Wingate Medical Centre

Updated 7 June 2016

Wingate Medical Centre is registered with CQC to provide primary care services. The practice is a long established GP practice within Kirkby in a purpose built building. The practice has a Primary Medical Services (PMS) contract with a registered list size of 12368 patients (at the time of inspection). The practice is based in one of the more deprived areas when compared to other practices nationally. The male life expectancy for the area is 75 years compared with the CCG averages of 76 years and the national average of 79 years. The female life expectancy for the area is 79 years compared with the CCG averages of 80 years and the national average of 83 years. The practice offers a range of enhanced services including minor surgery, flu vaccinations, timely diagnosis of dementia and learning disability health checks.

The practice has eight GP partners and seven salaried GPs (nine male GPs and six female GPs). They have one practice manager, a deputy manager, an I.T. technician, a pharmacist, four practice nurses, four domestic staff, three health care assistants and a number of administration and reception staff. The practice is a training practice for General Practitioner registrars. It is also a teaching practice hosting medical students on placement.

The practice has an appointment model where all patients receive a phone call from the GP to ascertain their needs. The practice is open Monday to Friday from 8am to 6.30pm. General practitioners start appointments and telephoning patients from 8am throughout the day. Patients requiring GP services outside of normal working hours are referred on to the local out of hours provider, Urgent Care 24.

Updated 7 June 2016

We carried out an announced comprehensive inspection at Wingate Medical Centre on 13 April 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 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. Feedback from patients about their care was consistently positive.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.
• The practice had introduced a new appointment model called a ‘Physician health assessment by telephone, (Phat.) This meant that all patients ringing the practice for an appointment received a telephone call back from a GP to discuss their needs and requests. The majority of patients liked the appointment system whereby they always spoke to a GP when needing an appointment.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice had strong and visible clinical and managerial leadership and governance arrangements. The practice had a clear vision with quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

• There was a high level of constructive engagement with staff and a high level of staff satisfaction.

• The practice invested in employing a diverse group of staff such as their own pharmacist and data technician to help them manage and develop their services.

• The practice used innovative and proactive methods to improve patient outcomes. The practice were proactive in developing their service and introducing new models of support such as their ‘Compound assessment model’ to help benefit their patients and their introduction to an intervention known as ‘Mindfulness.’
• The provider was aware of and complied with the requirements of the duty of candour.

There were areas of outstanding practice as follows:

• The practice had recently introduced a new model of support, the ‘Compound assessment model.’ The model supported a detailed review each year for patients with long term conditions and included four different professionals including: a health care assistant, a behaviourist, a practice nurse and a GP. The aim of the review was to provide a one stop shop helping patients to understand their condition and improve the way their condition was managed both at the practice and at home.

• The practice had introduced a series of clinics and services, including phlebotomy, travel vaccines, midwifery clinics, talking therapies provided by a councellor from the Primary Care Psychological Therapies Service (IAPT) and mindfulness sessions for supporting the wellbeing of patients. Some of the services provided onsite meant that patients could have their needs met at the local practice rather than travelling to the local hospital/external clinics.

The areas where the provider should make improvement are:

• Review recording systems for significant events so the outcomes and actions of all events are clearly identified and shared within staff teams.

• Develop a recording system for the management of blank prescriptions to show a clear audit trail of how they were managed.

• Review the strategic planning of completed audits for the practice.

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 June 2016

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

• The GPs had lead roles in chronic diseases and practice nurses held dedicated lead roles for chronic disease management. As part of this they provided regular, structured reviews of patients’ health. They had recently introduced a new model of support, the ‘Compound assessment model.’ The model supported a detailed review each year including four different professionals including a health care assistant, a behaviourist, a practice nurse and a GP. The aim being to provide a one stop shop helping patients to understand their condition and improve the way their condition is managed both at the practice and at home.

• Data showed that the practice was higher than and comparable with other practices nationally for the care and treatment of people with chronic health conditions such as diabetes. For example, the percentage of patients with diabetes, on the register, who had had an influenza immunisation was 99.45% compared to a national average of 94.45%.

• Longer appointments and home visits were available when needed. Staff had received training to help ‘flex’ appointments were needed with the practice nursing teams appointments to help facilitate good access to the practice nurse.

• The practice held regular multi-disciplinary meetings to discuss patients with complex needs.

Updated 7 June 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 those who were at risk. A GP was the designated lead for child protection.

• Staff we spoke with had appropriate knowledge about child protection and they had access to safeguarding policies and procedures.

• Child surveillance clinics were provided for 6-8 week olds and immunisation rates were comparable to the national average for all standard childhood immunisations.

• Appointments were available outside of school hours and the premises were suitable for children and babies. Baby clinics were held on a regular basis.

• Family planning services were provided and signposted to other local services.

• The practice was performing comparably to the local and national averages for cervical screening, data showed that the percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years (01/04/2014 to 31/03/2015) was 80.22% compared with 81.83%.

• Support is provided and signposted for services such as smoking cessation, alcohol and substance misuse.

Updated 7 June 2016

• The practice offered proactive, personalised care and treatment to meet the needs of the older people in its population. The community matron provided case management for patients with complex needs and multiple conditions. T

• he practice kept up to date registers of patients with a range of health conditions (including conditions common in older people) and used this information to plan reviews of health care and to offer services such as vaccinations for flu.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were similar to or better than local and national averages.

• GPs carried out weekly visits to local care homes to assess and review patients’ needs.

Home visits and urgent appointments were provided for patients with enhanced needs.

Updated 7 June 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.

• Telephone consultations were available and this meant patients did not always have to attend the practice in person.

• The practice provided a full range of health promotion and screening that reflected the needs of this age group.

• The practice was proactive in offering online services including the booking of appointments and request for repeat prescriptions. Electronic prescribing was also provided.

• The practice held minor surgery clinics each week with a selection of morning and evening appointments.

• A phlebotomy service was provided daily from 8am.

Updated 7 June 2016

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

• Data about how people with mental health needs were supported showed that outcomes for patients using this practice were comparable to national averages.

• The practice provided an enhanced service for screening patients to identify patients at risk of dementia and to develop care plans with them.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health and invited patients to these meetings.

• Processes were in place to prompt patients for medicines reviews at intervals suitable to the medication they took.

• Patients experiencing poor mental health were informed about how to access various support groups and voluntary organisations. The Primary Care Psychological Therapies Service (IAPT) was based at the practice and offered various support to patients.

• The practice had access to support from the Primary Care Mental Health Liaison Practitioner for Kirkby.

Updated 7 June 2016

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances in order to provide the services patients required. For example, a register of people who had a learning disability was maintained to ensure patients were provided with an annual health check.

• The practice offered longer appointments for patients with a learning disability. Medical receptionist were given permission to flex the appointment system as needed to facilitate good access. They involved carers and arranged appointments for when they could be present to attend.

• The practice have employed their own onsite pharmacist who provides support to patients both face to face and via the telephone whenever patients needed this support, including on discharge from hospital.

• 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.

• The practice support diverse groups of patients including a local women’s refuge, hostel and a violent patient’s scheme.

• The practice supported patients in accessing food bank vouchers when needed.

• The practice was accessible to people who required disabled access and facilities and services such as a hearing loop system (used to support patients who wear a hearing aid) and translation services were available.

• Information and advice was available about how to access a range of support groups and voluntary organisations.

• The practice facilitates a group known as TASC (Tailored Advice and Support for Communities). They attend weekly offering clinics for patients requiring information and advice with welfare benefits, council tax arrears, rent arrears, money and budgeting, fuel consumption and reducing outgoings.

• The practice used the ‘Gold Standard Framework’ (this is a systematic evidence based approach to improving the support and palliative care of patients nearing the end of their life) to ensure patients received appropriate care.