from 1.30pm to 6pm on Monday and Friday. Appointments were from 8.45am to 12.30pm Monday to Friday, and from 1.30pm to 6pm on Monday and Friday.

The practice has opted out of providing Out Of Hours services to their own patients. Patients can access NHS 111 and an Out Of Hours GP service is available. Information about the Out Of Hours service was available on the practice website and displayed at the entrance to the practice.

The Hadwen Medical Practice provides regulated activities from its location at Glevum Way, Gloucester, Gloucestershire GL4 4BL.

Updated 16 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Hadwen Medical Practice on 21 June 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.
• Staff assessed patients’ needs and delivered care in line with current evidence-based guidance. Staff had 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.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice provided the initial health assessments for all children entering local authority care homes and known to Gloucestershire social services agencies. Templates developed by the practice were adopted country wide and led to faster information recording rates. In 2014, the Care Quality Commission noted that the practice had a clear approach and good processes in place to ensure that their vulnerable child databases were kept up-to-date.
• 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.
• When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology and were told about any actions to improve processes to prevent the same thing happening again.

We found one area of outstanding practice:

• The patient participation group (PPG) was well engaged and represented across all age groups, including two 16 year olds and two carers also engaged and providing a contribution. The PPG suggestions for changes to the practice management team had been acted upon and as well as this, the group had raised awareness about patient services. For example, following PPG suggestions, the practice changed the release time of its next day appointments to better suit patient needs, and invested in telephone monitoring software that alerted staff whenever a caller had been waiting for an extended period of time.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 September 2016

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.
• Data for patients with long-term conditions compared well with national figures. For example, the percentage of patients with a diagnosis of diabetes, on the register, whose last measured total cholesterol was that of a healthy adult, was 82%, compared to the national average of 81%.
• Longer appointments and home visits were available when needed.
• All these 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 increased the length of individual appointment times for patients with complex medical conditions.
• The practice offered home visits by its health care assistants for urgent blood tests, self-testing monitoring and the completion of annual reviews, including an annual review for its coeliac patients.

Updated 16 September 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, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. The practice assessed the capability of young patients using Gillick competencies. The competencies are a means to determine whether a child is mature enough to make decisions for themselves.
• The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years was 89%, compared to the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice offered a number of emergency appointment slots, including telephone consultations, each weekday.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• The practice offered a weekly drop-in clinic for baby immunisations.
• The practice provided the initial health assessments for all children entering local authority care homes and known to Gloucestershire social services agencies. Templates developed by the practice were adopted country wide and led to faster information recording rates. In 2014, the Care Quality Commission noted that the practice had a clear approach and good processes in place to ensure that their vulnerable child databases were kept up-to-date.

Updated 16 September 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.
• Older patients with complex care needs or those at risk of hospital admissions had personalised care plans which were shared with local organisations to facilitate continuity of care.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice initiated the use of a recognised clinical measure of fitness and frailty in older people to assess their health needs.

Updated 16 September 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.
• 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.
• Patients could book late appointments on two evenings per week.
• On-line prescribing was available, which enabled patients to order their prescription on-line.
• The practice nurses and health care assistants offered extended hours appointments on a Saturday morning.
• The practice reception team was split into specialist hubs for repeat prescribing and patient services to improve the processes used to issue repeat prescriptions, and reduce access difficulties for patients.
• The practice offered a range of flexible appointment options. These included:
  • Pre-bookable Saturday morning appointments for patients who could not attend during normal weekday opening hours.
  • Emergency appointment slots, including telephone consultations, each weekday.
  • A 12.30pm time for release of next day appointments, also available to be booked online.
  • Telephone appointments where appropriate, as an alternative to face to face consultations.
• The practice offered text reminders for appointments.

Updated 16 September 2016

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

• 83% of patients diagnosed as living with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the clinical commissioning group (CCG) average of 86%, and the national average of 84%.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose level of alcohol consumption had been recorded over the course of a year was 97%, which exceeded the national average of 90%.
• The practice regularly worked with multi-disciplinary teams in the case management of people 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.
• The practice had a system in place to follow up patients who had attended accident and emergency 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.
• Patients were referred to art therapy sessions at a local community centre to improve their mental health, general wellbeing and social interaction.
• The practice hosted a weekly clinic with a mental health nurse, for people experiencing mental health issues.

Updated 16 September 2016

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.
• 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 was proactive in ensuring that vulnerable patients who do not attend their scheduled appointments are visited by the practice nurse, assessed and if necessary, booked for a same day, emergency appointment at the practice.

• There is a dedicated carers area in the practice, with information provided regarding services and links to local organisations.