Archived: Story street medical practice and walk in centre

Updated 6 July 2016

Please note that when referring to information throughout this report, for example any reference to population groups, this relates to only the patients registered at the practice.

Story Street Medical Practice and Walk-in Centre is situated in the centre of the City of Hull and provides services under an Alternative Provider Medical Services (APMS) contract with NHS England, Hull Area Team to the practice population list of 1,482, covering patients of all ages. The practice is part of a larger group, Virgin Care services, that is led by a senior regional operations team.

The practice has two locum GPs one male and one female. There is one practice nurse and one locum advance nurse practitioner. There is a Service Manager, an administration lead and reception staff.

The practice is open between 8am to 8pm Monday to Sunday. Appointments are from 8am to 8pm every day. Additionally the walk-in centre is open to all non-registered (and registered) patients 8am to 8pm seven days a week 365 days a year and in the last year, the practice has seen over 33,000 walk-in patients to provide care and support. A separate waiting area for patients that were currently registered with the practice was in place to ensure staff knew which patients were waiting in the walk-in centre. The walk-in centre provides care for minor ailments only.

The practice, along with all other practices in the Hull CCG area have a contractual agreement for NHS 111 service to provide Out of Hours (OOHs) services from 8pm. This has been agreed with the NHS England area team. Information for patients requiring urgent medical attention out of hours is available in the waiting area, in the practice information leaflet and on the practice website.

The proportion of the practice population in the 15-44 years age group is significantly higher than the England average. 60% of patients fall within this age group. Approx. 3% of the practice population is over 75. The practice scored one on the deprivation measurement scale, which is the first lowest deprived decile. People living in more deprived areas tend to have greater need for health services. The overall practice deprivation score is higher than the England average, the practice is 47 and the England average is 26. It is also in the fifth most deprived area of England.

Updated 6 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Story Street Medical Practice and Walk-in Centre on 20 April 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 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.
• Some patients said they found it difficult to make an appointment with a named GP however, urgent appointments were available the same day via the walk-in service.
• 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. This means providers must be open and transparent with service users about their care and treatment, including when it goes wrong.

The areas where the provider should make improvement are:

• The procedure for ensuring all alerts are read by all relevant staff should be re-enforced.

• The process for reviewing patient’s results/notes where they have attended health services ‘out of hours’ should be implemented.

• Ensure timings between multi-disciplinary team meetings are reviewed. .

• Ensure patients who are attending the ‘walk-in’ service are made aware of the waiting times to see a clinician and also told of any potential delay.

• Although patient feedback is being sort in other ways the practice should explore ways of introducing and implementing a patient participation group (PPG) to drive improvement through further suggestions from a patient perspective.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 July 2016

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

• 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 generally good. However, performance for diabetes related indicators was 80%; which was below the CCG average of 89% and below the national average of 89%.

• 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 process for repeat prescription was appropriate and ensured patients were reviewed by a GP when required.

Updated 6 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.

• Nationally reported data from 2014/2015 showed the practice’s uptake for the cervical screening programme was 92%, which was better than the CCG average of 82% and better than the national average of 82%.

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

Updated 6 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.

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

• The premises were accessible for patients with limited mobility.

Updated 6 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 reflected the needs for this age group.

Updated 6 July 2016

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

• Nationally reported data from 2014/2015 showed 100% of people diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was better than the CCG average of 85% and better than the national average of 84%.

• 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 100%. This was better than the CCG average of 88% and the same as the national average. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• It 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 people with mental health needs and dementia.

Updated 6 July 2016

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

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• It offered longer appointments for people 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.

• 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.

• Joint working with external organisations took place in the management of patients at risk of abuse or harm.