Havelock Grange Practice

Updated 7 July 2016

Havelock Grange Practice is in Hartlepool Town centre is situated in a purpose built facility and has a mixed client group. The health centre building provides a number of community services, pharmacy and other GP practices. There are 12700 patients on the practice list. The practice also provides a branch surgery at Brierton Medical Centre we visited the branch surgery as part of the inspection. The practice scored two on the deprivation measurement scale, the deprivation scale goes from one to ten, with one being the most deprived. People living in more deprived areas tend to have a greater need for health services. The practice population mirrors the practice average across England.

There are seven GP partners, three female, and four male and two salaried GPs one male and one female. Five practice nurses and two health care assistants (all female), one of the nurses was a nurse prescriber. There are two practice managers who have specific roles and were supported by department leads and a range of reception, medicines management, secretarial and other administration staff. The practice also employs their own pharmacists who provide a range of services such as medicine reviews, monitoring and ordering of medicines.

The practice is training and a teaching practice (Teaching practices take medical students and training practices have GP trainees and F2 doctors). The practice also provides support for GP registrars and GPs who have had performance issues. Pharmacy students are also allocated to the practice. One of the GPs also works with 6th form students who are interested in medicine.

The practice is open from 8.30am to 6pm, Monday to Friday at the Havelock Grange Practice. The Brierton Medical Centre is open between 8.30am and 12.30pm and between 2pm and 6pm on the afternoon Monday to Friday. The practice provides some extended hours on a Wednesday evening from 6.30pm until 8pm. We saw that appointments can be booked by walking into the practice, by the telephone and on line. The GPs had dedicated time allotted to contact patients requesting a telephone consultation. Patients requiring a GP outside of normal working hours are advised to contact the GP out of hour’s service provided by Northern Doctors via the NHS 111 service. The practice has a General Medical Service (GMS) contract. The practice is close to the town centre and there is parking available at the practice and nearby. There are good transport links near and good access to public transport.

Updated 7 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Havelock Grange Practice on 12 May 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. All opportunities for learning from internal and external incidents were maximised.

• 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. The practice promoted a no blame culture and encouraged staff to raise concerns and possible risks.
• The majority of 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. However seven patients said they had difficulty with telephone access and appointments.

• Feedback from patients about their care was consistently positive.

• The practice had good facilities and was well equipped to treat patients and meet their 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 provider was aware of and complied with the requirements of the duty of candour.

We saw three area of outstanding practice:

• The practice employed part-time pharmacists to improve their service to patients and have recently employed a further part-time pharmacist. Following a review of the pharmacist role it was identified that is has saved 2.5 sessions of GP appointments per week undertaking different functions which the practice expect will increase with the additional pharmacist. Examples of the work undertaken were medicine reviews, face to face and telephone consultations and the checking of all discharge summaries for any medication errors. The pharmacist has also produced policies which have been rolled out across the CCG area.

• During 2015 – 2016 the practice demonstrated a saving of £19,757 from reducing medication waste. Examples of these were reviewing prescriptionsand working with prescription clerks and local pharcies. During this period there was only one pharmacist working part-time in the practice. They hope to increase savings with the employment of the second part-time pharmacist.

• The practice provided a non-judgemental approach in welcoming transgender patients, homeless and drug and alcohol patients. The practice had reviewed their policies to remove some of the barriers these patients sometimes encounter when registering with a practice. Examples of these were not asking for proof of an address and ensuring transgender patients were addressed always by their chosen name.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 July 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Nationally reported data for 2014/2015 showed that outcomes for patients with long term conditions were good. For example, the percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5mmol/l or less was 78.6%). This was 4.6% below the local CCG average and 1.9% below the England average.

• Longer appointments and home visits were available when needed.

• All these 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 has a robust system for monitoring patients on anticoagulation medicine, NOACs and disease-modifying anti-rheumatic drugs (DMARDs). DMARDS are used in the treatment of rheumatoid arthritis and require regular monitoring and review of the patient. The practice monitoring was audited by the local medicines management team who complimented them on the high standard they achieved. The practice has produced guidelines which are being adopted by the CCG.

• The practice promotes self-management for some long term conditions. Examples of these were the use of rescue packs for patients with chronic lung disease (COPD) which has been successful.They also have a cohort of patients monitor their INR (the international normalized ratio) at home. This is a calculation used to monitor individuals who are being treated with the blood-thinning medicine.

Updated 7 July 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 had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood 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.

• The practice held monthly safeguarding meetings they reviewed child safeguarding and discussed those children who did not attend pre-booked hospital appointments, GP or immunisation appointments.

• Nationally reported data from 2014/2015 showed the practice’s uptake for the cervical screening programme was 74%. This was 9% below the local CCG average and 7% below the England average. The practice has reviewed this and has now introduced a practice recall and follow-up process to increase in uptake.

• 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.

Updated 7 July 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. Patients over the age of 75 had a named GP.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice had a proactive approach to dealing with poly-pharmacy. Polypharmacy is the use of four or more medications by a patient, generallyadults over 65 years. The employment of the pharmacists assisted this approach.

• The practice was delivering ‘The Care Home Scheme’ locally. This ensured patients living in care homes had structured annual reviews which included a review of medicines by a pharmacist, review of clinical care and advanced care planning. The care homes were visited on a fortnightly basis and home visits when required.

• The practice had identified and reviewed the care of those patients at highest risk of admission to hospital.All patients in this list who have an unplanned admission or present at Accident and Emergency A&E will have their care plan reviewed. We saw good examples of patient involvement in the care planning process.

• The practice kept a register of housebound patients and has established an annual review system to ensure that they all receive an annual review.

Updated 7 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.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• The practice provided Wednesday evening appointments which offered a range of services such as contraception, smears, travel vaccinations, pharmacist reviews, and dressings as well as GP appointments. The practice had previously offered Saturday Morning appointment were uptake had been poor.

Updated 7 July 2016

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

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  Nationally reported data from 2014/2015 showed the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in their record in the preceding 12 months was 91%, which was comparable to other practices and above the national average.

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

• 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.

• 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 audited the care provided to patients with depression. They work closely with mental health teams such as the affective disorder team.

• The practice had undertaken a review of Dementia screening and diagnosis the action plans showed a range of initiatives to improve the process in the practice.

Updated 7 July 2016

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

• The practice held a register of patients living in vulnerable circumstances and provided a supportive and non-judgemental approach. Examples of these patient groups were homeless, transgender, drug and alcohol problems and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

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

• The practice had over the last ten years had a large number of Polish speaking patients join the practice. The practice provided information in Polish and provided translators. One of the GPs also spoke Polish.

• 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 were aware of and participates in the food bank voucher project within the town.