Derby Road Health Centre

Updated 21 October 2016

Derby Road Health Centre provides primary medical services to approximately 9700 patients through a general medical services (GMS) contract. The practice is located in close proximity to Nottingham city centre, the University of Nottingham and the Queens Medical Centre hospital campus of the Nottingham University Hospitals Trust.

The practice was formed over a hundred years ago. It has been located within purpose-built premises owned by the practice since 2004. There is a pharmacy on the premises adjacent to the practice.

The practice deprivation scores indicated people living in the area were significantly less deprived than the CCG average, but in line with the national deprivation average. Data shows proportion of patients aged 65 years and above registered at the practice is significantly lower than the national average, and the proportion of 20 to 39 year olds is significantly higher than the national average due to the large number of students and working age patients.

The medical team comprises of nine GPs (including training doctors) and nine advanced care practitioners, practice nurses and healthcare assistants. They are supported by 25 members of the management and administration team. Some staff members including the management team also work at a ‘sister practice’ called Grange Farm Medical Centre. There are seven female GPs and two male GPs. It is a teaching and training practice for students in their second year of medical school, and qualified doctors training to become GPs.

The practice is open between 8am and 6.30pm Monday to Friday. Appointment times start at 8.30am and the latest appointment offered at 6.15pm daily. The practice provides the extended hours service opening at 7am on Tuesdays and Fridays.

When the surgery is closed, patients are advised to dial NHS 111 and they will be put through to the out of hours service which is provided by Nottingham Emergency Medical Services.

Updated 21 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Derby Road Health Centre on 6 July 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 and an effective system in place for reporting and recording significant events and near misses, and we saw evidence that learning was applied.

• The practice used proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, working with the local diabetes specialist nurse to improve the wellbeing of patients.

• There was easy access to appointments for patients with a range of appointments on offer including telephone consultations. The practice had invested in increasing the number of appointment telephone lines reducing waiting times for patients calling to book appointments or speak to a GP. This was successful and the results from the national patient survey on access were above average.

• The practice demonstrated a caring approach and held a ‘Tender Loving Care’ list for people who needed extra support, in addition to their vulnerable patients register. Patients on this list were offered open appointments and guaranteed to see a healthcare professional if their named GP was not available. Feedback from patients about their care was consistently positive

• The practice responded to the needs of their patients by providing services which were no longer commissioned locally such as a toe nail cutting service for the elderly in need of foot care.

• The practice planned and co-ordinated patient care with the wider multi-disciplinary team to deliver effective and responsive care to keep vulnerable patients safe.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group (PPG).
• The practice actively reviewed complaints to see if there were any recurrent themes, and identified issues where learning could be applied to improve patient experiences in the future.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision was documented and reviewed by the management on a regular basis.

• The practice had strong and visible clinical and managerial leadership and governance arrangements, and staff told us that they were well-supported and felt valued by the partners.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 October 2016

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

• The practice had a recall system for patients with long term conditions, audited on a monthly basis to identify patients who are due for a review. Patients were sent reminders in the month of their birthday to attend an annual check which incorporated a review of their long term conditions, and those who did not attend were followed up to book another appointment.

• All clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• A structured annual review was carried out to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• There was evidence of coordinated care with multi-disciplinary teams between the nursing staff and community matrons, diabetic specialist nurses and care coordinators to improve the outcomes for the patients.

• There were a large number of leaflets providing education and self-care advice and patients were directed to online resources. A specialist diabetes nurse visited the practice monthly to review complex patients and provide support to the nursing staff.

• QOF achievement on indicators for diabetes was consistently in line with CCG averages. For example, the percentage of patients with diabetes on the register who had a foot examination and risk classification in the preceding 12 months was 92%, compared to a CCG average of 85% and national average of 88%.

• QOF achievement on indicators for heart failure and chronic obstructive pulmonary disease were broadly in line with national averages. The practice achieved 100% on heart failure, compared to a CCG average of 94% and national average of 98%. The exception reporting rate was 9.7%, in line with the CCG average of 9% and national average of 9.3%.

• Longer appointments and home visits were available and offered when needed.

• The practice provided weight management clinics with referrals offered to local gyms for exercise. They promoted self-referral to services such as podiatry, physiotherapy and psychological therapies, whose clinics were offered in the practice premises.

Updated 21 October 2016

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

• The practice worked closely with midwives, health visitors and family nurses attached to the practice. 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 practice held meetings every six weeks with the health visitor and midwife, and also reviewed any children on a child protection plan at their clinical meetings.

• Immunisation rates were consistently above the CCG averages for standard childhood immunisations. Vaccination rates for children under two years ranged from 91% to 97%, compared against a CCG average ranging from 91% to 96%. Vaccination rates for five year olds ranged from 80% to 92%, compared to the CCG average of 87% to 95%. Patients new to the country with children under six years old were invited to see the nurses to discuss immunisations and ensure their records were written accurately.

• The premises were suitable for children and babies. Baby changing facilities were available and the practice accommodated mothers who wished to breastfeed.

• Appointments were available outside of school hours with urgent appointments available on the day for children and babies.

• There were services tailored to the needs of younger patients, including students. For example, the practice provided a meningitis vaccination for students going to university for the first time up to 25 years old, sexual health screening and C cards, and a scheme for the provision of free condoms. Practice supplied data showed 6.7% of patients aged 15 to 24 years had undertaken sexual health screening in 2015/16.

• The practice was awarded the You’re Welcome status for meeting the criteria for young people friendly health services. Teenage patients were actively encouraged to use online services to book their own appointments to ensure they were involved in their healthcare.

• There was a full range of family planning services offered including fitting of intra-uterine devices (coil), contraceptive implant fitting and emergency contraception. Urgent same day sexual health appointments were available.

Updated 21 October 2016

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. They offered home visits, same day telephone appointments and urgent appointments for those with enhanced needs. Phlebotomy, ear syringing, joint injections and chronic disease monitoring home visits were offered to housebound patients.

• The practice provided an in-house toe nail cutting service not funded by the NHS, to enable better foot care in the elderly. There were seven 30 minute appointments provided weekly and there was a small fee charged to patients using the service.

• The GPs discussed elderly patients who may be at risk of being vulnerable with multi-disciplinary teams including district nurses, social workers and local care coordinators to ensure patient needs were met and referrals to other services were made promptly.

• The practice hosted a seated exercise class weekly at the surgery provided by the local Falls team.

• All over 75s had a named GP for continuity of care. There were 639 patients aged 75 years and over, 77% of whom had been invited for annual health checks in the preceding 12 months as part of the chronic disease management recall system.

• Practice supplied data showed 55% of eligible patients were given flu vaccinations, and these included patients aged 65 and over. 74% of patients aged 75 years and over had been given flu vaccinations.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure were in line with or above local and national averages.

• The practice had good access for wheelchairs and height adjustable couches for patients who may need them.

Updated 21 October 2016

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. This included access to appointments before 9am and after 5pm every day and telephone appointments. The practice opened at 7am on Tuesday and Friday mornings.

• Online appointments services included booking and cancelling appointments, and ordering prescriptions. Additionally, there was a 24 hour automated telephone booking and cancelling of appointments service. Mobile phone text reminders were used for appointments, including the option to cancel an appointment via text.

• There was a full range of health promotion and screening information in the practice that reflects the needs for this population group. Services provided from the premises included phlebotomy, sexual health, dermatoscopy and minor surgery provided by the practice in-house, and physiotherapy, smoking cessation, and counselling provided by commissioned services.

• The practice’s uptake for cervical screening for eligible patients was 72%, compared to the CCG average of 81% and the national average of 82%. Breast cancer screening was marginally lower than the CCG and national averages, and bowel cancer screening data was broadly in line with CCG and national averages. They were aware of their performance and offered more opportunistic testing to improve uptake rates.

• Students registering with the practice were offered a ‘goody bag’ which included health promotion information such as a healthy food cook book, counselling and sexual health services for young people.

Updated 21 October 2016

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

• There were 93% of patients diagnosed with severe mental health condition who had their care reviewed in a face to face meeting in the last 12 months, which is above the CCG average of 84% and national average of 88% in 2014/15.

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

• There was a nominated dementia champion in the practice who had personal experience of caring for someone experiencing the condition. They offered support to patients and their carers about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support experiencing poor mental health, including young patients who may be at risk of self-harm and require urgent access to see the GPs. Patients were encouraged to self-refer to counselling services.

• The practice had participated in a research project on young people at risk of suicide which involved local practices engaging in audits and peer discussions. There was regular liaison with the local university counselling and welfare services to ensure patients were supported. Staff told us they routinely flagged patients who had recent episodes and contacted them for support.

• Information on drug and alcohol services was available in the reception area.

Updated 21 October 2016

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. In addition to this register, there was a ‘Tender Loving Care’ list for people who needed extra support, for example, people at risk of harm due to illness. Patients on this list had a code entered on their medical records to ensure all staff were aware of their needs. They were offered ‘open’ appointments to attend the practice whenever they felt they needed to see a healthcare professional, in addition to having a named GP or nurse who saw them on a regular basis.

• Practice supplied data indicated there were 28 patients on their learning disabilities register, and 82% had been reviewed in a face to face appointment in 2015/16.

• There were 14 patients registered with the practice who were resident in a local nursing home for people with learning disabilities. Feedback from one care home indicated a named GP carried out regular review visits and responded to urgent requests promptly when required to ensure continuity of care.

• The practice offered longer appointments for patients with a learning disability and for those who required it.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. Formal multidisciplinary meetings were held monthly to discuss patients at high risk of admission to hospital. In addition, palliative patients were reviewed at weekly GP partners’ meetings.

• 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.

• All staff had received training in domestic violence and one of the GPs had a specialist certificate in drug misuse. They told us they informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff told us they were aware of how to access interpreting and text talk services for their patients with hearing impairment and there was a hearing loop in the practice. An interpreter could be arranged for those who could not speak in English through Language Line.

• The practice adapted their facilities to ensure they were accessible to disabled patients. Staff told us they were awarded a five-star rating for their access by an independent provider of access information for disabled people.