Archived: The Midway Medical Centre

Updated 17 May 2016

Midway Medical and Walk In 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. An additional part of the contract is to provide 12 appointments with a GP and 12 appointments with a practice nurse for unregistered patients every day of the year. The practice definition of an unregistered patient is a one that is unregistered with another, or no, GP. Registered patients can also be seen at a weekend, although they would be classed as an unregistered patient in that arrangement. The contract has been held since 2009 and are due for renewal in September 2016.

The practice area is one of more deprivation when compared with the local and national averages. At the time of our inspection there were 3,150 registered patients at the practice. The average age of patients registered at the practice demonstrates a higher than average trend in patients aged between 20 and 39 and lower than average for patients aged over 45.

The practice first opened in 2009 as a new facility for patients in the area. This followed a government led review into the NHS. The report Next Stage Review (2008) recommended the introduction of 100 new GP practices, of which this practice was one.

The practice staffing consists of:

• One lead GP (male) giving one whole time equivalent (WTE).

• Six part time GPs (four male, two female) (0.71 WTE).

• GP vacancies (1.14 WTE).

• One female nurse practitioner (1 WTE).

• One male Paramedic Advanced Practitioner (0.5 WTE).

• Two female practice nurses (1.12 WTE).

• One female healthcare assistant (0.8 WTE).

• One practice manager.

• Administrative team of eight.

• One practice cleaner.

The practice is open from 8am to 8pm every day of the year. During these times the telephone lines and reception desk remained open.

Access for registered patients:

• Monday to Friday 8am to 8pm.

• Appointments can be made in person, by telephone or online for those who have registered in obtain services in this way.

Access for unregistered patients:

• 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

• Monday to Friday, 12 appointments with a GP and 12 appointments with a practice nurse. Appointments are released at 8am each morning and are staggered through the day.

• Saturday and Sunday, appointments are offered to a capacity basis. Appointments are released at 8am each morning.

Although the name of the practice includes ‘walk-in centre’, this service would not be reasonably viewed as a walk-in centre. The website NHS choices define a ‘walk-in centre’ as being available to everyone and patients not needing an appointment. The limited amount of appointments available resulted in patients who had presented at the service, or been directed to there, to be further signposted to other care providers.

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 Midway Medical and Walk In Centre on 1 February 2016. Overall the practice 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.
• The name of the practice as a Walk in Centre did not reflect the nature of the services provided.
• Feedback from registered patients was positive and complimentary about being treated with care, dignity and respect.
• Survey data from registered patients about access to, and experience of making, appointments showed satisfaction levels mostly below the national average.

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

Importantly, the provider must:

• Evaluate the reasons for the higher than clinical commissioning group (CCG) average number of registered patient emergency admissions to hospital and self-presentation attendance rates at A&E.

In addition the provider should:

• Implement a consistent system for checking that monitoring for patients, who take long term medicines on a shared care basis, has been provided before the medicines are issued.

• Investigate the reasons for, and where possible improve, lower than average rates of patients engaging in national cancer screening programmes

• Change the name of the practice to reflect a more accurate description of the services provided.

• Liaise with relevant parties to update NHS Choices with a more accurate description of services provided at the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 May 2016

The practice was rated as requires improvement for effective and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 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 number of patients with Chronic Obstructive Pulmonary Disease (COPD) admitted to hospital in an emergency was 7.6% lower than the Clinical Commissioning Group (CCG) average.

• 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.

• For those people with the most complex needs, the staff worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 17 May 2016

The practice was rated as requires improvement for effective and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice had systems in place for safeguarding children.
• The practice provided childhood immunisations and rates of uptake were in line with CCG and national averages.

• The practice’s uptake for the cervical screening programme was 81.5% which was higher than the CCG average of 79.5% and comparable to the national average of 81.8%.

Updated 17 May 2016

The practice was rated as requires improvement for effective and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 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.
• 70.3% of patients aged 65 or over had received seasonal flu vaccinations. This was comparable to the national average of 73.2%.

Updated 17 May 2016

The practice was rated as requires improvement for effective and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 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.
• The practice offered evening appointments to benefit those of a working age.

Updated 17 May 2016

The practice was rated as requires improvement for effective and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 100% of patients with severe poor mental health had a recent comprehensive care plan in place compared with the CCG average of 86.4% and national average of 88.3%.
• 100% of patients with dementia had a face to face review of their condition in the last 12 months compared to 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 17 May 2016

The practice was rated as requires improvement for effective and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice offered annual health reviews and longer appointments for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.