Orchard Medical Practice

Updated 12 September 2016

Orchard Medical Practice is a ten partner practice which provides primary care services to approximately 18,500 under a Personal Medical Services (PMS) contract.

• The practice is situated in the centre of Mansfield within Mansfield community hospital in a purpose designed wing of the hospital.

• The practice is on a bus route and is within walking distance of the town centre.

• There is a large car park at the practice and the practice is fully accessible to patients with mobility problems or those using wheelchairs.

• Services are provided from Orchard Medical Practice, Stockwell Gate, Mansfield, NG18 5GG.

• The practice consists of ten partners (seven male and three female) and one salaried GP. (female).

• The all female nursing team consists of a nurse practitioner, two nurse managers, five practice nurses, three health care assistants (HCA) and two phlebotomists.

• The practice has a practice manager and assistant manager who are supported by 23 clerical and administrative staff to support the day to day running of the practice including one apprentice.

• This practice provides training for doctors who wish to become GPs and at the time of the inspection had one doctor undertaking training at the practice. (Teaching practices take medical students and training practices have GP trainees and F2 doctors).

• The practice has a higher than average care home patients with double the CCG average.

• The practice has high deprivation and sits in the fourth more deprived centile.

• The practice is registered to provide the following regulated activities; surgical procedures, maternity and midwifery services; family planning, diagnostic and screening procedures and treatment of disease, disorder or injury.

• The practice lies within the NHS Mansfield and Ashfield Clinical Commissioning Group (CCG). A CCG is an organisation that brings together local GPs and experienced health professionals to take on commissioning responsibilities for local health services.

• The practice is open between 8am and 6.30pm Monday, Wednesday, Thursday and Friday; 8am and 8pm on a Tuesday. Appointments are from 8.10am to 6.15pm daily. Extended hours appointments are offered until 8pm Tuesday and every Saturday morning. When the practice is closed patients are able to use the NHS 111 out of hour’s service.

Updated 12 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Orchard Medical Practice on 4 August 2016. Overall the practice is rated as outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.

• The practice sent letters to all eligible patients for the flu vaccine to attend an annual event where they hired a room. The practice provided refreshments and enabled patients to come and receive their inoculation and meet up with other people at the same time.

• The practice manager telephoned anyone who gave feedback positive or negative to the practice to thank them personally and to let them know how appreciated it was.

• The practice’s computer system alerted GPs if a patient was also a carer.The practice had identified 764 patients as carers (4.1% of the practice list).

• Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this.

• Feedback from patients about their care was consistently positive.

• The practice staff were committed to going the extra mile for their patients. In 2015 one of the nurses was awarded practice nurse of the year and the reception staff, a HCA and the practice manager had received an award for ‘going the extra mile’. These awards were from the CCG following nominations by the patients of the practice.

• 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. For example increasing the number of reception staff and the introduction of ‘one problem clinics’.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints (verbal and written) and how they are managed and responded to, and made improvements as a result.
• The practice had a clear vision which had quality and safety as its top priority.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• Staff were proud of the practice and were constantly involved in developing and supporting new ways of providing treatment.

We saw areas of outstanding practice including

• The practice had produced a video that was played in one of the waiting areas which included some of the GPs and some members of the PPG. This was to encourage patients that maybe lonely and isolated to come and join the PPG or to join the walking group that had been set up in June 2015 in conjunction with members of the PPG. At the time of our inspection there were 15 patients that regularly attended. There were two walks that left from the practice each week where patients or the general public could join in for free and improve their health and wellbeing and meet other people. The practice had received feedback from patients saying how their fitness levels had improved and a consultant had written to the practice after seeing a patient that had started with the walking group and had improved with their wellbeing.

• The practice was passionate about helping people. The practice had a taxi fund which had been set up with the Patient Participation Group (PPG) in April 2016 to enable patients that were unable to get into the practice or those that needed to go to accident and emergency or the hospital were given money for the taxi. The fund had helped five people so far for example: a vulnerable drug user who could not and would not have gone to hospital with an infected ulcer as they could not afford it so the taxi fund was used; and a patient with long term conditions who had not been attending for reviews had telephoned the practice with a number of problems. This patient could not get into practice and therefore the taxi fund was used and the patient came into the practice for an appointment and also had a review. This patient was now a regular attender for their reviews.

• Appointments for mental health reviews were offered on Saturday mornings for patients to attend when surgery is quieter and less threatening this also meant that patients could be accompanied by friends or relatives who might be working Monday to Friday. Sit and wait appointments were also available for those patients of no fixed abode and those patients with mental health issues.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 September 2016

The practice was rated as outstanding for caring and well-led and good for safe, effective and responsive services. The issues identified as outstanding overall affected all patients including this population Group.

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

• Performance for diabetes related indicators showed the practice had achieved 97% of targets which was above the CCG average (82%) and the national average (89%).

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review 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.

Updated 12 September 2016

The practice was rated as outstanding for caring and well-led and good for safe, effective and responsive services. The issues identified as outstanding overall affected all patients including this population Group.

• 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. Immunisation rates were relatively high 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.

• The practice’s uptake for the cervical screening programme was 83%, which was in line with the CCG average of 85% and the national average of 82%. Patients that had not responded and who had a positive result were sent a letter by recorded delivery. The practice at this stage would also include a leaflet in relation to cervical screening ensuring that it was in the language that was appropriate to the patient, for example Polish or Latvian.

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

• We saw positive examples of joint working with midwives, health visitors and school nurses.

• The practice was a designated C-Card collection point (collection of condoms for ages 13-24). This meant that patients registered for this service could call into the practice to collect condoms. The practice staff had attended a course to be trained in this.

Updated 12 September 2016

The practice was rated as outstanding for caring and well-led and good for safe, effective and responsive services. The issues identified as outstanding overall affected all patients including this population Group.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Each care home was linked to a named GP to enable continuity of care and to build relationships with the care home and the patients.

• The nurse practitioner also completed home visits rather than patients waiting for the GPs to complete their morning surgery.

Updated 12 September 2016

The practice was rated as outstanding for caring and well-led and good for safe, effective and responsive services. The issues identified as outstanding overall affected all patients 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 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 had extended hours to 8pm Tuesday and Saturday 8am to 11.30am.

• Telephone consultations were available and had been increased to meet demand.

Updated 12 September 2016

The practice was rated as outstanding for caring and well-led and good for safe and effective services. The practice was also rated outstanding in responsive for this population group.

• Performance for dementia related indicators showed the practice had achieved 95% of targets which was above the CCG average (91%) and in line with the national average (95%).

• 100% of patients experiencing poor mental health were involved in developing their care plan in last 12 months which was better than the national average of 88%.

• Appointments for mental health reviews were offered on Saturday mornings for patients to attend when surgery is quieter and less threatening this also meant that patients could be accompanied by friends or relatives who might be working Monday to Friday. Sit and wait appointments were also available for those patients of no fixed abode and those patients with mental health issues.

• Sit and wait appointments were also available for those patients of no fixed abode and those patients with mental health issues.

• 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.

• 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.

Updated 12 September 2016

The practice was rated as outstanding for caring and well-led and good for safe, effective and responsive services. The issues identified as outstanding overall affected all patients including this population Group.

• The practice held a register of patients living in vulnerable circumstances including homeless people and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice informed vulnerable patients 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.

• Some GPs and a nurse manager had completed training in safeguarding children to level four.

• The practice would have sit and wait appointments for those patients that presented on the day who had no fixed abode or were otherwise vulnerable.