Archived: Hadley Health Centre

Updated 17 September 2015

Hadley Health Centre is located in Hadley, Telford. It is part of the NHS Telford and Wrekin Clinical Commissioning Group. The total practice patient population is 3,565. The practice has a higher proportion of patients aged 18 years and younger (46.3%) than the practice average across England (32.2%). Approximately 53% of the practice’s patients are of Asian descent. The practice is a tenant at the Health Centre and NHS Property Services are responsible for the maintenance of the building.

The staff team comprises of a full time male lead GP providing eight sessions per week and a female long term locum GP providing six sessions per week. The practice team includes an Advanced Nurse Practitioner/prescriber working 32 hours per week, an administrator/practice manager working 30 hours per week, and three reception staff working a variety of part time hours. In total there are seven staff employed at the practice.

Hadley Health Centre opening times are 8:30am to 6pm Monday to Friday. The practice closes for lunch but the practice staff answer phone calls between 1-2pm.The practice does not provide an out-of-hours service to its own patients but has alternative arrangements for patients to be seen when the practice is closed through Shropdoc, the out-of-hours service provider. During the period between 8am and 8.30am when the out-of-hours service is transferred to the practice calls are directed through to the GP.

The practice telephones switch to the out of hours service at 6pm each weekday evening and at weekends and bank holidays.

The practice provides a number of clinics, for example long-term condition management including asthma, diabetes and high blood pressure. It also offers child immunisations, travel vaccinations and minor surgery.

The practice has a General Medical Services (GMS) contract with NHS England. This is a contract for the practice to deliver general medical services to the local community or communities. It also provides some Direct Enhanced Services, such as the childhood vaccination and immunisation scheme, minor surgery, and in facilitating a timely diagnosis and support for patients with dementia.

Updated 17 September 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hadley Health Centre on 10 July 2015. Overall the practice is rated as inadequate.

Specifically, we found the practice inadequate for providing safe, effective, and well led services. It required improvement in providing a responsive and caring service. There were aspects of practice which were inadequate and related to all population groups, it was also therefore inadequate for providing services for the all population groups.

Our key findings across all the areas we inspected were as follows:

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example appropriate recruitment checks on staff had not been undertaken prior to their employment and no recruitment records were held by the practice.

• Staff were clear about reporting incidents, near misses and concerns but the systems in place were not robust and there was no evidence of learning and communication with staff.

• There was insufficient assurance to demonstrate people received effective care and treatment.

• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.

• There was a leadership structure with named members of staff in lead roles, but limited formal governance arrangements.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure recruitment arrangements include all necessary employment checks and that appropriate records are held for all staff. Ensure there is a robust recruitment policy in place for staff to follow.
• Put systems in place to ensure all clinicians are kept up to date with national guidance and guidelines.
• Ensure audits of practice are undertaken, including completed clinical audit cycles.
• Ensure there are formal governance arrangements in place including systems for assessing and monitoring risks and the quality of the service provision.
• Ensure staff have appropriate policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.
• Ensure the availability of medicines required in the event of an emergency are available such as oxygen. Oxygen is considered essential in dealing with certain medical emergencies. Ensure where there is an absence of emergency medicines, such as those used to treat suspected meningitis and seizures that an appropriate risk assessment is carried out to identify why they are not suitable for the practice to stock, and how this is kept under review.
• Complete a review of staffing sufficiency to ensure there are sufficient numbers of suitably qualified skilled and experienced staff.
• Complete an Infection Prevention and Control audit as the last audit took place in 2012.
• Ensure that all products subject to Control of Substances Hazardous to Health (COSHH) requirements are stored appropriately.

In addition the provider should:

• Consider equality and diversity training for all staff.
• Consider a practice website to improve patient access to information regarding the services it provides.
• Set up a patient participation group to assist the practice in gaining meaningful patient feedback.
• Ensure there is leadership capacity to deliver all improvements.

On the basis of the ratings given to this practice at this inspection I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 September 2015

The practice is rated as inadequate for the care of people with long-term conditions. There were aspects of the practice which were inadequate and these related to all population groups. The Advanced Nurse Practitioner had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP communicated with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 17 September 2015

The practice is rated as inadequate for the care of families, children and young people. There were aspects of the practice which were inadequate and these related to all population groups. 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. Appointments were available outside of school hours and the premises were suitable for children and babies. Every month the practice held a meeting with the health visitor. The agenda included children registered at the practice who were subject to protection plans.

Updated 17 September 2015

The practice is rated as inadequate for the care of older people. There were aspects of the practice which were inadequate and these related to all population groups. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Updated 17 September 2015

The practice is rated as inadequate for the care of working-age people (including those recently retired and students). There were aspects of the practice which were inadequate and these related to all population groups. The age profile of patients at the practice is mainly those under 18 years old and of working age, students and the recently retired but the services available did not reflect the needs of this group. Appointments could only be booked by telephone or in person and there were no early or extended opening hours for working people. There was a low uptake for both health checks and health screening.

Updated 17 September 2015

The practice is rated as inadequate for the care of people experiencing poor mental health (including people with dementia). There were aspects of the practice which were inadequate and these related to all population groups. The practice told patients experiencing poor mental health about how to access various support groups and voluntary organisations including MIND and SANE. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. The clinical staff said they had received training on how to care for people with mental health and dementia needs, however there were no accessible staff training records held at the practice to review. Staff described the dementia tool they were trained to use and that they referred patients to a local memory clinic. Of the 33 patients experiencing poor mental health their electronic systems showed that 27% had a care plan agreed. There were seven patients registered as living with dementia and only 25% had had a face to face review, however the practice systems demonstrated that 100% of those assessed as requiring a blood test had been completed. The Advanced Nurse Practitioner was unsure of why their systems suggested these figures and thought it could be due to a practice coding error. Dementia screening was undertaken and patients would be followed up with a referral to the memory clinic.

Updated 17 September 2015

The practice is rated as inadequate for the care of people whose circumstances may make them vulnerable. There were aspects of the practice which were inadequate and these related to all population groups. The practice told vulnerable patients about how to access various support groups and voluntary organisations. The practice held a register of patients living in vulnerable circumstances including those with a learning disability. It had carried out opportunistic annual health checks for patients with a learning disability, longer appointments and they had received a follow-up. Staff at two local learning disability care homes praised the practice and found the relationships and communication between the practice and these services to be exceptionally good. The practice was not involved in regular meetings with multi-disciplinary teams in the case management of vulnerable patients.The practice had no adult safeguarding policy or contact numbers available for staff to refer to. Non-clinical staff were unaware as to whether they had received safeguarding adults training and could not readily access adult safeguarding information or contact numbers. During the course of the inspection, the Advanced Nurse Practitioner (ANP) sourced the adult safeguarding team contact numbers for staff to refer to and placed the local authority safeguarding policy into the practice policy file.