Jubilee Healthcare

Updated 24 August 2016

Jubilee Healthcare is located in Westminster Road, which is on the outskirts of Coventry city centre. The practice is registered with the Care Quality Commission (CQC) as a partnership provider and delivers a full range of family medical services. Jubilee Healthcare holds a General Medical Services (GMS) contract with NHS England. The GMS contract is a contract agreed nationally between general practices and NHS England for delivering primary care services to local communities. At the time of the inspection Jubilee Healthcare was providing medical care to approximately 9,200 patients.

The area has higher than average deprivation, with mixed social housing, student accommodation, supported living, a parent and baby social services referral unit and residential homes. The universities of Coventry and Warwick are each within a few miles of the practice.

The practice has a car park to the rear of the building and a large, free car park is situated nearby in a shopping precinct. Coventry railway station and bus stops are all within five minutes’ walk of the practice. Wheelchair users can access the building via the rear entrance, which has a ramp. Consultation rooms on the upper floor are not suitable for patients with poor mobility, because the only access is by climbing narrow stairs. These patients have their consultations in a ground floor room, because the building is not suitable for a lift. The practice is in a Victorian house, which has been converted and extended to provide additional space.

Jubilee Healthcare has a branch site, Tile Hill Surgery, which is approximately six miles from the main site. The branch site was not visited on the day of the inspection.

There are three GP partners (one male, two female), plus two salaried GPs (female). The GPs are supported by a practice director, an IT lead, a nurse prescriber, a practice nurse, one health care assistant and administrative and reception staff.

Jubilee Healthcare is an approved training practice for trainee GPs. A trainee GP is a qualified doctor who is training to become a GP through a period of working and training in a practice. There are currently two GP trainees working at the practice.

The main site is open from 8am to 6.30pm on Mondays, Tuesdays, Wednesdays and Fridays and from 8am to 1pm on Thursdays. The branch site is open from 8am to 6pm on Mondays, Tuesdays, Wednesdays and Fridays and from 8am to 6.30pm on Thursdays. All calls are answered at the main site and diverted to the branch site as necessary. When the main site is closed on Thursday afternoons, calls are automatically diverted to the branch site. On the days when the branch surgery closes at 6pm, all calls are taken by the main site. Out of hours cover is provided by the NHS 111 service.

Updated 24 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Jubilee Healthcare on 6 July 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There were robust systems in place to monitor and maintain safety in the practice.
• Staff understood their responsibilities to raise concerns and to report incidents and near misses. Incidents were regarded as opportunities for learning and improving patient care.
• Patients’ needs were assessed and care delivered in line with best practice guidance.
• The practice team was well trained and had the skills and experience to deliver effective care and treatment.
• Patients’ feedback and comment cards described the care as very good and professional. They said that they were treated with kindness, dignity and courtesy. Patients told us that they felt 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 told us that it was easy to make an appointment with a named GP and that they valued the continuity of care. Urgent appointments were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Food vouchers could be issued to vulnerable patients.
• The practice director had devised a flowchart in conjunction with the GPs to help non-clinical staff to prioritise urgent calls. The flowchart had been adopted by other practices in the locality.
• The practice was visibly clean and hygienic. There were arrangements for assessing and mitigating the risks from healthcare associated infections.
• There was a clear leadership structure and staff said that they felt supported by management.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group. For example, the branch surgery now opened on a Friday afternoon in order to improve access as a result of patient suggestions.
• The provider was aware of and complied with the requirements of the Duty of Candour.

An area of outstanding practice was identified as follows:

• The practice director and deputy had attended a Food Bank training programme in June 2016, which enabled them to issue food vouchers to patients suffering from food poverty. This service was also available to patients from other practices.

The Practice should make improvements as follows:

• Continue to proactively identify carers (currently 1%).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 August 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.
• 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. Reviews for these patients were organised so that they only had to attend one annual review instead of having a separate review for each long term condition.
• 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 nursing team provided healthy lifestyle advice (smoking cessation, weight loss) and NHS health checks.
• An in-house pharmacist carried out reviews of patients with asthma and chronic lung disease, supported by the GP therapeutic lead.
• Data from the Quality and Outcomes Framework (QOF) achievement for 2014/15 showed that 75% of patients with diabetes had received a recent blood test to indicate their longer term diabetic control was below the highest acceptable level. This was 3% above the Clinical Commissioning Group (CCG) average and 3% above the national average.
• Data showed that 75% of patients with asthma had their care reviewed within the last 12 months, which was 1% below the CCG average and in line with the national average.
• The practice clinical team had received additional training in long term care. For example, a GP held a diploma in diabetes care and co-ordinated the care of more complex diabetic patients. 

Updated 24 August 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.
• Same day appointments were offered to all children under the age of five.
• Cervical screening was 78%, which was 3% below the Clinical Commissioning Group average and 4% below the national average.
• A range of contraceptive services was available at the practice (including coils and implants). Smears were offered in extended hours, which provided a greater choice for patients who could not attend during the core opening hours.
• A vasectomy service was provided by a GP, who used to be a partner at the practice.
• 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 24 August 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. Longer appointments were available if needed.
• The practice maintained a register for patients who required palliative care. Home visits and rapid access appointments were provided for these patients, who often had complex medical needs.
• The practice had signed up to the admissions avoidance service, which identified patients who were at risk of inappropriate hospital admission.
• Patients who found stairs difficult were able to be seen in consulting rooms on the ground floor.
• A named GP carried out weekly visits to four local care homes, which provided continuity of care.

Updated 24 August 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 provided continuity of care.
• Patients could book routine GP appointments online as well as request repeat prescriptions. At the time of the inspection 43% of patients had signed up to use the online services.
• Telephone appointments could be booked as an alternative to visiting the practice.
• Text messages were sent to remind patients about appointments.
• The practice had set up a Facebook page, which was used to keep patients up to date.
• Patients who had signed up to the Electronic Prescription Service could have prescriptions sent to a pharmacy close to their home or work.

Updated 24 August 2016

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

• 73% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was 9% below the CCG average and 11% below the national average. We were told that this was due to a coding error relating to temporary patients in care homes.
• 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 A&E where they may have been experiencing poor mental health.
• A GP was the mental capacity lead for the practice and staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 24 August 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.
• Vulnerable patients were flagged on the practice’s computer system, so that they were immediately identifiable to staff and could be given an appropriate level of service.
• The practice had 35 patients on the learning disability register. We saw that 25 had received their 2015/16 review and that eight had declined.
• Longer appointments were available for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• Vulnerable patients and their families were given advice about how to access various support groups and voluntary organisations.
• The practice director and deputy had attended a training programme to enable them to issue food vouchers to vulnerable patients suffering from food poverty.
• A GP was the child protection lead for the practice and triaged child referrals for the city.
• Staff had received training and 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’s computer system alerted GPs if a patient was also a carer. The practice had identified 71 patients as carers, which represented 1% of the practice list.