Archived: Gatehouse (Health) Ltd

Updated 7 July 2016

Gatehouse (Health) Ltd also known as the Fens Medical Centre, 434 Catcote Road,Fens Estate

Hartlepool, Cleveland. The practice is an Alternative Provider Medical Services APMS practice. These practices are primary care services provided by outside contractors. The practice is situated on the outskirts of Hartlepool town centre in a converted and extended dental premises behind a shopping centre. There is parking available near the practice. Many of the patients live within walking distance of the practice and there is good access to public transport. There is a mixed client group predominantly from the surrounding estates. There are 2719 patients on the practice list. The practice scored four on the deprivation measurement scale, the deprivation scale goes from one to ten, with one being the most deprived. People living in more deprived areas tend to have a greater need for health services. The practice population mirrors the practice average across England.

There are two GPs, one is the principle GP (female) and a salaried GP (male).There are two practice nurses, one advanced nurse practitioner, plus another practice nurse delivering diabetes care. There is one health care assistant (HCA) (all female). Much of the back office services such as human resources, finance, monitoring of significant events and the production of policies and procedures are provided by the company head office situated in another practice in Spenymoor. The practice has an acting senior medical administrator who takes on the day to day role of a practice manager.

The practice is open from 8am to 6.30pm, Monday to Friday. The practice provides some extended hours on a Saturday morning between 9am and 12.30pm. Appointments can be booked by walking into the practice, by the telephone and on line. 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.

Updated 7 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Fens Medical Centre on 9 June 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised. However we found that on three occasions the fridge temperature was above the recommended temperature and no reason or action had been recorded.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events referred to in the practice as critical incidents.

• Risks to patients were assessed and managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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. The practice promoted a no blame culture and encouraged staff to raise concerns and possible risks.
• The majority of 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.

• Feedback from patients about their care was consistently positive.

• 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 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.

In addition the provider should:

• The practice should assure themselves that they have process in place to ensure that the fridge temperatures are monitored and vaccines are stored at the correct temperatures.

• Address the  infection control issues identified during the inspection

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 July 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 percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5mmol/l or less was 80%). This was 3% below the local CCG average and the same as the England average 80%.

• 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 had introduced a care plan ‘Be The Best you can Be’. This is an annual health review and patient held care plan. The aim was to involve the patient in a holistic approach to the management of their care and conditions. This involved patients setting their own goals. The practice had commenced this work with patients suffering from chronic obstructive airways disease (COPD).

• The practice promoted self-management for some long term conditions. Examples of these were the use of rescue packs for patients with chronic lung disease (COPD) which h been successful.The practice was involved in the healthy lung and healthy heart checks.

Updated 7 July 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 held weekly clinical forum meetings attended by the practice leads and clinicians where they reviewed child safeguarding and discussed those children who did not attend pre-booked hospital appointments, GP or immunisation appointments.

• Nationally reported data from 2014/2015 showed the practice’s uptake for the cervical screening programme was 87 %. This was above the local CCG average which was 83% and the England 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 health visitors and school nurses.

• Young people were able to access contraception and screening for sexually transmitted diseases (STD).

Updated 7 July 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. Patients over the age of 75 had a named GP and nurse led annual reviews.

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

• The practice was delivering ‘The Care Home Scheme’ locally. This scheme ensured patients living in care homes had structured annual reviews. The care homes were visited on a fortnightly basis and home visits to the home when required. The staff visited the care homes to administer the flu vaccine.

• The practice had identified and reviewed the care of those patients at highest risk of admission to hospital. These patients who had an unplanned admission or presented at Accident and Emergency A&E had their care plan reviewed.

Updated 7 July 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.

• The practice provided Saturday morning appointments which offered a range of services such as contraception, smears, and dressings as well as GP appointments.

Updated 7 July 2016

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

• < >

  Nationally reported data from 2014/2015 showed the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in their record in the preceding 12 months was 100%, which was comparable to other practices and above the national average.

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

• Patients on medicines requiring regular monitoring and share care with mental health services were monitored regularly in the practice. Those patients with complex problems were reviewed regularly at multi-disciplinary meetings held in the practice. For patients who felt the stigma of attending mental health premises the practice offered the opportunity of having a consultation with the psychiatrist/therapist in the practice if they wished.

Updated 7 July 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 and provided a supportive and non-judgemental approach. Examples of these patient groups were drug and alcohol and 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. 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.