Whitefield Medical Services Limited Also known as Whitefield Health Care

Updated 5 July 2016

Whitefield Medical Services Limited provides services to 3,750 patients in the town of Nelson in East Lancashire. The local Clinical Commissioning Group (CCG) is East Lancashire. The practice provides primary health services under a personal medical services (PMS) contract with NHS England. Whitefield Medical Services Limited is one of five GP practices in Yarnspinners Health Care Centre in central Nelson. The building s is maintained by NHS Property Services Ltd.

Whitefield Medical Services Ltd partnership comprises two GPs, one male, one female and one business development manager. There is one female practice nurse and one female health care assistant (HCA) as well as a clinical pharmacist who has taken up post in 2016 under the NHS England part funded general practice pharmacist scheme. An office manager and four clinical support workers (who cover reception and administration duties) support the clinical team. The practice is also a training practice and supports trainee GPs.

The business development manager is also supporting a second local GP practice, several staff work across both practices and there are ongoing discussions over a more collaborative future partnership between the practices.

The practice is open between 8am and 6.30pm Monday, Tuesday and Friday, from 8am until 8.15pm on Wednesdays and from 8am until 1pm on Thursdays. Appointments are from 9am until 12pm every morning and 2.30pm to 6pm each afternoon, except Thursdays when the practice closes at lunchtime. The practice is open from 6.30pm until 8.15pm on Wednesday evenings when appointments are available with the practice nurse.

The practice population comprises over 65% British Pakistani patients with above average patients who are under 39 than national practice averages. There are significantly more young children and fewer older people than comparable practice populations. The practice estimates that around 10% of their patients have poor spoken English.

Practice data shows more patients than average have a long-standing health condition, 64% compared to an average of 54%. Male and female life expectancy is below East Lancashire Clinical Commissioning Group (CCG) and national averages (male: practice 75 years, CCG 77, England 79; female: practice 80 years, CCG 82, England 83).

Information published by Public Health England rates the level of deprivation within the practice population as two on a scale of one to 10 (level one represents the highest levels of deprivation and level 10 the lowest). East Lancashire has a higher prevalence of Chronic Obstructive Pulmonary Disease (COPD, a disease of the lungs), smoking and smoking related ill-health, cancer, mental health and dementia than national averages.

The practice provided information which showed that over 6.5% of patients on their register were diagnosed as having COPD; over 12.5% had diabetes and hypertension and 9.5% were diagnosed with asthma. The practice informed the inspection team that the population also included a higher than average number of patients with genetic diseases.

Out of hours treatment is provided by East Lancashire Medical Services Ltd on behalf of East Lancashire CCG.

Updated 5 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Whitefield Medical Services on 4 May 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.
• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
• There were systems in place to assess and monitor risks to patients.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• The practice used innovative and proactive methods to respond to the local population improve patient outcomes, working with other local and national NHS providers to share best practice. For example, the practice had invited patients in for bowel screening clinics in response to low take-up.
• The practice also ran a musculoskeletal clinic. This supported patients with pain management and a range of conditions which would otherwise have been referred to secondary care.
• Feedback from patients about their care was 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.
• There was a clear leadership structure and staff felt supported by management.
• The practice had a clear vision which put patient safety as the top priority.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Access to appointments was well managed.
• The provider was aware of and complied with the requirements of the Duty of Candour.

We found one area of outstanding practice:

The practice had reviewed a range of health activities and communication with patients to meet the needs of a diverse patient population group. The impact of this could be seen for childhood immunisation and cancer screening uptake. Specifically the practice had:

• Held bowel cancer screening awareness clinics within the practice to improve screening amongst the British Pakistani community. 21 additional patients had completed screening following this intervention. Of 106 patients eligible only 42% had completed screening according to National Cancer Information Network data published in March 2015, which was lower than the CCG and national averages of 58%. The practice had supported another 21 to complete screening, which should lead to an increase of 18% and bring the practice in line with averages when current data is published.

• Raised awareness with parents of the importance of childhood immunisations and the prevalence and risks of genetic diseases.

• Raised awareness within the British Pakistani community of the importance of cervical screening for women, this included overcoming cultural prejudice to achieve a screening rate of 89% which was higher than the national average of 82%.

The areas where the provider should make improvement are:

• Improve the system for authorising patient group directions and patient specific directions locally to ensure these are appropriately authorised.

• Review organisational health and safety arrangements and conduct risk assessments in line with the requirements of the Health and Safety at Work Act 1974.

• Maintain a local log of privacy curtain replacements and liaise with the building manager to ensure these are replaced in accordance with guidance.

• Record actions taken following Medicines and Healthcare products Regulatory Agency (MHRA) and other nationally issued safety information and ensure these are reviewed appropriately.

• Review local induction arrangements to include hand hygiene training and ensure that staff are aware of mandatory elements such as safeguarding if on-line resources are not available.
• Provide complaints information in languages or formats to meet the needs of the population groups

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 July 2016

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

• Practice nurses managed patients with chronic diseases under the guidance of GPs.
• 100% of patients with atrial fibrillation (a heart condition) whose stroke risk was assessed as high were treated with appropriate medication to reduce the risk of stroke compared with the national average of 98%.
• Patients with diabetes could be commenced on insulin therapy within the practice. This reduced travel to the local hospital for diabetic patients.
• 98% of patients with diabetes on the register had an influenza immunisation in the preceding flu season (national average 93%).
• 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 named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 5 July 2016

The practice is rated as good for the care of families, children and young people with outstanding for responsive in this population group.

• The practice provided ante natal clinics with the community midwife.
• The practice had overcome cultural barriers to target parents and ensure childhood vaccinations were valued by the community, as well as working with the local genetics team and parents to raise awareness of genetic diseases which were higher in the local population.
• Childhood immunisation rates were higher than local averages for some age groups.
• Unwell babies and children were seen the same day.
• 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 or missed immunisations.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice communicated effectively to raise awareness of screening. 89% of women aged 25-64 had attended screening in the previous 5 years, higher than the national average of 82%.

Updated 5 July 2016

The practice is rated as good for the care of older people.

• The practice offered same day longer appointments for older patients.
• All patients who were over 75 had a named GP and were offered an annual health check.
• The practice had recently begun to identify patients who were carers. Patients were signposted to the local carers support groups and invited to annual health checks.
• The practice offered proactive, personalised care through a care plan and worked with other professionals to deliver good care to this age group.
• The practice worked closely with a tele-hub service provided by Airedale General Hospital, which offered round the clock access to advanced nurse practitioners for patients residing in local care and nursing homes.
• The practice had undertaken a range of audits to review prescribing for older patients including Hospital Admissions Related to Medication (HARMs) and reducing prescribing of multiple medications which could lead to adverse reactions and hospital admissions.
• Home visits were carried out by the GPs to housebound patients and joint working with community staff and the integrated neighbourhood team ensured these patients were supported in their own homes.
• The practice had run bowel cancer awareness clinics to improve communication on the importance of screening for this population group.

Updated 5 July 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 for patients who were unable to attend the practice.
• The practice was proactive in offering online services.
• The practice adapted national health promotion and screening information and raised awareness of screening and immunisations to meet the needs of this population group.
• Extended hours appointments were available on Wednesday evenings with the practice nurse for patients who had difficulty attending during normal hours.

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Updated 5 July 2016

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

• 100% of people diagnosed with dementia had had their care reviewed in a face-to-face meeting in the last 12 months (national average 88%).
• 94% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the preceding 12 months, compared to 89% nationally.
• All staff had completed on-line dementia awareness training.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• The practice informed patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had comprehensive system in place to follow up patients who had attended hospital where they may have been experiencing poor mental health.

Updated 5 July 2016

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 and met bi-monthly with the integrated neighbourhood team to ensure health and social care needs were met.
• A monthly palliative care meeting was held which reviewed care plans for all terminally ill patients.
• The practice worked closely with the community learning disability team.
• The practice conducted thorough annual health checks for people with a learning disability and provided specialised information to encourage these patients to attend screening and immunisations.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• The practice was the designated practice for the local women’s refuge and offered care to the residents there.
• Staff clearly recognised 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.