Archived: Malling Health @ Wrekin

Updated 21 February 2017

Malling Health Wrekin Surgery provider organisation is Malling Health who joined with IMH Group during 2015 and is registered with the Care Quality Commission (CQC).

Malling Health Wrekin Surgery is located in Telford, on the same site as The Princess Royal Hospital and is run under an Alternative Medical Provider Services (APMS) contract. The practice provides a dual service to its patients; a traditional GP service for registered patients with a walk in element for unregistered patients. In February 2016, a contract variation took place that increased the capacity of walk in patients to unlimited and daily opening times from 8am to 10pm. The contract for providing this service is under review and due for renewal in 2017. The walk in service is provided by a GP and advanced nurse practitioner. In the past 12 months, the walk in service has provided 17,967 consultations (an average of 3.8 appointments per hour that the practice is open).

The practice is open every from 8am to 10pm Monday to Sunday including bank holidays.

The Malling Health Wrekin Surgery staffing consists of:

• One lead GP (female) giving 0.8 whole time equivalent (WTE) hours, one salaried GP (female) giving (0.8 WTE). The provider used regular locum GPS (male and female). The GPs were supported by a clinical team that consists of two Advanced Nurse Practitioners (ANP) providing two WTE, two practice nurses (1.7 WTE), one female Healthcare Assistants (full time) and two practice pharmacists working a combined number of hours equal to one WTE.
• The administration team is led by a full time Practice Manager, a full time Assistant Practice Manager, a full time senior receptionist. There are four administration staff (3.8 WTE) and six reception staff (5 WTE).
• The management structure within the Malling Health organisation supports the practice through an area manager and clinical director who visit the practice at least fortnightly.

At the time of the inspection the practice has 8,037 registered patients. The list size is growing and the past 12 months saw an increase of 556 patients. The practice age profile was broadly in line with national averages with a lower percentage of older patients. For example, the percentage of patients aged 65 and above is 12% compared to the local CCG practice average of 16% and the national practice average of 17%. The percentage of registered patients from ethnic minorities is 3.5% which includes Polish, Asian and African patients.

The practice has seven treatment/consulting rooms, all located on the ground floor. As well as providing the contracted range of primary medical services, the practice provides additional services that included minor surgery.

Updated 21 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Malling Health Wrekin Surgery on 9 November 2016. Overall the practice is rated as requires improvement.

Our key findings were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. However, this did not include the monitoring of outcomes and we saw examples of when agreed actions did not happen.
• Staff assessed patients’ needs but the care delivered was not always 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 generally 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.
• Patients’ comments on the appointment system were mixed. The negative comments in relation to the appointment system generally came from registered patients wanting a non-urgent appointment with a GP.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and most staff felt supported by the area 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.

However, t here were also areas of practice where the provider must make improvements:

• Review the significant event process to ensure that information is shared by all relevant staff and to check that agreed actions have taken place.
• Implement a systematic approach to alerts to ensure that relevant alerts have been actioned.
• Ensure that patient group directions are completed and authorised for the nursing staff in advance of medicines being delivered to patients.

There were also areas of practice where the provider should make improvements:

• Ensure that the physical and mental health of all newly appointed staff is considered to ensure they are suitable to carry out the requirements of the role.
• Review the clinical capacity to ensure that planned work can be accommodated.
• Formulate an action plan to address the below average feedback in the GP national patient survey.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 February 2017

The practice is rated as requires improvement for the care of people with long-term conditions. The provider was rated as requires improvement for safe, effective and well-led and good for caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group.

• Patients at the highest risk of unplanned hospital admissions were identified and care plans had been implemented to meet their health and care needs.
• 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 people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice involved the patients carer where consented to do so in their medicines management reviews.
• Nursing staff had lead roles in chronic disease management and had undertaken additional training. For example, a practice nurse with specialist diabetic nurse training supported diabetes patients with dietary advice and nurses had been trained to offer advice on healthy living.
• The practice Quality and Outcomes Framework (QOF) for the care of patients with long-term conditions was worse than the local and national average. The most recent published data was for 2015/16 showed us that the overall QOF performance was just below the local and the national averages. However, the practice performed below national averages for the management of asthma and diabetes. The provider was aware of their performance and had taken action. For example, they had recently trained a nurse in improving care for those patients with diabetes.
• The GPs and nursing team worked with relevant healthcare professionals to deliver a multidisciplinary package of care to patients with complex needs. However, the care given was not always in accordance with nationally recognised guidelines. For example, the treatment of hypertension for patients with diabetes did not follow guidelines for the treatment of raised blood pressure.

Updated 21 February 2017

The practice is rated as requires improvement for the care of families, children and young people. The provider was rated as requires improvement for safe, effective and well-led and good for caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group.

• 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.
• 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’s uptake for the cervical screening programme was 81% which was comparable with the local CCG average of 81% and national average of 82%.
• Extended opening hours provided early morning and late evening appointments seven days a week. Children under five were prioritised for emergency appointments.
• Immunisation uptake rates for standard childhood immunisations were all in with the CCG and the national averages. For example, childhood immunisation rates for the vaccination of children under two years of age ranged from 97% to 98%, children aged two to five 98% to 99% and five year olds from 93% to 96%.

Updated 21 February 2017

The practice is rated as requires improvement for the care of older people. The provider was rated as requires improvement in providing a safe, effective and well-led service and good for providing a caring and responsive service. The issues identified as requiring improvement overall affected all patients including this population group.

• The practice offered proactive, personalised care to meet the needs of the older people in its population. They were responsive to the needs of older people, home visits and telephone consultations were offered to elderly patients who found attending the surgery difficult. This included regular visits to a care home for elderly patients.
• The practice provided patients with non-clinical support coordinating with other organisations such as district nurses, physiotherapists and charity and other voluntary organisations.
• All eligible patients aged between 70 and 80 were offered annual vaccination for influenza, pneumococcal and shingles.
• Patients aged over 75 had been advised on their named, accountable GP. Patients had been written to and advised that they could speak with their allocated GP within 24 hours.
• The practice engaged with community teams involved in care of the elderly population.
• Older patients at increased risk of hospital admission had a written care plan and contact details for their support workers, carers and next of kin were recorded on the patient’s record.

Updated 21 February 2017

The practice is rated as requires improvement for the care of working-age people (including those recently retired and students). The provider was rated as requires improvement for safe, effective and well-led and good for caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group.

• The practice offered telephone appointments and these were also bookable for working patients unable to attend the practice.
• The practice provided online services that enabled registered patients to use the service to book appointments, order repeat medicines and access some parts of their health records online. Prescriptions could be requested by email.
• The practice provided appointment reminder text messages.
• Health promotion and screening services reflected the health needs of this group. This included signposting patients to a ‘Healthy Lifestyle Hub’ run by the local authority.
• The provider offered NHS Health Checks to eligible patients. Sixty-five invites had been sent out in the last quarter and 50 patients had attended for a health check.

Updated 21 February 2017

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia).The provider was rated as requires improvement for safe, effective and well-led and good for caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group.

• 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.
• Performance for poor mental health indicators was slightly higher than the national averages. For example, 92% of patients with enduring mental health had a recent comprehensive care plan in place compared with the CCG average of 91% and national average of 89%.
• Staff had a good understanding of how to support patients with mental health needs and dementia. However, the number of reviews undertaken for patients with mental health needs was below the national average.

Updated 21 February 2017

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. The provider was rated as requires improvement for safe and well-led and good for effective, caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group.

• The practice held a register of patients living in vulnerable circumstances including known vulnerable adults, those who were housebound and patients with a learning disability. There was a register of 11 patients with a learning disability. Since April 2016 five had received an annual review and four had been sent an invite. The practice planned to complete reviews on all 11 patients by March 2017.
• Practice reception staff told us that they supported those patients unable to read and write.
• 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.
• The practice held a register of the practices’ frail and vulnerable patients and had identified patients who may be at risk of unplanned hospital admissions.
• The building and areas for patients and staff included disabled access, hearing loop, automatic doors, disabled toilets and a low level counter at reception for wheelchair users.