Village Surgery

Updated 6 January 2017

Village Surgery provides general medical services to approximately 11,188 patients, and is run by a partnership of six GPs (four male and two female) and a salaried GP who is female.

As the practice is a training practice, GP Registrars work at the practice throughout the year. (GP Registrars are fully qualified doctors who are receiving additional training to work as a GP)

There is currently one Registrar working at the practice.

The main practice is in Derby with a branch surgery about two miles away in the area of Sinfin. Patients can attend either the main practice or the branch practice.

We did not visit the branch surgery as part of our inspection.

The practice population live in an area of high deprivation, which is the 4th most deprived on the decile scale. Income deprivation affecting children is 4% higher than the CCG and national averages and affects older people by around 9% more than the CCG average.

Around 9% of the practice population are unemployed which is almost double the CCG and national averages, which are both 5%.

The practice demand for people with a chronic illness is aroung 5% higher than CCG and national averages.

The practice team includes a nurse manager who is also an Advanced Nurse Practitioner (ANP), four practice nurses, one of whom is able to prescribe medicines and two Health Care Assistants (HCA). There are two prescription clerks, a full time practice manager, a reception manager and a number of reception and administrative staff.

The practice holds the General Medical Services (GMS) contract to deliver essential primary care services. The practice is generally open between 8am and 6.30pm Monday to Friday with an early opening time of 7am on Tuesdays, Thursdays and Fridays and a later closing time of 8.30pm on Wednesdays. Appointments are available from 7.15am to 12MD and 2pm to 6.30pm on Tuesdays, Thursdays and Fridays, and from 8.15 to 12MD and 2pm to 6.30pm on Mondays and Wednesdays. Extended evening surgey is available on Wednesdays until 7.40pm.

The main Derby practice is purpose built and houses the community nursing team and other colleagues and also has a pharmacy on site which operates independently of the practice.

The practice does not provide out-of-hours services to the patients registered there. During the evenings and at weekends an out-of-hours service is provided by Derbyshire Health United. Contact is via the NHS 111 telephone number.

Updated 6 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Village Surgery on 5 October 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. Learning outcomes were shared with staff.
• Risks to patients were assessed and well managed. Health and safety precautions had been taken which included checking that equipment was fully working and safe to use and infection prevention and control measures were in place.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Comment cards we received from patients showed that they felt they were treated with compassion, dignity and respect.
• The practice cared for 158 residents in 13 nursing/care homes and worked closely with care staff to provide proactive ongoing care
• The practice collaborated with local practices and worked with Derbyshire Community Health Services(DCHS) to develop the community matron role, and provide a service for patients with multiple long term conditions to be reviewed by a dedicated team on a weekly basis to plan their care.

• The practice worked with the local women’s refuge, children’s home and a supported living facility for people with a learning disability.
• The practice engaged with two local practices on a project to provide co-ordinated care for frail and elderly people with complex needs who were vulnerable and so at risk of admission to hospital. The practices received funding to support a dedicated GP resource to lead the weekly collaborative meetings with the community team where complex cases were discussed and plans agreed. Analysis had not yet been completed, however, the practice were confident that there had been a reduction in admission rates for this group of patients in the preceding 10 months.
• A reception manager was the appointed practice ‘Carers’ Champion’ to develop the identification and support of carers and had identified 2.3% of the practice list as carers. This has been supported by the local carers connect services who attended the surgery monthly to encourage patients who may be carers to utilise the services available to them.
• A total of 93% of patients with a serious mental health condition had a comprehensive care plan documented in the preceding 12 months. This was slightly higher than CCG and national averages which were 92% and 98% respectively. Exception reporting for this indicator was also slightly lower than CCG and national averages. Recently published data for 2015/16 showed that this figure had increased to 97%.
• The practice supported their local food bank by providing a base for food items to be brought in by the local community. These  were then collected by the food bank to distribute locally.
• The practice used audits to drive improvement and had completed 27 audits during the preceding tow years.
• Information about services and how to complain was available and easy to understand..
• 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 and patients, which it acted on.

We saw areas of outstanding practice:

• The practice provided an ‘enhanced nursing beds’ service to patients at the end of their lives. This enabled patients to be discharged earlier from hospital into an enhanced nursing bed at a local nursing home for a period of up to two weeks. This allowed for the patients condition to be stabilised and symptoms managed prior to going home.
• The practice initiated a recall system where a dedicated administrator identified vulnerable and forgetful patients and provided the list monthly to GPs for those patients whose test or injection was due.
• The practice were committed to providing services closer to home as they believed that their population responded more favourably to this and were more likely to attend for treatment at the practice than in secondary care.

However the providers should

• Continue to review patient satisfaction with access to appointments and to evaluate the impact of the steps taken to address this

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 January 2017

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

• Nursing staff had lead roles in chronic disease management and patients had a named GP and a structured annual review to check their health and medicines needs were being met.

• Patients at risk of hospital admission were identified as a priority and their needs assessed by a multi-disciplinary team that included a Lead GP, care coordinator, District Nursing teams, Social Services, Community Psychiatric Nurse and voluntary groups where appropriate. Patients and carers were referred directly to a number of different services to enable them to receive a coordinated package of care tailored to their individual needs.
• Performance for diabetes related indicators in 2014/15 was 89% which was 4% below the CCG average and the same as the national average. The practice had identified that a high ‘did not attend’ (DNA) rate had contributed to their under performance and had implemented an improved recall system managed by the care coordinator. Recently published data for 2015/16 showed that they had improved their performance to 92% which was in line with CCG average and above the national average for this indicator.
• Performance for indicators relating to chronic obstructive pulmonary disease indicators in 2014/15 was 95% which was 3% below the CCG average and the same as the national average. Recently published data for 2015/16 showed that the practice had improved performance and achieved 100% for this indicator.
• Performance for indicators relating to heart failure was 100% which was above both CCG and national averages. Recently published data for 2015/16 showed that this performance had been maintained.
• Longer appointments and home visits were available when needed. Home visits for housebound patients with a long term condition were also provided by a senior nurse with a qualification in chronic disease management.

Updated 6 January 2017

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

• 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 had direct links with health visitors who regularly attended practice meetings. Immunisation rates were in line with CCG and national averages for all standard childhood immunisations. Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• Performance for providing cervical screening tests for appropriate women was 73%. This was comparable with CCG national averages. Recently published data for 2015/16 showed that performance had increased to 79% for this indicator.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Babies and children were treated as a priority and any parent seeking support during opening hours were able to speak with the on call GP for advice or an appointment was made for the same day.

• The practice were working with the CCG on a project to develop young person’s services and to initiate a young person’s steering group to assist in developing services that are age appropriate.

Updated 6 January 2017

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

• The practice had engaged with two local practices on a project to provide coordinated care for frail and elderly people with complex needs who were vulnerable to admission. The practices received funding to support a dedicated GP resource to lead the weekly collaborative meetings with the community team where complex cases were discussed and plans agreed. An analysis had not yet been completed, however, the practice were confident that there had been a reduction in admission rates for this group of patients in the preceding 10 months and that the requests for home visits had also reduced.

• The practice was responsive to the needs of older people, and offered home visits for housebound patients and urgent appointments for those with enhanced needs.
• Requests for a home visit were triaged by phone initially to ensure that patients were prioritised appropriately, and to see whether additional services may be helpful to the patient prior to the visit.
• The practice GPs made weekly ward round visits to local nursing and residential homes aligned to them and provided an enhanced care package to patients who required palliative care. This was an extended Hospice facility in a Nursing Home setting. Lead GPs work closely with the patients, their relatives and the Nursing Home to support the patient and family to achieve comfortable end of life and their preferred place of death.
• The practice supported 158 patients in nursing and care home and a supported living facility.
• The practice provided some services on site so that patients were able to access these without travelling, these included physiotherapy, counselling, psychiatric consultant, aortic aneurysm testing, podiatry services and a dietitians sevice.
• The practice liaised closely with the District Nursing team and Community Matron and a care co-ordinator to enable patients to receive coordinated care and be directed to services to assist them in all aspects of their lives to facilitate better health
• The practice worked closely with their in-house pharmacy who also provided a delivery service where required.

Updated 6 January 2017

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 was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• The practice used a triage system which allowed patients to speak to a clinician, patients can obtain advice, support, signposting or an appointment with a Health Care Professional within the team
• The practice offered extended hours for three mornings each week commencing at 7am and one evening each week until 8pm
• They provided telephone consultation appointments to assist working patients, students and carers.

Updated 6 January 2017

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

• A total of 95% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is higher than the national average which was 85% and 84% respectively. Their exception reporting rate at 6% was slightly lower than CCG and national averages. Recently published data for 2015/16 showed an achievement of 89%, however, the exception reporting at 3% was significantly lower than CCG and national averages.
• A total of 93% of patients with a mental health condition had a comprehensive care plan documented in the preceding 12 months. This was slightly higher than CCG and national averages which were 92% and 98% respectively. Exception reporting for this indicator was also slightly better than CCG and national averages. Recently published data for 2015/16 showed that this figure had increased to 97%.
• 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 their 141 patients with dementia.
• The practice had told patients experiencing poor mental health 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 patients with mental health needs and dementia.
• The practice provided a service whereby patients could see a Psychiatric Consultant in-house rather than travelling to hospital.This also enabled GPs the opportunity to discuss individual patientswith the consultant so that early decisions could be made.
• Patients with a mental health issue were regularly reviewed and the practice had a dedicated administrator to recall patients who did not attend their appointment. GPs often contacted patients by telephone if they failed to attend their appointment.

Updated 6 January 2017

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 homeless people, and those with a learning disability.
• The practice offered double appointments for patients with a learning disability and for those who required an interpreter .
• The practice regularly worked with a care coordinator and other health care professionals in the case management of vulnerable patients and assisted them in accessing various support groups and voluntary organisations.
• There was an effective recall system that was managed by a dedicated administrator to ensure that vulnerable patients followed through with their appointments.
• The practice worked with the local women’s refuge, children’s home and a supported living facility for people with a learning disability.
• The practice supported their local food bank by providing a base for food items to be brought in by the local community. These were then collected by the food bank to distribute locally.
• The practice ensured that there was always a female GP on duty as there was a large number of ethnic minority patients who required to see a female GP.
• 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.