Practice Quality Appraisal Report
2016-2017
Practice & Visiting Team Information /Practice Name / Whitwick Health Centre / Practice Code: / C82120 /
Appraisal Team: / Dr Chris Barlow (Clinical Appraiser)
Ruth Waddington (CCG Lead) / Appraisal Date: / 20.3.17 /
Agenda /
Agenda Item / Overview /
Practice Attendees / The Practice was well represented with a broad selection of staff and all personnel were able to contribute to discussions
Present:
Roy Hill – PPG
Paul Siddals - PPG
Sarah Chalmers – Practice Manager
Dr Liz Hepplewhite – GP Partner
Dr Sumit Virmani – GP Partner
Brief summary of practice / Whitwick Health Centre houses 2 practices. Dr Hepplewhite’s Practice has a list size of 3583 which has risen by over 4% last year. It has 45 patients spread across 5 Residential / Nursing Homes. The practice has the lowest core funding per patient in the CCG and also has a Carr-Hill reduction in list size of nearly 300 or just over 8% which represents a financial challenge. The demographics show a fairly wide spread ages. The clinical work is supported by one nurse and the equivalent of 1.5 phlebotomists
Practice Identified Areas for discussion / Workload / Recruitment
The Practice is concerned at the increasing workload through rising demand and increasing population. Dr Hepplewhite’s upcoming retirement may prove a barrier – as it is difficult to recruit new GPs. The practice has also received the resignation of their Advanced Nurse Practitioner who will also need replacing.
Practice Merger
There had been plans for a Practice merger wityh the other practice housed in the same building. However after a couple of exploratory meetings this has been put on hold which limits the pressure that the practice can bring on the building owners for a variation in use of rooms to aid capacity.
Community Colleagues
The Practice expressed concern at the lack of input from community colleagues regarding MDT meetings. It was discussed how this is hoped to change in respect of the contracting with LPT
Finance
The combination of inability to recruit and subsequent difficulty achieving QoF QIPP and enhanced service contracts is a worry in respect of financial stability
Actions Taken since Practice Appraisal in 2015/16 / Last year’s Action Plan was reviewed. All areas had been addressed:
Palliative Care
The Practice has struggled to get engagement of community staff with MDT meetings. It appears that there is more virtual than actual interaction. It is hoped that the formation of integrated locality teams will help remedy this situation.
SystmOne
The Practice has undertaken a successful transition from EMIS to SystmOne. It was felt that the change was not as difficult as had been anticipated. The Practice is still not sure whether the system is better but has found it easier to create a multi-team approach
Pharmacist
The Practice has appointed a Pharmacist within the scheme to encourage Pharmacist roles in Practice. The appointee is a former community pharmacist which has helped in providing access to patients and ameliorated the nurse absence. However it has been felt that the Pharmacist role has not been as extensive as hoped as the role requires training. The post holder is due to attend a prescribing course which should help extend the role
Health Centre Space
Health Visitors and District Nurses have been relocated to alternative premises. This has helped the car parking but as yet not altered the ability of the practice to use the vacated building space. The rental on this space is very high so cannot be used to its full potential. This situation was discussed and the CCG will consider trying to negotiate on this
NHS Health Checks
Unsurprisingly given the staffing challenges these have not increased. It was discussed whether there was a lower rate of conversion from offer to check being completed – suggesting a patient non-compliance rather than lack of practice effort.
Practice Profile Feedback / The Practice Profile was discussed
Clinical
Prevalence of Chronic Disease remains at of above CCG levels with a particular spike in hypertension.
QoF achievement for the current year is lower although not yet complete. This may also be a reflection of the Practice workload problems and will need to be addressed to help finances. Historical performance has been very high
ED attendances continue to be well below CCG average as have Eye casualty attendances and emergency admissions.
Referral rates are low. The practice has made good use of the AVS. Prescribing costs have shown a similar trend to the rest of the CCG with an upward trend. The PQIS data was not up to date for assessment of QIPP attainment. The Practice was advised that the Medicines Team are currently assessing this and it would be available in the near future
Patient Experience
The posted survey is of very high standard and increased in all but one category this year. The Friends and Family test returns were very low. Techniques to improve the FFT return were discussed including placing cards on seats.
The Practice has a good PPG which is very positive about the Practice. The PPG has undergone a self-appraisal and set itself objectives for the coming year. A document regarding this was presented.
Areas of Good Practice / QoF achievement
This has remained high despite the staff challenges
New Manager
The Practice feels that the new manager has created a more settled and hardworking team
Appointment of Pharmacist
The Practice believes that this is work in progress but the appointee has already shown some benefits after initial induction and will continue to develop the role with additional training
SystmOne
The system transition has gone to plan and it was felt that the Practice coped well with the change
Increased Bowel Screening Uptake
Al letter is sent to non-attenders from the Practice and this has increased subsequent uptake
Increased formal practice meetings
Practice meetings have become more structured with agendas /. Minutes and regular frequency
Areas for Sharing Best Practice PLT event / Pharmacist role in safe prescribing
The Pharmacist role in care home prescribing / drug reconciliation and improved access has begun to pay dividends to the practice as a whole
Areas for Improvement and suggested areas for consideration / General
It is clear that the Practice has maintained a very high standard of care and clinical service to its population, despite the challenges.
Sustainability
In difficult times the Practice has benefitted from the appointment of a new Practice Manager and from utilising the Pharmaciust in Practice scheme
Organisation
The Practice has become increasingly well organised with regular meetings with minutes. There is a process for assessing referrals both pre and post referral. Prism is increasingly used. The Practice should be encouraged by this and continue to use review of practices
Datix
There is little / no use of the datix system. This was discussed including the upcoming plans to simplify the process. It was discussed how this can create a log for CQC assessment.
Contractual concerns raised / There is a concern regarding the ability of the practice to maintain current access to meet the growing population. The building is limited – although this does seem as though it could or should be negotiable.
The ability to recruit a new GP to replace Dr Hepplewhite in retirement and the need for a new ANP are of concern
QIPP / The engagement of the Practice with Federation QIPP was discussed. Advice and information regarding payments / achievement will be forthcoming in the next few weeks via CCG and Federation
CCG Actions / Ruth Waddington to review the situation regarding the continuation of contract – single handed v partnership
Consider negotiation of better rental to enable use of vacated space within the Health centre
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