James Alexander Family Practice

Updated 27 October 2017

James Alexander Family Practice, Goodhart Road, Bransholme, Hull, North Humberside HU7 4DW is a GP practice in Hull situated in a modern accessible building which is leased from Community Health Partnership CIC. There are also six other GP practices in the building and a range of community health services. The practice registered with the Care Quality Commission in April 2016 and has seen several changes such as relocation in the building to the second floor in September 2016. The practice have been recruiting staff since then and have recently recruited four Nurse Practitioners who are due to start in the next couple of months. The practice place emphasis on a multi-disciplinary team approach to patient care. The current staff are;

Two male GP partners, one full time and one part time, two salaried GPs ( one male and one female), a Nurse Practitioner (female) and a Advanced Nurse Practitioner who is able to prescribe (male), three Practice Nurses (all female), two Health Care Assistant (both female) and a Clinical Pharmacist. The practice is supported by an Operational Lead, a Branch Manager, a Service Development Nurse, Office supervisor, Secretary, and a range of administrative and reception staff.

The practice has a General Medical Services contract. It has approximately 7300 patients mainly from a white British background. The practice is in an area measured as having high levels of deprivation and is scored as one on the indices of deprivation. Practices with high levels of deprivation typically have more need for health care services. It is a teaching and training practice to both nursing staff, medical students, junior doctors and GP trainees and participates in research. There is a large car park and good transport links.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are available from 8am every morning to 6.20pm daily. Extended hours appointments are offered on Wednesday evening each week until 8pm.

When the practice is closed patients are advised to contact the Out of Hours service (111) provided by City Health Care Partnership CIC in Hull.

Updated 27 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at James Alexander Family Practice on 30 August 2017. Overall the practice is rated as good.

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

• The practice had become registered with the Care Quality Commission in May 2016 and was on a trajectory of improvement. This was a new registration following a practice split. Some initiatives such as improvement in patient satisfaction scores and Quality outcomes framework were not demonstrable in the national figures quoted as they included some data from the previous governance team but we saw evidence of improvement on the day of inspection.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• There were high levels of staff satisfaction. Staff were proud of the organisation as a place to work and spoke very highly of the culture. There were consistently high levels of constructive staff engagement.

• Staff at all levels were actively encouraged to raise concerns.

• 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.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• 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 good facilities and was well equipped to treat patients and meet their needs.
• Staff told us that they had seen many improvements in the practice since registration.

• The practice had strong and visible clinical and managerial leadership and governance arrangements. The practice had funded leadership training for two of the key members of staff. This had resulted in nominations by practice staff and also from doctors training at the practice for awards in inspirational leader and best team categories.

• The practice proactively sought feedback from staff and patients, which it acted on.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example a jointly funded pilot scheme had recently been completed; evaluation had shown a reduction in pain and an improvement in mental well-being in patients suffering from arthritis and multiple sclerosis. This was due to be presented to local commissioners with a view to becoming shared across the area.

• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.

• 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 practice had introduced GP telephone triage, introduced a new automated telephone system and recruited staff to build a multi-disciplinary team to suit the needs of their patients.
• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

We saw areas of outstanding practice:

• Members of staff were inspired to care for patients and we saw numerous examples of this care.

• The practice had recognised that Hull had the highest incidence of Ischaemic Stroke in England and was an outlier. The practice had funded equipment to screen patients for atrial fibrillation and had identified patients with previously undiagnosed atrial fibrillation who were now receiving treatment. This indicated undiagnosed atrial fibrillation in almost 10% of patients tested. They were in negotiation with the CCG to be a pilot for this service with the aim of roll out across the area.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 October 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• In the last reported data the percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5 mmol/l or less was 69% which was 11% below the national average. This was data relating to the previous governance, the practice had recognised this and recent data provided by the practice on the day of the inspection showed an improvement to 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 additional needs.

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

• The practice were proactively screening patients for chronic obstructive pulmonary disease and atrial fibrillation as they were aware that the figures for patients diagnosed with the disease were lower than expected.

• 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 27 October 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.

• On the day of inspection we saw 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 worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, 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 27 October 2017

The practice is rated as good for the care of older people.

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

• 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 may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

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

• Where older patients had complex needs, the practice shared summary care records with local care services.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 27 October 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 and telephone appointments.

• 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 had recognised that screening rates were lower for their patients and planned to have a two day event in a local shopping centre to raise awareness.

Updated 27 October 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.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia.

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

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in the record, in the preceding 12 months was 96% which was above the national average.

• 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. The practice was dementia friendly and had named staff who trained, advised and signposted patients to support.

Updated 27 October 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.

• 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. They had organised for a volunteer from a local organisation to attend weekly for any patients wanting advice on social prescribing.

• 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.