Archived: Care UK - Hanley Health and Wellbeing Centre

Updated 17 May 2016

Care UK – Hanley Health and Wellbeing Centre is registered with the Care Quality Commission (CQC) as an organisational provider. The provider holds an Alternative Medical Provider Services (APMS) contract with NHS England to provide services to registered patients. The provider also holds an additional contract with NHS Stoke on Trent Clinical Commissioning Group (CCG) to provide appointments to unregistered patients on a walk in basis. Both contracts have been held since 2009 and are due for renewal in September 2016.

The locality is one of more than twice the level of deprivation when compared with the national average. At the time of our inspection the practice had 3,487 registered patients and this had grown at a modest rate since the service started. The demographic of registered patients differed from the national average. The practice has a much greater rate of patients aged 20 to 34 years when compared with local and national averages. Conversely the number of registered patients aged 45 -84 is significantly less than local and national averages.

The access for registered patients is from 8am to 6:30pm from Monday to Friday. Appointments can be made in person, by telephone or online for those who have registered to obtain services in this way.

The practice offers a walk in service for unregistered patients to be seen between 8am to 8pm 365 days a year. The definition of an unregistered patient is one who is registered with another, or no, GP. Practice records showed that the practice had seen 32,434 unregistered patients on a walk in basis during 2015. The commissioners of the service set out the range of expected conditions to be seen which includes a list of urgent and minor injuries and illnesses. Patients who are registered patients can access the walk in service and be classed at as unregistered patient, although there are bookable appointments for registered patients to be seen on the same day.

Registered patients see GPs or a member of the practice nursing team dependent on their preference or health need.

Unregistered patients are normally seen by a nurse practitioner during 8am to 6:30pm Monday to Friday, although after 6:30pm and at weekends one to two GPs assess and treat unregistered patients also. Data from the practice demonstrates that around 25% of unregistered patients are seen by a GP with the remaining 75% assessed by a member of the nursing team dependant on need.

Current staffing at the time of our inspection:

• Four male GPs working differing hours although adding up to around two whole time equivalent (WTE).

• One male GP had been recruited on a full time basis in a lead capacity and was awaiting a start date.

• Vacancies of 2.62 WTE were covered by locum GPs.

• One male and one female nurse practitioners (registered nurses with extended training and independent prescribers).

• Vacancies of 1.25 WTE were covered by locum nurse practitioners.

• The wider practice nursing team consisted of a female practice nurse, assistant practitioner and two healthcare assistants. The practice also had a part time male practice nurse working on a part-time basis.

• The administrative team of 12 was led by a service and deputy service manager.

• Two members of cleaning staff.

The practice has opted out of providing cover to patients in the out-of-hours period. During this time services are provided by Staffordshire Doctors Urgent Care, patients access this service by calling NHS 111.

Updated 17 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Care UK – Hanley Health and Wellbeing Centre on 8 February 2016. Overall the practice is rated as good, although caring services and the care provided for people whose circumstances make them vulnerable is rated as requires improvement.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the Care Quality Commission (CQC) at that time.

Our key findings were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Risks to patients were assessed and well managed.
• Data detailing patient satisfaction levels was mixed. Registered patient satisfaction rates regarding interaction with GPs were lower than local and national averages.
• Registered patients said they found it easy to make an appointment with a named GP.
• There was a clear leadership structure and staff felt supported by the 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.

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

Importantly, the provider must:

• Evaluate and where possible improve their performance in the national GP patient survey regarding registered patient satisfaction rates in relation to their interactions with GPs.

There were areas of practice where the provider should make improvements.

• Improve internal processes to signpost appropriate patients with a learning disability to annual health assessments.

• Implement a system to alert staff to known vulnerable adults.

• Review the systems in place to maximise the opportunities to promote national screening programmes.

• Add a plan in partnership with the patient participation group to establish priorities of action for improvement and development of services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 May 2016

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

• Patients at the highest risk to unplanned hospital admissions were identified and care plans had been implemented to meet their health and care needs.

• The practice had implemented a weekly long-term condition review clinic, in which patients had 30 minute appointments for combined checks with nursing staff and GPs.

• 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 medicines needs were being met.

• Data showed 77.3% of registered patients with asthma had a review of their condition within the previous year. This was higher than the CCG average of 75.2% and national average of 75.3%.

Updated 17 May 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 did not attend practice appointments or immunisations.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

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

• The practice offered contraceptive and sexual health advice for both registered and unregistered patients.

Updated 17 May 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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice also offered all patients aged 75 and over a health check, with most taking place in the patient’s home.
• 76% of patients aged 65 or over had received seasonal flu vaccinations. This was higher than the national average of 73.2%.

Updated 17 May 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 reflected the needs for this age group.

Updated 17 May 2016

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

• Data showed 93.5% of registered patients with severe poor mental health had a comprehensive care plan completed within the previous 12 months. This was higher than the CCG average of 86.4% and national average of 88.3%.
• Data showed 83.1% of registered patients with dementia had a face to face review of their condition in the last 12 months compared with the CCG average of 85.1% and national average of 84%.
• 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.

Updated 17 May 2016

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

• The practice had 29 registered patients recorded with a learning disability. Staff were not clear on how any additional care needs of patients in this group were met.
• There was no system in place to alert staff to known vulnerable adults.
• Staff were unclear on how patients with a learning disability could access annual health checks.
• The care of other patients who circumstances who may make them vulnerable was discussed at internal practice meetings. Although the practice had recently introduced a system of arranging meetings with multi-disciplinary professionals to proactively review the care needs of patients in this group.