Friargate Surgery

Updated 25 January 2017

Friargate Surgery provides primary medical services to approximately 5000 patients through a general medical services contract (GMS). This is a locally agreed contract with NHS England.

The practice is located in purpose built premises close to the Derby city centre. It is near student residential halls. All facilities are on the ground floor including consulting and treatment rooms. The practice is located near university halls of residence and accommodates an independent pharmacy within its premises.

The level of deprivation within the practice population is below the national average with the practice falling into the fourth most deprived decile. The level of deprivation affecting older people is above the national average. The practice has higher than average numbers of patients aged between 25 and 40 years old. Numbers of young people under 18 years old is lower than local and national averages, and the number patients aged over 65 years old is in line with local and national averages.

The clinical team includes four GP partners and two long term locum GPs (three female, three male), a practice nurse and a healthcare assistant. The clinical team is supported by a practice manager and a team of reception and administrative staff. At the time of the inspection a pharmacist had just joined the practice team. The surgery is a teaching practice for second and fifth year medical students.

The surgery is open from 8am to 6.30pm on Monday to Friday. Extended opening appointments are provided by the GPs and practice nurse from 7.30am to 8am on Monday to Friday. Telephone lines open at 8am and patients can contact the GPs on Wednesday afternoons on the telephone when the practice is closed. Consulting times vary but are usually from 8.30am.

The practice has opted out of providing out-of-hours services to its own patients. This service is provided by Derbyshire Health United and is accessed via 111.

Updated 25 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Friargate Surgery on 10 October 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety within the practice. Effective systems were in place to report, record and learn from significant events. Learning was shared with staff and external stakeholders where appropriate.

• Risks to patients were assessed and well managed. Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• The practice demonstrated innovation in managing care to achieve better outcomes for their patients by securing an audible blood pressure monitor for a patients with sight problems to manage their health at home.

• Training was provided for staff which equipped them with the skills, knowledge and experience to deliver effective care and treatment.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• GPs demonstrated a caring approach by convening multi-practice multi-disciplinary meetings to coordinate care and tailor it to the needs of patients.

• Patients told us they were able to get an appointment with a GP when they needed one, with urgent appointments available on the same day.

• Feedback from the GP patient survey was in line with local and national averages.95% of patients stated they had confidence in the last GP they saw or spoke to.

• 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 and learning from complaints was shared with staff and stakeholders.

• The practice had good facilities and was well equipped to treat patients and meet their needs. Services were designed to meet the needs of patients.

• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on. The partners held quarterly meetings where all staff were involved.

However, the areas where the provider should make improvements are:

• Consider developing a patient participation group is established to encourage patient-led engagement.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 January 2017

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

• Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. There were 2048 patients identified as having a long term condition and 85% of them had been invited for a health check appointment in the last 12 months.

• The practice developed an in-house asthma action plan which was completed by the patient together with their GP or nurse, and a copy given to the patient to help them manage their condition at home.

• Published data showed the proportion of patients with asthma who had a review in the preceding 12 months was 51%, compared to the CCG average of 79% and the national average of 76%. The exception reporting rate was 2%, below the local average of 11% and the national average of 8%.

• Performance for chronic kidney disease related indicators was 100% which was the same as the CCG and national average. GPs told us they had carried out joint work with the pharmacist to manage patients with acute kidney injury, including a leaflet for patients taking medicines that could affect their kidney function.

• Longer appointments and home visits were available when needed.

• For patients with the most complex needs, practice staff worked with relevant health and care professionals to deliver a multidisciplinary package of care. Regular multidisciplinary meetings were hosted by the practice. The practice worked closely with the community trust employed care coordinator.

• The practice demonstrated innovation in managing care to achieve better outcomes for their patients. For example, they secured an audible blood pressure monitor for a patient with sight problems to assist them in managing their health problems at home.

Updated 25 January 2017

The practice is rated as good for the care of families, children and young people.

• Systems were in place to identify children at risk. The practice had a child safeguarding lead and staff were aware of who they were.

• 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. The GP lead for safeguarding liaised with other health and care professionals to discuss children at risk.

• Childhood immunisation rates for the vaccinations given were slightly lower than CCG averages. For example, childhood immunisation rates (2015/16) for the vaccinations given to under two year olds averaged 80% against a local average of 86%. For five years olds the practice rates averaged 84% against a local average of 89%.

• Reception staff invited new mothers for their newborn checks and post-natal appointments by telephone instead of writing to them with specific appointments, in order to offer the most suitable appointments for them.

• The practice offered a range of contraception services including implants, and referrals for patients who requested for coil fittings.

• There was a wide range of information targeted at parents and young people to improve their wellbeing. For example healthy living clubs for families with children who had higher body mass index (a measure that uses height and weight to work out if someone’s weight is healthy).
• Urgent appointments were available on a daily basis to accommodate children who were unwell.

Updated 25 January 2017

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. Regular multidisciplinary meetings were held to review frail patients and those at risk of hospital admission to plan and deliver care appropriate to their needs. For example, a GP convened a multi-disciplinary meeting to support an elderly man who was not a registered patient, who cared for his wife who had complex health needs. This resulted in a number of agencies working together to provide a joint package of care for the family as a whole.

• A consultant in Medicine for the Elderly provided onsite clinics and home visits, including care home visits for patients deemed to be at risk of falls.

• GPs provided services to patients resident in six care homes in the area as part of a local enhanced service agreement. A named GP carried out weekly ward rounds to review patients and their medicines. Staff told us they linked care home staff with training offered by the CCG to ensure they were up to date on care guidance appropriate to them.

• Feedback from one of the care homes was positive about the continuity of care provided by the practice and their responsive manner to requests for visits.

• The practice was responsive to the needs of older people, and offered GP and healthcare assistant home visits and urgent appointments for those with enhanced needs. Medicine reviews were carried out by the practice employed pharmacist.

• Data supplied by the practice showed 69% of eligible patients aged over 65 years were given flu vaccinations in 2015/16, compared to the local average of 74%.

• All patients aged over 75 years old had a named GP for continuity of care.

• However, nationally reported data showed that most outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure were significantly below local and national averages. For example, in 2015/16 the proportion of patients with rheumatoid arthritis who had a face to face annual review in the preceding 12 months was 75%, compared to the CCG average of 93% and the national average of 91%. The exception reporting rate was 1.9%, lower than the CCG average of 10% and the national average of 8%. A register was kept of patients on anti-rheumatic medicines with weekly monitoring arrangements in place.

• The practice was aware of areas where their performance needed to improve and there were plans to use the recently employed pharmacist to carry out more opportunistic reviews of patients who did not attend appointments for reviews.

Updated 25 January 2017

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 offered continuity of care.

• Extended opening hours appointments were offered from 7.30am every week day to accommodate working age patients.

• Appointments could be made and cancelled online as well as management of repeat prescriptions. The practice offered the electronic prescribing service enabling patients to collect prescriptions from a pharmacy of their choice.

• GPs used additional skills in occupational health to offer occupational health medicals and retirement reports.

• The practice was proactive in offering a full range of health promotion and screening that reflects the needs for this age group. This included travel vaccinations (including yellow fever vaccinations), health checks and referrals to counselling services. Meningitis vaccines were offered to patients aged 18 years to 25 years including those attending university for the first time in the area.

• The practice’s uptake for the cervical screening programme was 76%, which was slightly below the CCG average of 83% and below the national average of 81%.

Updated 25 January 2017

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

• The practice supported patients with mental health conditions living in a low secure rehabilitation centre in the area by providing general medical services to them on site.

• Data from 2015/16 showed the number of people with a complex mental health condition that had received a comprehensive care plan in the preceding 12 months was 75%, compared to the CCG average of 94% and the national average of 89%. This was with an exception rate of 4%, which was significantly lower than the local average of 20% and the national average of 12%.

• The proportion of patients with a diagnosis of dementia who had their care reviewed in a face-to-face review in the last 12 months was 97%, compared to the local average of 85% and the national average of 84%. This was achieved with an exception reporting rate of 3%, below the local average 8% and the national average of 7%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 25 January 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 including those with a learning disability. There were 27 patients identified on the learning disabilities register in 2015/16, and 12 had attended a face to face review appointment.

• Longer appointments were available for patients with a learning disability and for those who required it with easy to read information sheets for patients eligible for screening procedures.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. For example, joint visits were carried out with the learning disabilities specialist nurse where appropriate to ensure holistic care was provided to patients.

• GPs provided general medical services to students registered at the Royal School for the Deaf in Derby.  A health care assistant at the practice had attended a sign language course in order to assist in communication.

• Feedback from the care coordinator was positive about the engagement of the practice team and liaison with district nurses and community matrons to resolve and reduce hospital attendances.

• Regular multidisciplinary meetings were hosted by the practice. In addition the practice held regular meetings to discuss patients on their palliative care register. There were 13 patients on the palliative care register. A list of patients on this register was kept on a board in the reception office to ensure staff were aware of patients with enhanced needs.

• GPs worked closely with their local Police Witness Protection Scheme to secure general medical services for named patients.

• A GP provided additional support to a transgender patient who could not access some services locally by researching into regional providers and liaising with the CCG to ensure the patient could access the required care.

• Staff 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.