Archived: Hartfields Medical Practice Also known as IntraHealth Limited

Updated 10 May 2016

Hartfields Medical Practice is situated in a purpose built older people’s retirement village surrounded by a new housing development. The practice opened in April 2009 with a zero list as an Alternative Primary Medical Service (APMS). The contract was for five years and currently the contract has been extended until March 2017. The practice attributes some of the difficulties in attracting a salaried GP over the past year to the uncertainty of the practice’s future.

Despite the practice being in a retirement village there is a lower than average number of older people and a large number of younger people on the practice list compared to the practice average across England. There are 2392 patients on the practice list. There are two locum GPs, both male, working a total of three days per week. The practice is also supported by two ANPs and a practice nurse. The ANP works three days per week when there is no locum GP in the practice. During this time they are supported by GPs and the medical director remotely from other practices in the intrahealth group, should they require clinical assistance. The ANP told us they felt well supported by these clinicians. There is a primary support manager who provides direction and managerial support to this practice and three others. The practice has a practice supervisor and other administration staff.

The practice is open from 8am to 6.30pm, Monday to Friday. The practice does not provide extended hours. We saw that appointments can be booked by walking into the practice, by the telephone and online. The practice does not use a telephone triage system. However telephone slots are offered to patients requesting a call back from the GP or nurse. These are booked at the end of each surgery. Patients requiring a GP outside of normal working hours are advised to contact the GP out of hour’s service provided by Northern doctors via the NHS 111 service. The practice is situated on the outskirts of Hartlepool. There is parking available at the practice and nearby. There are good transport links and access to public transport. For the majority of patients the practice is within walking distance.

Updated 10 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hartfields Medical Practice on 25 February 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, there was a corporate approach from the Intra Health senior governance board for the provider to centrally review all serious risks.
• 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.
• The majority of the patients said they found it easy to make an appointment. The practice used a long term locum GP as they had been unable to employ a salaried GP for a short fixed term contract. On the days that no locum was in the practice, cover was provided by an Advanced Nurse Practitioner (ANP). There had been some comments from patients about difficulties in the continuity of care with a named GP. We saw that urgent appointments were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs. The practice was situated in an older person’s retirement village.
• 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 long term locum GP was not actively involved in providing clinical leadership, which was provided by the clinical director corporately, the ANP and practice nurse.
• The provider was aware of and complied with the requirements of the Duty of Candour. This means providers must be open and transparent with service users about their care and treatment, including when it goes wrong.

The areas where the provider should make improvement are:

• Address the ongoing problems with phone lines which intermittently stop working.

• Carry out clinical audits and re-audits to improve patient outcomes.

• Ensure staff are aware of the Deprivation of Liberties safeguards (DOLs).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 May 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.

• Nationally reported data for 2014/2015 showed that outcomes for patients with long term conditions were good. For example, the proportion of patients on the diabetes register with a record of foot examinations in the preceding 12 months was 95% which was above the national average of 88%.

• Longer appointments and home visits were available when needed.

• All these patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the practice nurse, ANP and GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• The practice provided Healthy Heart and Healthy Lung checks for the practice population between the ages of 40-74.

Updated 10 May 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 average for all standard childhood immunisations.

• Nationally reported data from 2014/2015 showed 83.8% of patients diagnosed with asthma, on the register, had had an asthma review in the last 12 months which was above the national average of 75%.

• 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.

• Nationally reported data from 2014/2015 showed the proportion of women aged 24 -64 who had had cervical screening performed was 95.8% which was above the national average of 81%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 10 May 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 patients in its population. The older population in the practice was below the national average despite being housed in the retirement village.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Every patient over 75 had a named GP.

• Patients who were carers were identified and added to the carers’ register. Information about support groups and useful contact details was provided. The practice worked alongside Hartlepool carers and the GP liaison officer attended the surgery every two weeks interacting with patients to find and recognise unknown carers.

Updated 10 May 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 offered well women and well men clinics.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 10 May 2016

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

• 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.

Updated 10 May 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 homeless people and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• 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.