Castlefields Surgery

Updated 4 July 2017

Castlefields Surgery is registered with the Care Quality Commission (CQC) as a partnership provider. The practice holds a Primary Medical Services contract with NHS England. At the time of our inspection the practice was caring for 6,449 patients. The practice is situated in Stafford, and is part of the NHS Staffordshire and Surrounds Clinical Commissioning Group. Car parking, (including disabled parking) is available at this practice. The practice area is one of more deprivation when compared with the local average, although lower than the national average. The practice also provides a GP service to a local care home of approximately 40 patients.

The practice is a teaching practice and supports medical students. The practice also works with the research department of Keele University and is a practice that supports nurse training which commenced in April 2017.

The practice team comprises of:

• Four GP partners (one male and three females).

• A lead nurse practitioner, a practice nurse and a healthcare assistant/phlebotomist

• A practice manager

• Clinical Co-ordinator

• Reception manager and a team of reception and administration staff.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are from 8am to 12.30pm every morning and 3.30pm to 5.40pm daily. Extended hours surgeries are offered at 7am on two mornings per week. When the surgery is closed the phone lines are switched to an answering machine message that instructs patients to dial 111 or 999 if it was an emergency. Out of hours care is provided by Staffordshire Doctors Urgent Care Ltd.

The practice is one of five member GP practices that now form the Stafford Primary Care Health Alliance. They have collaborated on several joint work streams with the aim of redesigning the way they provide services for their community. All five practices are on the same clinical system and at the weekend have access to an overarching EMIS system which allows GPs and Nurses access to all the patients’ records (with appropriate data sharing agreements in place). The practices all belong to the local GP Federation, (which covers all GP practices in Stafford and Cannock CCGs). They are able to augment their capacity and capability by utilising services currently being delivered by the GP Federation via the Prime Ministers GP Access Fund.

Updated 4 July 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Castlefields Surgery on 20 April 2016. The overall rating for the practice was as ‘Good’ with requires improvement in providing a safe service. The full comprehensive report on the 20 April 2016 inspection can be found by selecting the ‘all reports’ link for Castlefields Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 12 June 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations identified in our previous inspection on 20 April 2016. This report covers our findings in relation to those requirements.

Overall the practice is rated as Good.

Our key findings were as follows:

• Patient Group Directives (PGDs) were up to date and current.

• Appropriate checks were undertaken to ensure vaccines are always stored in line with manufacturers’ guidelines.

• The nursing roles were clearly defined.

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

• Improvements were needed in how patients who were carers were identified and recorded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 June 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. The practice had developed a clinic coordinator role to maintain disease registers and to arrange appropriate recall and review.

• Patients at risk of hospital admission were identified as a priority. Admission Avoidance Plans had been drawn up. The number of Emergency Admissions for 19 Ambulatory Care Sensitive Conditions was below the National average.

• Performance for the five diabetes related indicators were comparable to or better than the national average. For example, the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 97% compared with the National average of 88%.

• 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.

Updated 17 June 2016

The practice is rated as good for the care of families, children and young people.

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

• Same day emergency appointments were available for children.

• All patients had a named GP which promoted continuity of care and allowed the GP to know which families may be in more need of support and to respond appropriately.

• Patients had access to a Community Midwife who held clinics at the practice.

• Childhood immunisation rates for the vaccinations given were comparable to CCG/national averages. 

• Chlamydia screening and a full range of reversible contraception and contraception counselling was offered including coil fitting.

Updated 17 June 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.

• Each patient within the practice had a named GP, which promoted continuity and an in-depth knowledge of the patient.

• The practice was actively engaged in immunisation and health promotion for the elderly. Vaccination rates for uptake of the seasonal flu vaccination were all above national averages and were the highest in the CCG area. For example, 77% of patients aged 65 or over had received the vaccinations compared to the national average of 68.8%.

Updated 17 June 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.

• Extended hours appointments were available from 7.00am to 8.00am on two mornings per week. Patients were able to speak with a doctor for advice when necessary every working day via the telephone clinic which started at 11.00am.

• 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.

Updated 17 June 2016

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

• 79% of patients diagnosed with dementia, had their care reviewed in a face to face meeting in the last 12 months. This was comparable to the national average.

• Performance in four mental health related indicators was in line with the national average. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in

  the record was 95% compared with the national average of 88%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. Patients were referred when necessary for support from other agencies for example Community Mental Health Services, Emotional Wellbeing, Perinatal Psychiatry, CAMHS, One Recovery (Drugs and Alcohol), Dementia Team, Stafford Bereavement and Loss and Eclipse (child bereavement).

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 17 June 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.
• 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 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.
• An identified administrator managed the list of those on the Child Protection Register and all associated correspondence, ensuring that it was acted upon appropriately.