Greengate Medical Centre

Updated 21 December 2018

Greengate Medical Centre is a GP practice providing primary medical services under a General Medical Services (GMS) contract to around 11,600 patients with an increasing list size.

The registered provider of services is Greengate Medical Centre and they are registered to deliver the regulated activities of diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury. The provider is registered with CQC to deliver these services from one location; Greengate Medical Centre at 1, Greengate Lane in Birstall. Leicester which we visited as part of our inspection.

Birstall is a suburb three miles north of Leicester City centre. The practice is housed in a large residential property which has been converted and extended. There is disabled access to the ground floor, disabled parking and short stay parking on site. There is an independent pharmacy adjacent to the surgery. The practice’s services are commissioned by West Leicestershire Clinical Commissioning Group (WLCCG).

The practice is in an area of low deprivation. The practice population has a higher than local and national average of patients over the age of 75. The practice has around 70 patients in a local care home. There is a permanent site for travelling families close to the practice.

The practice has six GP partners. Four GPs work full-time and two are part-time. There is one female GP and five male GPs. There are two practice nurses, two health care assistants and a phlebotomist (who also works on reception). They are supported by a practice manager, an assistant practice manage and a team of administrative and reception staff.

Greengate Medical Centre is open between 8am and 6pm Monday to Friday. A duty doctor is available until 6.30pm and appointments are available each day from 8.05am to 10.45am and from 2.30pm until 5.40pm. Extended hours appointments are also available to patients at additional locations within the area. This service is commissioned by West Leicestershire CCG. Primecare provide services between 6pm and 6.30pm Monday to Friday From 6.30pm to 8am and at weekends, out of hours services are accessed by calling the NHS 111 service. Patients are directed to the correct numbers if they phone the surgery or via the practice website when it is closed.

Updated 21 December 2018

This practice is rated as Good overall. (Previous inspection March 2018 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced focused inspection at Greengate Medical Centre on 6 November 2018. The inspection was carried out to follow up on a breach of regulations identified at our inspection in March 2018. At that inspection the rating for the key question of well led was requires improvement. During this inspection we looked at the key questions of safe and well led.

At this inspection we found:

• The system and processes in place to maintain the cold chain had been fully reviewed and were now operating effectively.
• The storage of equipment and medicines had been reviewed and rationalised and medicines and equipment were readily accessible if required in an emergency.
• Recruitment information was now readily available in staff files and assurance gained that all necessary employment checks had taken place, including in respect of locum GPs.
• The system for maintaining oversight of staff training had been improved and all training was now up to date.
• Practice policies had been reviewed and the practice acted in accordance with their policies.
• Information about the complaints process was readily available to patients.
• The mitigating actions identified by means of risk assessment were being followed.
• Systems and processes within the practice were operated effectively. Governance arrangements maintained oversight of all areas.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Updated 3 March 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 worked closely with visiting specialist nurses.

• Patients at risk of hospital admission were identified as a priority.

• 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. This work was supported by the new post of clinical care coordinator.

• The practice had established a screening programme for diabetes and the number of patients who were identified as being at risk of diabetes had increased from 189 to 234 in a year. These patients were offered annual checks and lifestyle counselling by the health care assistant who provided this service.

• Prevalence of diabetes had increased and the diabetic practice nurse had increased her hours to help address this. The practice was able to offer insulin initiation.

• The practice offered anticoagulant monitoring saving patients regular hospital trips.

• The practice had started to develop its own templates to help ensure that patients with several long-term conditions received consistent care and were offered a longer appointment to review all their conditions.

Home visits were available when needed.

Updated 3 March 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. The practice told us they maximised uptake by offering immunisation and asthma checks for young people during school holidays

• Data showed that 77% of patients with asthma had been given an asthma review in the last 12 months.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals. Chlamydia screening packs were available in different areas of the practice.

• Data showed 84% of eligible women had received a cervical screening test.

• Appointments were available outside of school hours and the premises were suitable for children and babies. The practice offered 24 hour and six week baby checks.

Staff told us they had good working relationships midwives and health visitors and we saw notes of meetings evidencing this.  

Updated 3 March 2016

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of older people in its population.

• It had developed a comprehensive bespoke risk stratification tool to identify patients most at risk of hospital admission. Each patient had a personalised care plan and an alert was put on the patient record. Any admissions were reviewed to identify avoidable factors.

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

• The practice had created a register of housebound patients were offered a home visit health and social care check by the GP or practice nurse.

Updated 3 March 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 offered services that were accessible, flexible and, where possible, offered continuity of care.

• The practice offered a range of online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Appointments could be pre-booked four weeks in advance. Urgent same-day appointments and telephone consultations were available.

Updated 3 March 2016

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

• 87% of patients living with dementia had a face-to-face care review in the previous 12 months

• 90% of patients with mental health problems had a comprehensive agreed care plan on their records which is comparable with national figures.

• 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 provided patients experiencing poor mental health with information 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. The practice had also scheduled a practice learning event with input from the Alzheimer's Society.

Updated 3 March 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 and staff were aware of individual patient needs such as what time of day a patient might prefer their appointment.

• Patients with learning disabilities were offered annual health checks and the practice had achieved an 84% uptake.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. The clinical care coordinator had weekly contact with health visitors and she kept other staff up-to-date and put appropriate alerts on patient records.

• 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.