Deer Park Family Medical Practice

Updated 6 May 2016

Deer Park Family Medical Practice provides primary medical services to approximately 8200 patients through a Primary Medical Services (PMS) contract. The practice is located in the affluent suburb of Wollaton, in Nottingham. The level of deprivation within the practice population is below the national average.

Services are provided from a purpose built health care centre co-located with another GP practice and local community services. This includes health visitors, district nurses, community matron, midwives and care coordinators.

The clinical team comprises:

• Three GP partners (male); of which two partners offer seven sessions a week and another partner eight sessions a week

• Three salaried GPs (female); of which two GPs offer four sessions a week and one GP offers three sessions a weekly

• One nurse prescriber

• Two part-time practice nurses

• One part-time healthcare assistant

The administration team comprises of:

• A practice manager

• Practice secretary

• Clinical coder

• Coordinator

• Four receptionists

• An apprentice.

The practice is open between 8.30am and 6.30pm Monday, Wednesday, Thursday and Friday; and 8.30am to 8pm on Tuesday.

GP appointments are available from 8.30am to 12pm and 3pm to 6pm daily. Extended opening hours are offered on Tuesdays with appointments available until 7.45pm. Additional appointments are released for on the day emergency access and 48 hour access for people that need them. Extended surgery hours are offered on Tuesdays between 6.30pm and 8pm.

When the practice is closed patients are directed to the out of hours’ service provided by Nottingham Emergency Medical Services at (NEMS) via the 111 service.

Updated 6 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Deer Park Medical Practice on 15 February 2015. 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 for dealing with information concerning safety. This included an effective system for reporting and reviewing significant events; although the recording of the learning outcomes needed to be strengthened.

• Risks to patients were assessed and well managed overall.

• Suitable arrangements were in place to ensure staff had the skills, knowledge and experience to deliver effective care and treatment.

• The practice worked closely with other health and social care teams and the local community to deliver coordinated care for patients.

• The practice had lower rates for outpatient referrals, hospital admissions and accident and emergency attendances when compared to the local average.

• The practice had effective systems in place for identifying and referring patients at risk of cancer. Data showed the practice had achieved high screening rates for cancer compared to local and national averages.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. They also found it easy to make an appointment with a GP and urgent appointments were available the same day.

• This was reflected in the national GP patient survey results where 90% of respondents would recommend this surgery to someone new to the area.

• 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 and easy to understand.

• The practice had a clear vision which had equality, quality and safety as its top priority. High standards were promoted and owned by practice staff with evidence of team working across all roles.

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

• The practice proactively sought feedback from staff, patients and the patient participation group, and acted on suggestions made to improve the overall service.

There were areas of practice where the provider should make improvements:

• Ensure detailed and up to date records relating to the overall management of the regulated activities are kept. This includes meeting minutes, prescriptions held by doctors and business plans.

• Review arrangements in place to identify, assess and manage all risks including infection control for those areas of the building that are occupied and used by the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 May 2016

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

• The 2014/15 Quality and Outcomes Framework (QOF) data showed the practice had achieved good outcomes in relation to the conditions commonly associated with this population group. For example, the practice had achieved the maximum points available to them for providing recommended care and treatment for patients with heart failure and hypertension. This was above the clinical commissioning group (CCG) and England averages.

• Nursing staff had lead roles in chronic disease management and offered reviews for conditions such as asthma, heart disease and hypertension.

• The practice staff were committed to working collaboratively with other providers to ensure patients received coordinated care and services. For example:

• Multi-disciplinary meetings were held regularly to review the needs of patients with end of life care needs; and patients at risk of hospital admission were identified as a priority.

• The practice worked with community specialist nurses who ran clinics at the practice for conditions such as diabetes.

• All these patients had a named GP and a structured annual review to check their health and medicine needs were being met.

• Longer appointments and home visits were available when needed.

Updated 6 May 2016

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

• There were robust systems in place for identifying and following up children at risk of hospital admission or abuse. For example, children and young people who had a high number of accident and emergency (A&E) attendances were reviewed and child protection meetings were held to safeguard the patients from abuse.

• We saw positive examples of joint working with midwives, health visitors and school nurses. This included the delivery of maternity care clinics (ante-natal care, post-natal reviews and baby checks).

• Immunisation rates were relatively high for all standard childhood immunisations.

• The practice had suitable arrangements in place to promote ease of access for this population group. For example, there was a range of routine and urgent appointments each day to enable parents and young people to book appointments at convenient times for them.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice engaged with teenagers via text messages and promoted access for under 16s (via parents) to book appointments, order prescriptions and cancel unwanted appointments.

Updated 6 May 2016

The practice is rated as good for the care of older people.

• The practice had a high proportion (about 15%) of patients aged 70 and over, with multiple health needs and living alone. As a result, the practice was proactive in engaging with this patient group and other health and social care services to improve services and outcomes. This included facilitating multi-disciplinary meetings where patients at risk of hospital were discussed and their care plans were reviewed as part of the avoiding unplanned admissions programme.

• All patients aged 75 years and over had a named GP. The practice offered “enhanced tailored care” health checks and immunisations such as pneumonia and shingles when needed.

• Care and treatment of older people reflected current evidence-based practice. This included dementia screening.

• Nationally reported data showed the outcomes for conditions commonly found in older people were positive. For example, 100% of patients aged 75 or over with a record of a fragility fracture on or after 1 April 2014 and a diagnosis of osteoporosis, were being treated with an appropriate bone-sparing agent.

• Longer appointments, home visits and urgent appointments were available for older people when needed, and this was acknowledged positively in feedback from patients.

Updated 6 May 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.

• The practice offered online services which enabled patients to order repeat prescriptions, book and cancel appointments. Electronic prescribing was due to be tested in February 2016 before being made available to all patients.

• A full range of health promotion and screening that reflected the needs for this age group was offered. For example, the uptake of NHS health checks for patients aged 40 to 64 years and cancer screening was higher compared to the local and national averages.

• Extended opening hours were available every Tuesday (6.30pm to 8pm) for GP appointments and telephone appointments were also available.

• The practice offered services such as minor surgery and early morning phlebotomy appointments.

• Patients could access sexual health advice and services. This included family planning and fitting of intrauterine devices (IUD) such as coils and contraceptive implants.

• The practice hosted the obesity management service and this was accessible to patients registered with local GP practices.

Updated 6 May 2016

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

• The practice carried out dementia screening and advance care planning for patients with dementia. The 2014/15 data showed 87.3% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was above the CCG average of 84% and the national average of 83.9%.

• An audit undertaken by the practice also showed 78% of patients with dementia had been reviewed in the past six months.

• 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.

• A total of 89.2% of patients with schizophrenia, bipolar affective disorder and other psychoses had an agreed and documented care plan in the preceding 12 months. This was above the CCG average of 83.6% and national average of 88.3%.

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

• Staff had a good understanding of how to support patients with mental health needs and dementia. This included advising patients about how to access various support groups and voluntary organisations.

Updated 6 May 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 with a learning disability and a lead GP facilitated the annual health checks.

• Longer appointments were offered for patients with a learning disability and their carers.

• The practice worked with multi-disciplinary teams in the case management of vulnerable people. Patients were signposted to various support groups and voluntary organisations when needed.

• Staff had received relevant training in safeguarding adults and children, domestic violence, learning disability and deaf awareness for example. Staff knew how to recognise signs of abuse in vulnerable adults and children. They were aware of their responsibilities in relation to information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

• Staff had quick access to clinicians if a patient contacted the reception in a distressed state.