Archived: New Parkfields Surgery

Updated 23 October 2018

New Parkfields Surgery is presently registered with the CQC as a location under Hollybrook Medical Centre’s provider registration. It is a partnership of four GPs although we were informed that the registration was in the process of being changed at the time of the inspection, and would become part of Aspiro Healthcare. Aspiro Healthcare manage practices across three counties with over 50,000 registered patients across five locations.

Hollybrook Medical Centre was selected as a caretaker provider for the services at New Parkfields Surgery by Southern Derbyshire CCG with effect from April 2017. This was initially for a time-limited period, but the provider was later successful in being awarded a five-year contract in June 2018.

The practice is situated in Alvaston, which is a large suburb and ward, approximately three miles to the south-east of Derby city centre. It provides primary care medical services commissioned by NHS South Derbyshire CCG and NHS England.

The practice has a population of approximately 6,300 registered patients. There has been a slight reduction in registered patient numbers since our previous inspection at this location in 2016. Patients are predominantly of white British origin, although 11% of registered patients are from BME groups. The age profile of registered patients shows a higher percentage of younger patients in comparison to local and national averages, with a slightly lower proportion of patients aged over 65. The practice serves a population that is ranked in the second most deprived decile for deprivation, which is an indicator of greater health needs.

There are 21 staff working at the practice. The clinical team consists of two GPs. These GPs are part of a larger group which rotate between New Parkfields and Hollybrook, but there are always two GPs on site for each session. This arrangement has ensured that a female GP is available for some clinical sessions, which was not previously available under the former provider. An advanced nurse practitioner has recently been appointed who will work on site for at least one session each week, and a nurse practitioner also works at the practice one day each week. These nurses also work across other sites. There are also three part-time practice nurses, a part-time pharmacist, and two healthcare assistants. The clinical team is supported by a deputy operations manager, a team of eight reception and administrative staff, and an apprentice.

New Parkfields Surgery was approved for registrar GP placements on the day of our inspection, and a registrar has commenced working at the practice since our inspection (A registrar is a qualified doctor who is training to become a GP through a period of working and training in a practice). Foundation year 2 (F2) GPs also work at the practice (the foundation programme is a two-year, general postgraduate medical training programme which forms the bridge between medical school and specialist/general practice training)

The practice opens from 8am until 6.30pm Monday to Friday. Scheduled GP appointment times are available each morning between 8.30am to 11.30am and on each afternoon from 3.30pm to 6pm.

The surgery closes for one afternoon each month for staff training. When the practice is closed, patients are directed to Derbyshire Health United (DHU) out of hours via the 111 service.

Updated 23 October 2018

This practice is rated as ‘Requires Improvement’ overall.

The key questions at this inspection are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? - Requires improvement

We carried out an announced comprehensive inspection at New Parkfields Surgery (also known as Parkfields Surgery) on 22 August 2018. This inspection was undertaken following Hollybrook Medical Centre’s partnership registration, as the new provider for regulated activities at this location, with the Care Quality Commission (CQC) on 14 September 2017. The inspection was carried out under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• The new provider, Hollybrook Medical Centre, had been selected to take over the management of the New Parkfields Surgery by the Southern Derbyshire Clinical Commissioning Group (CCG) with effect from April 2017 (their registration with the CQC was effective from September 2017). The CCG initially awarded the contract for a period of 12 months, which was later extended to 18 months. The provider had since been successfully awarded a five-year contract, with effect from June 2018.
• The new provider informed us they had inherited a significant number of problems which needed to be resolved. We were informed how the issues had been addressed that were identified at CQC inspections under the previous registered partnership. In addition, further challenges were discovered by the new contractor leading to a comprehensive change programme for the practice, which had been ongoing for almost 18 months when our inspection took place.
• The new provider was part of a wider organisation and were in the process of updating their CQC registration at the time of our inspection. This organisation provided a corporate management structure which included the benefits of working at scale.
• There was improved continuity of care with GPs now providing regular clinical sessions on site, and patients told us they saw improvements. A female GP had been introduced to the team allowing choice for patients in consultations, and to promote choice when accessing services such as family planning.
• Skill mix arrangements were being developed with advanced nurse practitioner/nurse practitioner roles, although these only amounted to a few hours on site each week. A part-time pharmacist provided support on medicines management issues, and reviews of patients’ prescribed medicines. Joined up working with Hollybrook Medical Centre meant there was greater flexibility and capacity for GP clinical sessions, and staff such as a nurse with a specialism in diabetes management, offered more extensive care options to patients.
• Due to issues of multiple medicines being previously prescribed to patients, the provider had completed almost 2,000 medicines reviews since taking over the contract. This impacted significantly in reducing prescribing costs and ensured patients were only in receipt of the medicines they required to ensure they had appropriate and safe care.
• The provider had an achievement of 95% in the 2017-18 Quality and Outcomes Framework (QOF). These figures remained subject to external verification. We saw that the new provider had made good progress in tackling an inherited high level of exception reporting.
• Systems for safeguarding had improved significantly under the new provider. There was an identified lead for safeguarding on site and within the organisation. However, not all GPs were able to demonstrate they had completed up to date level 3 safeguarding training.
• The practice had systems to manage risk so that safety incidents were less likely to happen. However, we found that some incidents were not being reviewed effectively and opportunities for learning were not always identified.
• Environmental risk assessments had been undertaken, including fire and Legionella (Legionella is a term for a particular bacterium which can contaminate water systems in buildings). However, action plans were not being updated to evidence that issues had been effectively addressed. On site monitoring records (for example, water temperatures) was not always followed up when an issue had been identified.
• The practice ensured that care and treatment was delivered according to evidence-based guidelines.
• The results from the national GP patient survey were mostly below local and national averages. However, the practice was undertaking their own internal surveys and we saw that some improvement was being achieved. The majority of feedback we received from patient comment cards was positive, and some commented on the improvements that were being made in the last 18 months. On the day of the inspection, we saw staff treat patients with kindness, dignity and respect.
• Appointment systems had been reviewed and we observed that this was facilitating improved access to care when it was needed. The procurement of a new and improved telephone system, and an IT based interactive system was nearing completion. It was hoped these measures would impact positively on patient experience. Patients could access extended hours via a local hub service as part of the GP federation.
• The practice encouraged learning and improvement, and we saw that most staff were up to date with the practice’s training schedule. However, records for clinical staff training were not easily accessible.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients in accordance with the fundamental standards of care. For details, please refer to the requirement notice at the end of this report.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. For details, please refer to the requirement notice at the end of this report.

The areas where the provider should make improvements are:

• The provider should continue to work towards improving patient experience.
• The practice should review and improve quality improvement programmes in the practice.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Updated 23 October 2018

Updated 23 October 2018

Updated 23 October 2018

Updated 23 October 2018

Updated 23 October 2018

Updated 23 October 2018