Castle Mead Medical Centre

Updated 28 April 2017

Castle Mead Medical Centre is situated in Hinckley which is a market town in North West Leicestershire. It has a small branch with a dispensary in the rural village of Stoke Golding about two miles north of Hinckley which we did not visit. The practice has a contract with West Leicestershire Clinical Commissioning Group to provide General Medical Services (GMS) for its patients.

The practice has occupied purpose built surgeries in Hinckley town centre and in Stoke Golding since 1991/2. It has approximately 9850 patients

There are seven GPs, three of whom are female. There is a male urgent care practitioner and four female practice nurses who together provide minor illness and urgent care, and manage long-term conditions such as diabetes, asthma and chronic obstructive pulmonary disease (COPD). There are also two health care assistants. The practice has also recently employed a clinical pharmacist who was training to become an independent prescriber and there were trained dispensers at the branch surgery. The clinical team is supported by a practice manager, and other support staff some of whom take lead responsibilities for areas such as reception and prescriptions. The practice is training and teaching practice which has medical students on placement and trainee GPs.

The practice is open between 8.00am and 6.30pm Monday to Friday. Appointments can be pre-booked up to 4 weeks in advance. Appointments for both face to face and telephone consultations are available on the day with the duty doctor and advanced nurse practitioner who also see some patients on an urgent basis.

Out of hours services are commissioned by West Leicestershire Clinical Commissioning Group and provided by DHU (Derbyshire Health United).

Updated 28 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Castle Mead Medical Centre on 19 October 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.
• 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.
• Urgent appointments and telephone consultations were available especially for unwell children.
• The practice had adequate facilities and equipment.
• 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.
• The practice had a dispensary at its branch surgery in Stoke Golding which was managed according to the Dispensing Services Quality Scheme (DSQS)

The practice should consider whether a risk assessment is necessary regarding the use of volunteer members of the PPG delivering medicines to patients in rural areas and whether they need to be DBS checked as some of the patients may be vulnerable.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 April 2017

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

• Nursing staff had lead roles in chronic disease management with support from GPs. The practice had identified 2% of its patients who were at risk from unplanned hospital admissions and shared information with out of hours and district nurse services to help keep people out of hospital where appropriate.

• The practice's performance for diabetes management was similar to or slightly higher than national averages, for example, the practice achieved 86% for the QOF indicator relating to blood sugar control management for diabetic patients compared to the local average of 83% and national average of 78%.

• Longer appointments and home visits were available when needed. The practice kept a register of patients who were housebound.

• Where possible patients with several conditions were invited for one appointment to review all their conditions.

• All 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 kept a list of those patients such as those receiving end of life care, patients with mental health problems and patients with multiple conditions to ensure that they received same-day call-backs from their regular GP wherever possible.

Updated 28 April 2017

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 above local and national averages.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

• The practice took advantage when young people attended for booster immunisations to offer health and lifestyle advice.

• Data showed 82% of eligible women had received a cervical screening test compared with the local average of 83% and national average of 81%.

• Appointments were available outside of school hours and the premises were suitable for children and babies. Young children who were ill were always seen and the practice used a sepsis screening tool to help identify this condition.

• The practice offered 24 hour and 6 week baby checks.

• We saw examples of joint working with midwives, health visitors and school nurses. The practice informed the health visitor of new child registrations.

Updated 28 April 2017

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.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. It had a register of those patients who were housebound and provided vaccinations at home when necessary.

• The practice’s approach was to undertake frailty assessments, dementia screening and an integrated approach to include, where needed, end of life planning and a multi-agency approach.

• The practice had identified those older patients at risk of hospital admission and had developed care planning which identified key health problems and their ongoing management including medicines monitoring. Special notes were included on records for out of hour’s services to avoid unnecessary or inappropriate hospital admissions.

• The practice provided care for approximately 65 patients living in local care homes some of whom were receiving end of life care. A named GP attended the three care homes for which the practice had responsibility on a weekly basis to perform a ward round helping to ensure continuity of care for the patients.

• The practice arranged for the delivery of medicines to patients who found it difficult to collect them from the dispensary at the branch in Stoke Golding.

Where necessary to help patients take medicines correctly medicines were put into blister packs.

Updated 28 April 2017

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 reflected the needs for this age group.

• Bookable telephone consultations were available.

• Patients who needed to be seen urgently were offered telephone consultations or appointments on the day.

The practice offered a travel vaccination service.

Updated 28 April 2017

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

• 89% of patients living with dementia had a face-to-face care review in the previous 12 months, compared with the local average of 86% and national average of 84%.

• The practice offered dementia screening to patients identified as high risk individuals.

• The practice carried out advance care planning for patients with dementia which included appropriate end of life care plans.

• 100% of patients with severe mental health problems had an agreed care plan documented in their records compared with the local average of 94% and national average of 89%. Alerts on their records meant that they were routinely offered longer appointments and annual reviews with the Mental Health Facilitator. The practice undertook regular medication reviews where needed.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice had told patients experiencing poor mental health and where appropriate their carers 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 recognised that these patients benefited from routine and tried to ensure they saw the same GP or healthcare professional, for example, if they needed regular blood tests.

Updated 28 April 2017

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

• The practice held registers of patients living in vulnerable circumstances including carers, people with a learning disability (LD), people who were housebound and those with alcohol or substance misuse problems.

• Patients without a permanent address were encouraged to register at the practice and offered a new patient health check so that their health needs could be identified and where appropriate they were offered advice about where they could access help with their social needs.

• The practice offered longer appointments for patients including those with serious mental health issues and those with a learning disability.

• The practice offered annual health checks to the 38 patients on the learning disability register. Most recent figures showed that 35 of the 38 patients on the register had received a check with the others declining. A practice nurse took the lead role and working with the local learning disability team had developed easy read invitation letters and health action plans.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice had identified 209 or 2% of its patients who had caring responsibilities. They were offered a referral to a local support service for a carer assessment, and given information about local authority services such as First Contact, which could offer practical assistance with a variety of housing and other matters. There was also information available in the waiting area and on the website.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• All staff were aware of the signs of abuse in vulnerable adults and children. Staff understood their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.