Northgate Medical Centre

Updated 23 December 2016

Northgate practice is in Aldridge, Walsall an area of the West Midlands. The practice is registered with the Care Quality Commission to provide primary medical services. The practice has a general medical services contract (GMS), a nationally agreed contract with NHS England. Under this contract the practice is required to provide essential services to patients who are ill and includes chronic disease management and end of life care.

The practice runs an anti-coagulation clinic, yellow fever vaccination clinic, enhanced family planning services and also provides enhanced services such as minor surgery, childhood vaccination immunisation schemes.

The practice is situated in a multipurpose building with other community services and another GP practice. Based on data available from Public Health England, the levels of deprivation in the area served by Northgate practice are ranked at eight out of ten, with ten being the least deprived. The practice has a registered list size of approximately 10,000 patients, with 28% of the patients aged 65 years and over, which was higher than the national average of 17%.

There are five GP partners (3 male, 2 female) and two salaried GPs (1 male, 1 female). The nursing team consists of one nurse prescribing practitioner, one practice nurse prescriber, one practice nurse and two health care assistants. The non-clinical team consists of a practice manager, administrative and reception staff.

The practice is a training practice for qualified doctors training as GPs and a teaching practice for medical students.

The practice is open to patients between 8am and 6pm Monday to Thursday and Friday from 7.20am to 6pm. Extended hours appointments are available on Friday morning from 7.20am to 8am. When the practice is closed, primary medical services are provided by Primecare, an out of hours service provider and NHS 111 service and information about this is available on the practice website.

The practice is part of a federation and works with another practice during bank holidays to offer a GP service for their patients.

The practice is part of NHS Walsall Clinical Commissioning Group (CCG) which has 63 member practices. The CCG serve communities across the borough, covering a population of approximately 274,000 people. (A CCG is an NHS Organisation that brings together local GPs and experienced health care professionals to take on commissioning responsibilities for local health services).

Updated 23 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Northgate practice on 25 October 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.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance and staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice worked closely with other organisations in planning how services were provided to ensure that they met patients’ 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 practice acted on suggestions received from patients, for example, specific health events and educational evenings and had active support from the Patient Participation Group.
• Patients could access appointments and services in a way and at a time that suited them and 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 and an e-consultation service.
• Notices in the patient waiting room told patients how to access a number of support groups and organisations including the introduction of information leaflets on coloured paper and in large print to assist patients with sight difficulties and dyslexia.
• The practice actively reviewed complaints and how they are managed and responded to and made improvements as a result. The provider was aware of and complied with the requirements of the duty of candour.
• The practice had purchased computer tablets for all the GP partners to support them on home visits and when doing medication reviews and consultations at the local nursing home.
• The practice shared bank holiday opening hours with other practices, so patients could access medical care during this time.

We saw areas of outstanding practice:

The practice held a variety of educational events with the adjoining practice in the health centre for their patients and the local community. For example:

• A bowel screening awareness event in July 2016 was held, supported by specialist screening practitioners from Royal Wolverhampton Hospital. A total of 32 patients attended.
• A ‘diet and diabetes’ event was organised in September 2016. A guest speak from the community diabetes team ran the event with the support of the GPs and staff and 40 patients attended.

We found areas where the provider should make improvements:

• Continue with establishing an effective process to increase the identification and support of carers.
• Following clinical audits undertaken, ensure appropriate monitoring and follow up of patients is acted on.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 December 2016

• Nursing staff 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.
• The practice had employed a community respiratory nurse for one session a week to support patients with chronic obstructive pulmonary disease (COPD).
• The practice ran an anti-coagulation clinic for patients, which included diagnosis and in-house initiation of medicines.
• The practice offered a range of services to support the diagnosis and management of patients with long term conditions including the organisation of regular health and educational events. For example, a diet and diabetes event had been held in September 2016.
• The practice held a bowel screening awareness event in July 2016, supported by specialist screening practitioners from Royal Wolverhampton Hospital. This was offered to patients at both of the GP surgeries situated in the health centre and a total of 32 patients attended. The latest published results for screening showed the practice had a higher uptake for bowel cancer screening. For example, 65% of patients aged 60-69 years, had been screened for bowel cancer in the last 30 months compared to the CCG average of 53% and the national average of 58%.
• 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. We saw evidence that meetings were held every three months.

Updated 23 December 2016

• 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.
• 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. The midwife provided antenatal care every week at the practice. The practice held meetings with the health visitors every three months.
• Childhood immunisation rates for under two and five year olds were comparable to local and national averages for most vaccinations ranged from 75% to 100% compared to the CCG averages which ranged from 74% to 99%. Immunisation rates for five year olds ranged from 77% to 99% compared to the CCG average of 73% to 99%.
• There were policies, procedures and contact numbers to support and guide staff should they have any safeguarding concerns about children.
• The practice’s uptake for the cervical screening programme was 83% which was higher than the national average of 82%.

Updated 23 December 2016

• The practice offered proactive, personalised care to meet the needs of the older people in its population. Care plans were in place for those at risk of unplanned admissions. The practice had systems in place to identify and assess patients who were at high risk of admission to hospital. Patients who were discharged from hospital were reviewed to establish the reason for admission and care plans were updated.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. This included blood tests and vaccinations for those patients who were unable to access the practice.
• The practice worked closely with multi-disciplinary teams so patients’ conditions could be safely managed in the community.
• The practice supported a local nursing home and carried out weekly ward rounds and multi-disciplinary team meetings to offer continuity of care, this included the practice purchasing computer tablets to ensure clinical staff had appropriate access to patients records.

Updated 23 December 2016

• 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 reflected the needs for this age group this included e-consultations. Results showed 83% of females aged 50-70 years of age had been screened for breast cancer in the last 36 months compared to the CCG average of 72% and the national average of 72%.
• Enhanced sexual health services were also offered (including contraceptive implants and intra uterine devices) to registered patients.
• The practice provided a health check to all new patients and carried out routine NHS health checks for patients aged 40-74 years.
• The practice offered extended hours to suit their working age population, with early morning appointments available once a week. Results from the national GP survey in July 2016 showed 85% of patients were satisfied with the surgery’s opening hours which was higher than the local average of 81% and the national average of 79%.

Updated 23 December 2016

• 98% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was higher than the national average of 84%. Data provided by the practice showed that 72% of patients on the dementia register had had their medication reviewed in the past 12 months.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• Staff had a good understanding of how to support patients with mental health needs and dementia. The local nursing home also had a dementia unit and the practice was working with the dementia support workers and nursing home team to support the patients residing in the unit
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• A community mental health nurse held a clinic once a week to support patients with mental health needs.
• 92% of patients on the practice’s mental health register had had their care plans reviewed in the last 12 months, which was higher than the national average of 88%.

Updated 23 December 2016

• The practice held a register of patients living with a learning disability, frail patients and those with caring responsibilities and regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice offered longer appointments and annual health checks for people with a learning disability. Data provided by the practice showed 25 patients were on the learning disability register and44% of these patients had received their annual health checks and 76% had had a medication review in the past 12 months. The practice sent appointment reminders to patients and was actively trying to reduce the number of patients who did not attend their health checks.
• The practice informed vulnerable patients about how to access support groups and voluntary organisations and held meetings with the district nurses and community teams every three months.
• 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.
• The practice’s computer system alerted GPs if a patient was also a carer. There were 72 patients on the practices register for carers; this was 0.7% of the practice list. The practice told us they were in the process of further developing their register and encouraging patients to identify themselves if they had caring responsibilities.