Peel Croft Surgery

Updated 6 September 2016

Peel Croft Surgery is located in the town of Burton on Trent, Staffordshire. The practice is situated in the town centre area. This area has lower unemployment levels overall than the national average. There are patients living in deprived areas and the overall level of deprivation for the patient list is higher than the national average.

The practice was established in 1897 and moved to a purpose built premises in 1988. The practice is registered as a partnership of two full time GP partners. The building is single storey and owned by the partners. There are two treatment rooms and four consulting rooms. Rooms in the building are used by a number of external providers, for example; physiotherapy clinics and the Citizens Advice Bureau.

The practice has a list size of 3,250 patients. The population distribution is similar to local and national averages with a higher numbers of patients aged 25-49 and a lower percentage of patients over the age of 65. The ethnicity data for the practice shows 83% of patients are white British. The practice has a large number of Polish patients and a transient population that sees an average annual change of approximately 23% of the patient list.

The two full time GPs are assisted by a clinical team consisting of a GP registrar, one practice nurse and a healthcare assistant. The administration team consists of a practice manager and four administration/reception staff.

The practice is open from 8am to 6.30pm, Monday to Friday. Consulting times in the morning are from 8.30am to 11am each day and in the afternoon from 3.30pm to 5.30pm each day with the exception of a Wednesday when there is when there is emergency surgery and individual case management care programme sessions led by GPs. The practice offers extended hours for pre-booked appointments on a Monday when early appointments are available from 7.30am and later appointments up to 7pm. When the practice is closed, patients are advised to call the 111 service or 999 in the case of an emergency. The practice has opted out of providing an out of hours service choosing instead to use a third party provider, Staffordshire Doctors Urgent Care. The nearest hospital with an A&E unit and a walk in service is Queen’s Hospital, Burton-on-Trent. There nearest walk in centre is in the town centre.

Updated 6 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Peel Croft Surgery on 16 May 2016. Overall the practice is rated as Outstanding.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the Care Quality Commission (CQC) at that time.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses. Information about safety was recorded, monitored, reviewed and addressed.
• Risks to patients and staff were comprehensively assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients spoke of a very high level of service that was supported by a large quantity of complimentary written patient feedback from 318 patients out of a list size of 3,250. The national GP patient survey scored the practice in the top 4% of practices in England.
• Information about services and how to complain was available and easy to understand.
• Patients told us they could get an appointment when they needed one. Urgent appointments were available the same day.
• The practice had achieved an overall 23% reduction in accident and emergency attendances and hospital admissions.
• The GPs and practice manager have pioneered the co-location of counselling services to allow patients to be seen at the practice.
• The practice had adopted a proactive approach to monitor patients at risk of some long term conditions such as diabetes.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff, patients and third party organisations, which it acted on.
• The practice evidenced a strong culture of education and learning that provided positive outcomes for patients.

We saw a number of areas of outstanding practice:

• The practice used a system to detect patients that could be victims of human trafficking that had identified nine cases that have been referred to the health visitor since October 2013.
• The practice provided outreach services for vulnerable groups of patients.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 6 September 2016

The practice is rated overall as outstanding. The features which led to these ratings applies to everyone using the practice, including this population group.

The practice had a robust recall system that invited patients for regular reviews. Patients were reviewed in GP and nurse led chronic disease management clinics that had a pro-active, empowered approach to care. We saw that nursing staff had the knowledge, skills and competency to respond to the needs of patients with long term conditions such as diabetes and asthma. Nurses had received specific training for diabetes and the practice had achieved the highest performance within the local CCG for diabetes care. Longer appointments and home visits were available when needed. Written management plans had been developed for patients with long term conditions and those at risk of hospital admissions. For those people with the most complex needs, the GPs worked with relevant health and social care professionals to deliver a multidisciplinary package of care. The practice held a list of patients who required palliative care and a GP partner acted as the lead. The gold standards framework (GSF) was used for the coordination of end of life care. GSF is a framework to improve the quality, coordination and organisation of care.

Updated 6 September 2016

The practice is rated overall as outstanding. The features which led to these ratings applies to everyone using the practice, including this population group.

It was practice policy to provide same day access to all children. There were systems in place to identify and follow up children who were at risk, for example, children and young people who had protection plans in place. Children who had not attended appointments were followed up, and where non-attendance continued, the GP child safeguarding lead was informed. Appointments were available outside of school hours and the premises were suitable for children and babies. There were screening and vaccination programmes in place for children, and the practice indicators were comparable with the local Clinical Commissioning Group averages. The practice worked with the health visiting team to encourage attendance. New mothers were offered post-natal checks and development checks for their babies. A birthday card was sent to patients on their sixteenth birthday to advise of how their legal status had changed and the impact it had on future visits to see the clinicians. The practice worked with Changes, a council led project to improve the lives of 16-25 year olds.

Updated 6 September 2016

The practice is rated overall as outstanding. The features which led to these ratings applies to everyone using the practice, including this population group.

The practice had high levels of patients over the age of 75 who lived independently and each had a named GP. All hospital admissions were reviewed and a detailed medication review was completed on discharge from hospital. Patients identified as being at risk of hospital admission, which included those that resided in nursing and care homes, had a written care plan. Practice staff had regular communication with the community team and met formally on a quarterly basis. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of services, for example, pneumonia and shingles vaccinations (100% of eligible patients had been invited to attend the practice for these vaccinations, records showed they had either received or declined the vaccination). The practice screened hospital letters for fractures and bone density scans to diagnose and manage osteoporosis. The practice was responsive to the needs of older people and offered home visits and offered longer appointments as required. Any patient who reached 100 years of age was hand delivered a card and a personalised gift.

Updated 6 September 2016

The practice is rated overall as outstanding. The features which led to these ratings applies to everyone using the practice, including this population group.

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. The practice worked with Changes, a council led project to improve the lives of 16-25 year olds. A range of on-line services were available, including medication requests, booking of GP appointments and access to health medical records. The practice offered same day turnaround for prescription requests that included online ordering. Patients aged 40 to 74 years old were offered a health check with the nursing team. The practice offered a full range of health promotion and screening that reflected the needs for this age group.

Updated 6 September 2016

The practice is rated overall as outstanding. The features which led to these ratings applies to everyone using the practice, including this population group.

Patients who presented with an acute mental health crisis were offered same day appointments and staff had received training to be dementia friends. People experiencing poor mental health were offered an annual physical health check. Dementia screening was offered to patients identified in the at risk groups. GPs carried out advance care planning for patients with dementia.

The practice had regular meetings with other health professionals in the case management of patients with mental health needs.

The practice worked closely with the health visiting team to support mothers experiencing post-natal depression. It had told patients about how to access various support groups and voluntary organisations and signposted patients to support groups where appropriate.

Updated 6 September 2016

The practice is rated overall as outstanding. The features which led to these ratings applies to everyone using the practice, including this population group.

The practice supported three Young Men’s Christian Association (YMCA) housing projects in the town centre and had voluntarily attended clinics at the Burton Addiction Centre to gain an understanding of patient needs. We found that the practice enabled all patients to access their GP services and assisted those with hearing and sight difficulties. A translation service was available for non-English speaking patients. The practice had automated entrance doors and provided facilities suitable for disabled patients. The practice had identified and supported patients who were also carers. The practice provided onsite GP appointment access to 130 homeless patients and hosted the Changes scheme run by the Council to promote wellness, recovery and social inclusion. The practice used a system to detect patients that could be victims of human trafficking.

The practice held a register of patients with a learning disability and had developed individual care plans for each patient. Out of 15 patients on the learning disabilities register, all had been invited and 11 had received annual health checks in the preceding 12 months. Longer appointments were offered for patients with a learning disability and carers were encouraged by GPs to be involved with care planning.

The practice had a register of vulnerable patients and displayed information about how to access various support groups and voluntary organisations. 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. The practice offered discretionary registration to homeless patients.