Mickleover Medical Centre

Updated 5 February 2018

Mickleover Medical Centre provides primary medical services to approximately 11,530 patients through a general medical services contract (GMS). The practice is located in purpose built premises within the residential suburb of Mickleover. The practice has car parking facilities and is accessible by public transport.

The registered practice population is predominantly of white British background. The practice is ranked in the tenth least deprived decile meaning that it has a lower proportion of people classed as deprived when compared to the national average.

The practice is managed by four GP partners (two female and two male) and they are supported by two salaried GPs (both female). The nursing team comprises of a team leader, two triage nurses, two practice nurses and a health care assistant. Two of the nurses are also prescribers.

Mickleover Medical Centre is a teaching practice providing placements for medical students from the University of Nottingham and the University of Derby.

The management team comprises of a practice manager, an operations manager, a staff training and development manager, and a management support officer. They are supported by a team of reception (care navigators), secretarial and administrative staff.

The practice is open between 8am and 6.30pm Monday to Friday, and 9am to 12midday on a Saturday. Consulting times are generally from 8.30am to 10.30am and from 3pm to 6pm daily. Some late surgeries are held on a Tuesday, Wednesday and Thursday evening between 6.30pm and 8pm. Extended hours surgeries are available on Saturday morning from 9am to 12 midday.

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 5 February 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Mickleover Medical Centre on 30 August 2017. 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 and an effective system in place for reporting, recording and investigating significant events. We saw evidence of applied learning relating to these events.

• Risks to patients were assessed and monitored on an on-going basis. This included infection control and staffing levels.

• The practice had clearly defined and embedded systems in place to safeguard children and vulnerable adults.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge, and experience to deliver effective care and treatment.

• The practice used clinical audit to drive quality improvement within the practice.

• The practice worked effectively with the wider multi-disciplinary team to plan and deliver effective and responsive care for patients with complex care needs.

• Feedback from patients about their care and interactions with staff was very positive. Patients said they were treated with compassion, dignity, and respect and they were involved in their care and decisions about their treatment.

• The majority of patients said they could usually get an appointment when they needed one, with further improvements suggested. The practice continually sought to improve access for patients and systems were in place to monitor the demand for appointments.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.

• The practice had a clear vision, which had quality and safety as its top priority. The strategy to deliver this vision was regularly reviewed and discussed with most staff.

• There was a clear leadership structure and staff felt supported by management.

However there were areas of practice where the provider should make improvements:

• Continue to ensure effective systems are in place to review, monitor and act upon patient experience data to continually drive service improvement. This includes access to the service.

• Improve access to health checks for people with learning disabilities.

• Embed identified improvements to ensure good communication across all staffing groups.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 February 2018

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

• The practice nurses had lead roles in long-term disease management and were able to offer expert advice and support. This included prescribing of specific medicines, monitoring of patients with diabetes and the initiation of insulin treatment within the practice.
• Nationally reported data for most of the clinical indicators related to long term conditions were above local and national averages. For example, performance for diabetes related indicators was 100% compared to the local average of 95% and the national average of 91%.
• An effective system was in place to recall patients for a structured annual review to check their health and medicines needs were being met. The review was also used to promote patient education and self-care on the management of their condition.
• Patients with complex health needs and at risk of hospital admission were identified as a priority. The practice team worked closely with relevant health and care professionals including the attached care coordinator to deliver a multidisciplinary package of care.
• Staff followed up patients discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were processes in place to facilitate urgent care and treatment for patients who experienced a sudden deterioration in health.
• Patients could book longer appointments if they wished to be seen for multiple conditions or had complex health issues to discuss. Home visits were also offered for patients that were unable or had difficulties attending the practice.

Updated 5 February 2018

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

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
• Children living in disadvantaged circumstances, at risk of abuse or deteriorating health were regularly discussed and monitored at monthly safeguarding meetings held with the health visitor.
• The practice team had established communication links to promote joint working with midwives, health visitors and school nurses. This included child health surveillance clinics and the provision of antenatal and post-natal care.
• The practice offered adolescent vaccinations and immunisation rates were relatively high for most of the standard childhood immunisations.
• A flexible appointment system including the use of telephone triage was utilised to ensure children could be seen on the same day when this was indicated. Appointments were also available outside of school hours.
• The practice had emergency processes for acutely ill children and young people, as well as processes for monitoring patients presenting at accident and emergency (A&E) services.
• The premises were suitable for children and babies. Baby changing facilities were available and the practice accommodated mothers who wished to breastfeed.

Updated 5 February 2018

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.
• Every patient over the age of 75 years had a named GP.
• Regular multi-disciplinary meetings were held to review frail patients and those at risk of hospital admission to ensure the delivery of integrated care to meet their needs.
• The nationally reported data showed most of the patient outcomes for conditions commonly found in older people, including osteoporosis and heart failure were above local and national averages.
• Influenza and shingles vaccinations were offered in accordance with national guidance.
• The practice was proactive in identifying older people who may need palliative care as they were approaching their end of life and involved them in decisions about their care.
• The practice accommodated the needs of older patients by offering home visits, longer appointments and urgent appointments for those who needed them.
• A named GP carried out care home visits for regular monitoring of patients identified by staff as requiring an appointment/review.

Updated 5 February 2018

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice had adjusted the services it offered to ensure these were accessible and flexible. This included access to telephone appointments as well as evening and Saturday morning appointments. Evening appointments were available between 6.30pm and 8pm at least two days a week.
• The practice was proactive in offering online services, which included appointment booking, prescription services, access to summary care records and coded patient records.
• A range of health promotion and screening services were offered and promoted. For example, the practice’s uptake rates for cervical, breast and bowel cancer screening were above the local and national averages.
• The practice provided travel vaccinations and was a registered yellow fever centre.
• A range of services were offered at the practice including minor surgery and joint injections.
• A virtual patient participation group was in place to accommodate the views of patients who could not attend the face to face meetings.

Updated 5 February 2018

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

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Published data showed 96% of patients with a mental health condition had a documented care plan in the preceding 12 months compared to the local average of 92% and national average of 90%.
• The practice told patients experiencing poor mental health about how to access services including talking therapies, various support groups and voluntary organisations.
• The practice had a system in place for monitoring repeat prescribing for patients receiving medicines for mental health needs as well as following up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• The practice considered the physical health needs of patients with poor mental health and dementia.
• Published data showed 73% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the preceding 12 months, which was below the local and national averages of 84%.
• Patients at risk of dementia were identified and offered an assessment.
• Advance care planning was incorporated in the reviews for patients with dementia.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 5 February 2018

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• Staff went the extra mile by facilitating “coffee and chat” sessions to enable patients to meet socially on a Saturday morning at the practice. The sessions were held every six to eight weeks and used to promote patient education with external guests being invited. This outstanding feature has consistently been facilitated since our last inspection in 2015. Patient feedback was also consistently positive about the impact it had on their wellbeing and promoting social stimulation.
• The practice worked with multi-disciplinary teams including the attached care coordinator, in the case management of vulnerable people and informed patients how to access various support groups and voluntary organisations.
• End of life care was delivered in a coordinated way, and professionals involved took into account the needs of those whose circumstances may make them vulnerable.
• The practice held a register of patients living in vulnerable circumstances including informal carers and those with a learning disability. Records reviewed showed 25% of patients with a learning disability had received an annual review in the last 12 months.
• Staff interviewed knew how to recognise signs of abuse in 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.
• A hearing loop and translation services were available.