Archived: Sheepcot Medical Centre

Updated 20 January 2017

Sheepcot Medical Centre provides primary medical services to approximately 10,200 patients in Watford, Hertfordshire. The practice moved into a new purpose built premises in 2015 and services are provided on a General Medical Services (GMS) contract (a nationally agreed contract between NHS England and GP Practices).

The practice serves a slightly higher than average population of those aged between 45 and 54 years. The population is 84% White British (2011 Census data). The area served is less deprived compared to England as a whole.

The practice team consists of four GP Partners; three of which are male and one is female. There is one female salaried GP, one nurse practitioner, who is qualified to prescribe certain medicines, two practice nurses and two health care assistants. The non-clinical team consists of a practice manager, IT manager and 14 members of the administration and reception team.

Sheepcot Medical Centre is a teaching and training practice and has been approved to train student nurses and 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 Monday to Friday. Appointments with a GP are available from 8.30am to 11.30am and from 3pm to 5.30pm daily. Emergency appointments are available daily. The practice offers extended opening hours between 7am and 8am on alternate Tuesdays and Wednesdays, between 6.30pm and 7.30pm on alternate Mondays and between 8am and 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 and on the practice website.

At the time of our inspection the provider did not have a Registered Manager in place as required under the CQC (Registration) Regulations 2009. The practice told us that they were in the process of updating their registration with us to ensure their registration is accurate.

Updated 20 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sheepcot Medical Centre on 16 November 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.
• The practice told us that patients with a learning disability were provided with a telephone number to a dedicated phone line in order to contact the senior practice nurse who was the lead for learning disabilities. All of these patients were offered a home visit for their annual reviews.
• Shortly after the inspection the practice told us that they had been accredited with a Purple Star award in recognition of their work with vulnerable patients. This locally developed quality kite mark had been developed by service users, carers, the University of Hertfordshire Business School and the Community Learning Disability Service in Hertfordshire, to award services for providing good quality, accessible health care for adults with a learning disability.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• 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.
• 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 provider was aware of and complied with the requirements of the Duty of Candour.

The practice should make improvements in the following areas:

• Complete a periodic review of significant events to identify trends.
• Ensure all staff complete essential training relevant to their role, for example infection prevention and control.
• Continue to monitor and improve systems in relation to the patient review and recall processes.
• Implement a system to ensure annual health checks are completed for patients who are eligible for them.
• Review signage at the reception desk to promote patient confidentiality.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 January 2017

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

• Nurses had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• 85% of patients with diabetes, on the register, had a record of a foot examination, which was comparable to the local CCG and national average of 89%.
• 93% of patients aged 8 or over with asthma, on the register, with measures of variability or reversibility recorded between three months before or any time after diagnosis, which was in line with the local CCG average of 87% and national average of 89%.
• 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.
• The practice nurses and healthcare assistants provided chronic disease annual reviews to housebound patients within their homes.

Updated 20 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 identified as being at possible risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were comparable with the local and national average 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’s uptake for the cervical screening programme was 83% which was comparable with the local and national average of 82%.
• Appointments were available on the same day and outside of school hours.
• We saw positive examples of joint working with midwives and health visitors for vulnerable children and families.

Updated 20 January 2017

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. 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 offered a daily in house phlebotomy service to take blood samples from patients for required testing. This service was provided to elderly housebound patients.
• 67% of patients aged 65 years or over had received a seasonal flu vaccination between September 2015 and January 2016.
• The practice worked closely with a multidisciplinary team to support older people and patients considered to be in the last 12 months of their lives.
• A named GP carried out a weekly visit to a local care home. We spoke to the manager and one of the nurses at the care home and they told us the practice provided a good service. They described the practice as accessible and responsive to needs of their residents and were positive about all aspects of the services provided by the practice.
• The practice provided health checks for patients aged over 75 years. The practice told us that they had completed 120 health checks in the last 12 months, which was 16% of this population group.

Updated 20 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 on line services such as appointment booking, a 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.
• The practice provided an electronic prescribing service (EPS) which enabled GPs to send prescriptions electronically to a pharmacy of patients’ choice.
• Extended appointment times were available to patients on a daily basis through a locality wide initiative and the practice also offered extended appointment times on alternate weekdays and on a Saturday once a month.
• 55% of patients aged 60 to 69 years had been screened for bowel cancer in the last 30 months compared to the local CCG average and national average of 58%.
• 77% of female patients aged 50 to 70 years had been screened for breast cancer in the last three years which was comparable with the local CCG and national average of 72%.

Updated 20 January 2017

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

• The practice held a register of patients experiencing poor mental health and offered regular reviews and same day contact.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive care plan documented in the record, in the preceding 12 months, agreed between individuals, their family and/or carers as appropriate was 100%, which was above the local CCG average of 92% and national average of 89%. The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• NHS counsellors provided one-to-one sessions to patients at the practice on a regular basis.
• 82% of patients diagnosed with dementia had received a face-to-face review in the preceding 12 months, which was comparable with the local CCG average of 85% and national average of 84%.
• 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.

Updated 20 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 those with a learning disability. The practice had a system in place which highlighted any patient with a learning disability on their computer system.
• The practice told us that patients with a learning disability were provided with a telephone number to a dedicated phone line in order to contact the senior practice nurse who was the lead for learning disabilities. All of these patients were offered a home visit for their annual reviews. The practice had 32 patients on their learning disability register and all of these patients had received a health check in the 2015/2016 year. Shortly after the inspection the practice told us that they had been accredited with a Purple Star award in recognition of their work with vulnerable patients.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• Vulnerable patients had been told how to access support groups and voluntary organisations.
• Staff had accessed safeguarding training and knew how to recognise signs of abuse in vulnerable adults and children. 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.
• The practice held a register of carers with 141 carers identified, which was approximately 1.5% of the practice list.