Archived: Willows Medical Centre

Updated 2 August 2017

The Willows Medical Centre is located at 184, Coleman Road, Leicester, LE5 4LJ, in the Rowlatts Hill area of Leicester. It is a modern purpose built building with a lift, and parking, including disabled parking and on street parking. It has automatic doors, a hearing loop, an on-site wheelchair, and both on-screen and audio announcement of appointments.

• There are two GP partners and two associate GPs providing 2.6 whole time equivalents. There are also two trainee GPs. There is a full-time primary care practitioner (with a paramedic background) a part-time nurse and part-time health care assistant.

• There are three male and three female GPs (including the trainee GPs).The nurse and primary care practitioner are female and the health care assistant is male.

• There is a range of support staff including receptionists, a practice manager, business manager and specialist roles, including a compliance facilitator and a data quality manager who work part-time but also undertake similar roles at two other GP practices.

• Willows Medical Centre is a training and teaching practice with GP trainees who are fully qualified doctors training to be a GP and also post-graduate medical students (Foundation 2)

• The practice is open between 8am and 6.30pm Monday to Friday.Routine appointments are from 9am to midday and 3pm to 6pm. The duty doctor is available from 8am to 6.30pm. Extended hours appointments are offered from 6.30pm to 8pm on Tuesdays; this includes assessment appointments with a physiotherapist.

• Out of hours services are provided by Derbyshire Health United (DHU) via the 111 telephone number.

• Patients registered with Leicester City practices can also access (initially by telephone) three ‘Healthcare Hubs’ (located at health centres/GP practices) during evenings and weekends.

• The number of patients registered with the practice has been increasing and is now 5000.

• 70% of the practices patients are Asian or Asian British, 22% are White British, and 7% are Black or Black British.

• The number of patients registered with the practice aged 34 or under is above the national average with a relatively high proportion of young children.

• Leicester is the 25th most deprived local authority area in England and the practice catchment area includes patients living in the most deprived 20% of areas in England. The practice estimates that about 74% of its patients live in areas that are in the most deprived 40% in England.

Updated 2 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Willows Medical Centre on 24 May 2017. 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 a system in place for reporting, recording and reviewing significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain or raise concerns was available. Improvements were made to the quality of care because of complaints and concerns. All complaints were treated as significant events.
• Patients we spoke with 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.
• The practice had recently moved into a new purpose built building which provided good facilities and was well equipped to treat patients and meet their needs now and in the future
• 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
• The practice had developed a care plan questionnaire which was being used by all the practices in the local Federation.

The area where the provider should make improvements are:

To continue to ensure that it identifies patients who are carers so that it can provide appropriate care and support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 August 2017

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

• Patients at risk of hospital admission were identified as a priority.

• Nursing staff had lead roles in long-term disease management such as COPD and were supported by the GPs and specialist nurses.

• Performance for diabetes related indicators was similar to the CCG and national averages. For example, the percentage of patients in whom the last IFCC-HbA1c was 64mmol/mol or less in the preceding 12 months was 81% compared with the local average of 77% and national average of 78%.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any changed needs.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• All these patients had a named GP and there was a system to recall patients for 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 2 August 2017

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

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.

• Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

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

• The practice provided support for premature babies and their families following discharge from hospital, working closely with the health visitor based in the building.

• The practice kept a rolling register of babies up to the age of three months so that it could offer support and advice to families and begin to encourage the take-up of immunisations.

• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of antenatal, post-natal and child health surveillance clinics.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 2 August 2017

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 patients in its population.

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

• The practice identified at an early stage older patients who might need palliative care as they were approaching the end of life. It involved older patients and where appropriate their families or carers in planning and making decisions about their care, including end of life care.

• The practice had developed a care plan questionnaire for completion by patients and/or their carers in advance of an appointment to discuss care needs and preferences.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any changes to their care.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• Staff knew many of the patients well and if concerned about them, for example, if they had become confused raised this with the clinical staff to help ensure care and support.

• Where older patients had complex needs, the practice shared summary care records with local care services. The practice held monthly multi-disciplinary meetings where the needs of patients, for example, receiving end of life care were discussed.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. Patients were referred to a local ‘Care Navigator’ service which provided practical support and advice to help people live as independently as possible in their own homes.

• The practice was involved in the Mid-frail study which was a new research project involving patients over 75 year old with type two diabetes to identify levels of frailty and to see if an exercise and education programme could improve their health.

Updated 2 August 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours on a Tuesday evening from 6.30pm to 8.pm

• During these extended hours, appointments were also available for patients to see a physiotherapist for an assessment about the suitability of providing physiotherapy. (‘Physio First’) and nurse appointments were available until 6.30pm.

• The practice had substantially increased the number of telephone consultations available to about 50 per week to help working people in particular.

• 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 offered proactive smoking cessation advice and referrals, and alcohol/drug abuse service referrals

Updated 2 August 2017

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

• The practice carried out advance care planning for patients living with dementia.

• 100% of patients diagnosed with dementia had their care reviewed in a face-to-face meeting in the last 12 months, which is above the local average of 86% and national average of 84%. Exception reporting was 8% compared with 10% locally.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia, for example, offering regular health checks and medicines reviews.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• The practice’s ratings for mental health care was comparable with other practices, for example, 94% of patients with severe mental health problems had a comprehensive agreed care plan documented in their record in the preceding 12 months compared with the local average of 93% and national average of 89%.

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

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia, for example, by offering longer appointments with the patient’s regular GP unless in an emergency.

Updated 2 August 2017

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, carers and those with a learning disability.

• Carers were able to see or speak to a clinician on the same day.

• People who were homeless were directed to a local primary care service specifically designed for homeless people

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

• 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 information available for vulnerable patients about how to access various support groups and voluntary organisations and where appropriate referred them directly.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.

• Staff were able to describe situations where they had had concerns for patients and took action to keep them safe.