The Springs Health Centre

Updated 4 November 2016

Dr DJ Collins’ Practice (also known as The Springs Health Centre) provides care to approximately 9,900 patients in the village of Clowne, in the Bolsover district of North Derbyshire. It is located approximately nine miles from the town of Chesterfield.

The practice provides primary care medical services via a Personal Medical Services (PMS) contract commissioned by NHS England and North Derbyshire Clinical Commissioning Group (CCG). The practice operates from a modern purpose built two-storey building constructed approximately ten years ago. All patient services within the practice are provided on the ground floor of the building, whilst the upper floor is utilised for administration.

The partnership was originally formed in 2000, and by 2004 had expanded to replace three former locally based practices. The practice is now run by a partnership of five GPs (three males and two females) who employ two female salaried GPs. The Springs Health Centre is a training practice and supports placements for GP registrars (this is a qualified doctor who is undertaking additional training as a GP). There was one GP registrar in post at the time of our inspection. The practice also hosts visiting medical students.

The nursing team consists of one male and one female nurse practitioner, five practice nurses and three health care assistants. The partners employ two community matrons (one of whom has a dual role as a practice nurse), and a care co-ordinator. The clinical team is supported by a practice manager, an office manager and a reception manager, who oversee a team of 13 administrative and reception staff. The practice employs their own domestic services’ team consisting of five staff, headed by a caretaker.

The registered patient population are predominantly of white British background. The practice age profile shows slightly higher numbers of people aged over 45, and lower numbers of under 15 year olds, when compared against the national average. The practice is ranked in the fifth more deprived decile and serves a mix of rural and semi-rural areas. Due to the previous mining history in the area, there is a higher prevalence of some industrial-related illnesses. Deprivation scores (2015) at 22.1 were in line with the national average (21.8), but above local rates (18). Due to the proximity to the M1 motorway and the relative affordability of newer housing developments, the area had attracted commuters, which had reduced the local level of deprivation and unemployment in more recent years.

The practice opens Monday to Friday from 8am until 6.30pm, with additional extended hours being provided each Tuesday evening when the practice is open until 8pm. The practice closes at 1.30pm on one Wednesday afternoon each month for staff training.

GP consultations commence each morning from 8.30am until 10.30am, and then from 11.30am until 12.30pm. Afternoon GP surgeries run between 3.30pm until 5.30pm. There is a duty doctor available every day and they will see patients until 6.30pm. The last GP appointment during extended hours on Tuesday evenings is available at 7.40pm.

The practice has opted out of providing out-of-hours services for its own patients. When the practice is closed, patients with urgent needs are directed via the 111 service to an out-of-hours and walk-in urgent care centre in Chesterfield, operated by Derbyshire Health United (DHU). 

Updated 4 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr DJ Collins (The Springs Health Centre) on 28 September 2016. Overall, the practice is rated as good.

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

• There was an effective system in place for the reporting and recording of significant events. Learning was applied from events to enhance the delivery of safe care to patients.

• Clinicians kept themselves updated on new and revised guidance and discussed this at clinical meetings. Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• We saw evidence of an active programme of clinical audit that reviewed care and ensured actions were implemented to enhance outcomes for patients.
• Patients told us they were treated with compassion, dignity and respect. They also said they were involved in their care and decisions about their treatment. This was corroborated bythe outcomes of the latest national GP patient survey and CQC comment cards.
• The practice planned and co-ordinated patient care with the wider health and social care multi-disciplinary team to deliver effective and responsive care to keep vulnerable patients safe. Fortnightly meetings took place to discuss and review patients’ needs.
• The practice directly employed two community matrons and a part-time care co-ordinator to deliver and co-ordinate care and support to vulnerable patients in their own homes.
• The practice had an appraisal system in place and supported staff training and development. The practice team had the skills, knowledge and experience to deliver high quality care and treatment.
• Arrangements were in place to assess and manage risk effectively.
• Feedback from patients we spoke with on the day, and from CQC comment cards, demonstrated that people had good access to GP appointments.
• The practice had good facilities and was well-equipped to treat patients and meet their needs. The premises were accessible for patients with impaired mobility.
• The practice provided care to residents across three local care homes for older people. Regular planned visits to the home by both the community matron and by a GP ensured continuity of care and a reduction in the number of acute visits.
• There was a clear leadership structure in place and the practice had a governance framework which supported the delivery of good quality care. Regular practice meetings occurred, and staff said that GPs and managers were approachable and always had time to talk with them.
• The practice management team consisted of the GP partners, the practice manager and the nurse manager. All decisions were agreed collectively as a team rather than solely as a partnership, demonstrating a more inclusive approach to decision making within the practice.
• The partnership had a vision for the future. They were proactively engaged with their Clinical Commissioning Group (CCG) in order to provide joined-up care closer to people’s homes via an integrated care model.
• The practice had an open and transparent approach when dealing with complaints. Information about how to complain was available, and improvements were made to the quality of care as a result of any complaints received.
• The practice had a patient participation group (PPG) which met bi-monthly. The practice consulted with their PPG, although we did not see evidence of the PPG driving change within the practice.

We saw the following areas of outstanding practice:

• Two community matrons worked a total of 47 hours per week. The practice directly funded half of these hours. The two matrons proactively engaged with the wider multi-disciplinary teams to deliver responsive care to support patients and their families, and provided bereavement support following a patient death. One of the matrons had worked with the CCG’s lead medicines management technician on a deprescribing project (deprescribingrefers to reducing or stopping the prescribing of medicines that may be causing harm, may no longer be providing benefit, or may be considered inappropriate). The outcome of the project resulted in cost savings of almost £14,000 with 18% of prescribed medicines being stopped. Other medicines were reduced, changed or new medicines initiated after the review.
• The practice had significantly higher rates of screening for cervical and breast cancer in relation to local and national averages. For example, uptake for the breast screening programme for 50-70 year olds within six months of invitation was 84.3%, which was above the CCG average of 79.6% and the national average of 73.2%. The practice also had higher bowel screening rates than the national average and had achieved good performance in the uptake of NHS health checks. This was due to a proactive approach taken by the practice team including opportunistic reminders to patients, and motivating patients to receive screening if it was observed that they had refused the test.

The areas where the provider should make improvement are:

• Improve the uptake of annual health checks for patients with a learning disability.
• Review immunisation training updates for nurses in line with recognised standards.
• Consider a review of infection control management within the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 November 2016

• The practice undertook annual reviews for patients on their long-term conditions registers, including a review of their prescribed medicines. Practice data showed that 87.3% of patients with chronic obstructive airways disease and 79% of patients with asthma had attended for an annual review during 2014-15.
• QOF achievements for clinical indicators were generally in line with CCG averages, and above national averages, although outcomes for diabetes were slightly lower. The practice achieved 84.3% for diabetes related indicators, in comparison to local and national averages of 96.7% and 89.2% respectively in 2014-15.
• Patients with multiple conditions were usually reviewed in one appointment to avoid them having to make several visits to the practice.
• The recall system was co-ordinated by the administration team. A protocol was in place to ensure that patients received one of 16 specific letters for their condition(s). This meant that each patient was booked into see the right person for the correct amount of time. It also accounted for follow up tests, for example after a patient had received spirometry (a test to assess breathing) or a blood test.
• There was a lead designated GP or nurse for the clinical domains within QOF.

Updated 4 November 2016

• The midwife held ante-natal clinics and saw new mothers for a post-natal review at the practice each week. The health visitor held fortnightly well-baby clinics in the practice.
• Childhood immunisation rates were high and were either in line with, or marginally above, local averages. Overall rates for the vaccinations schedule given to children up to five years of age ranged from 94.7% to 100% (local averages 95.2% to 99.1%).
• Same day appointments were provided for babies or children who were unwell.
• The practice had an identified lead GP for child safeguarding. The health visitor and midwife attended a meeting approximately every four to six weeks with the lead GP to review and discuss any child safeguarding concerns. Child protection alerts were used on the clinical system to ensure clinicians were able to actively monitor any concerns.
• A full range of family planning services were accessible throughout the week. The practice had pioneered a system with the local school so that the person could present different coloured cards denoting either a request for emergency or routine contraception, without having to discuss this.
• The practice had baby changing facilities, and a small play area was available for children. The practice welcomed mothers who wished to breastfeed on site, and offered a private room to facilitate this if requested.

Updated 4 November 2016

• The practice offered proactive and personalised care to meet the needs of older people. Care plans were in place for older people with complex needs, and the practice worked collaboratively with other providers to deliver tailored care packages to patients. Fortnightly multi-disciplinary meetings were held to review frail patients and those at risk of hospital admission to plan and deliver care appropriate to their needs.
• The practice directly employed two community matrons and their own care co-ordinator to facilitate the planning of care for patients being discharged from hospital, or to provide support to help vulnerable patients remain in their own home. Specific groups had been targeted for assessment and appropriate follow-up support including patients aged over 80, and older patients prescribed multiple medicines.
• The community matron had worked with the CCG’s lead medicines management technician on a deprescribing project focussing on older patients. The outcome of the project resulted in 18% of prescribed medicines being stopped, as they were no longer needed. Other medicines were reduced, changed or new medicines initiated after the review. This impacted on care for older patients due to the potentially adverse effects associated with taking multiple medicines, such as the increased risk of falls.
• The practice provided care to residents across three local care homes for older people. Regular planned visits to the home by both the community matron and by a GP ensured continuity of care and a reduction in the number of acute visits. We spoke with managers of the homes who were very satisfied with the care provided by the practice, and described the relationship with the practice as being extremely positive and responsive to their residents’ needs.
• Longer appointment times could be arranged for patients with complex care needs. Home visits were provided for those unable to attend the surgery.
• Uptake of the flu vaccination for patients aged over 65 was 71%, which was in line with local (73.9%) and national (70.5%) averages.
• The practice had actively participated with commissioners in the re-structuring of care programmes for older people to deliver joined-up services closer to patients’ homes.

Updated 4 November 2016

• Extended hours consultations were available with a GP, nurse, and health care assistant until 8pm every Tuesday evening to enable improved access for working patients.
• Telephone consultations and advice were offered each day when this was appropriate, so that patients did not always have to attend the practice for a face-to-face consultation.
• The practice offered on-line booking for appointments and requests for repeat prescriptions. Participation in the electronic prescription scheme meant that patients on repeat medicines could collect them directly from their preferred pharmacy.
• Health reviews were available for new patients, and for those aged between 40-75 as part of the NHS health check programme. Services such as smoking cessation, and input from a health trainer from the ‘Live Life Better Derbyshire’ scheme promoted healthier lifestyles.
• The practice actively promoted health screening programmes to keep patients safe. The practice’s uptake for the cervical screening programme was 86.3%, which was above the CCG average of 84.1% and the national average of 81.8%. Uptake of bowel and breast cancer screening was also higher than local and national averages.
• The practice offered out of area registrations for patients, which allowed them to access the service closer to their place of work. 

Updated 4 November 2016

• The practice achieved 96.5% for mental health related indicators in QOF, which was 1.6% below the CCG and 3.7% above the national averages. This was achieved with lower exception reporting rates at 7% compared against local (14.5%) and national rates (11.1%).
• 84% of patients with severe and enduring mental health problems had a comprehensive care plan documented in the preceding 12 months according to 2014-15 QOF data. This was below the CCG average of 93.2% and the national average of 88.5%, but with much lower levels of exception reporting at 7.4% (CCG 17.4%; England 12.6%)
• The practice worked closely with local community mental health teams and representatives regularly attended the multi-disciplinary team meetings.
• The practice told patients experiencing poor mental health and patients with dementia about how to access local services, support groups and voluntary organisations. Information was available for patients in the waiting area.
• There was access to counselling and associated talking therapies’ services on site. Patients could self-refer to this service.
• 87.2% of people diagnosed with dementia had had their care reviewed in a face-to-face meeting in the last 12 months. This was above local and national averages by 3% with lower exception reporting rates at 6%, compared to local and national averages of 8.3%.
• Staff had received dementia awareness training from the Alzheimer’s Society at a team meeting. The practice planned to achieve ‘Dementia Friendly’ status before the end of 2016.  

Updated 4 November 2016

• Patients with end-of-life care needs were reviewed at a monthly multi-disciplinary team meeting including a lead GP, district nurses, a Macmillan nurse, and a matron from a local care home. Some of these patients were also reviewed at the fortnightly multi-disciplinary meetings if their care package needed closer monitoring, with input from the wider care team.
• The community matron developed care plans for the most vulnerable patients including those at end of life. A specific template was used to ensure key information was available to the ambulance service, the out of hours’ provider, and social services to ensure continuity of care for the patient. This included the patient’s preferred place of care and whether a Do Not Attempt Resuscitation order was in place.
• The practice had identified 2.4% of their registered patients as carers. The community matrons and care co-ordinator identified carers as part of their work with vulnerable patients, and new patients were identified as part of the registration process. Information on various support agencies and groups was available.
• Staff had received adult safeguarding training and were aware how to report any concerns relating to vulnerable patients. There was a designated lead GP for adult safeguarding.
• The practice had undertaken an annual health review for 20% of their patients with a learning disability in 2014-15. The practice recognised this needed improvement and the team had discussed ways to address this. Figures for the first six months of 2016-7 showed that 12% of patients had been seen for an annual review at the time of our inspection.
• The practice had signed up to be a safe haven for vulnerable people. Any person in need could enter the practice as a point of refuge until they could be safely collected by relatives or carers.
• The practice had low number of patients whose first language was not English. These patients were able to access interpreter services in person or by telephone if required.