Archived: Sunrise Medical Practice - Ghattaora Also known as Sunrise Medical Practice

Updated 14 January 2016

Sunrise Medical Practice is located in Radford, which is in an area of Nottinghamshire. It provides its services to residents within the NG7 postcode area. It also provides services within an outer boundary which extends to the NG1 postcode area. These are mostly urban and suburban districts. We visited this site as part of this inspection.

The practice has a branch surgery located at Clifton campus, Nottingham Trent University. We did not visit the practice’s branch surgery located at Clifton Campus, Nottingham Trent University, George Eliot Building, Clifton Lane, Nottingham NG11 8NS as part of this inspection.

The practice is distinctive as it is a part university and part community practice with patients who have differing needs.

The practice currently has a list size of approximately 6,000 patients. Around 5,000 of these patients attend the branch practice at the university. Patients mainly consist of students and staff. Between 1200 to 1500 new students register at the practice at the start of each academic year so the practice list size fluctuates to incorporate those who start and finish their academic studies. The practice therefore has a large annual patient turnover of approximately 35%. Approximately 1,000 patients attend the Radford site.

The practice holds a Personal Medical Services (PMS) contract which is a locally agreed contract between NHS England and a GP to deliver care to the public. The practice provides GP services commissioned by NHS Nottingham City.

The practice is managed by two GP partners, (both male). One works on a full time basis and one in 50% of a full time role. (0.5 Whole Time Equivalent, WTE) They are supported by clinical staff; one part time female locum GP (0.1 WTE), two part time female practice nurses, one part time male locum nurse prescriber and a female healthcare assistant who has a dual role as the senior receptionist. The practice also employs a practice manager, assistant manager and a team of reception, clerical and administrative staff. The practice is a teaching practice where three junior doctors work in a year.

The site at Radford is open from 8.30am to 6.30pm on Mondays, Tuesdays, Wednesdays and Fridays and on Thursdays from 8.30am to 12.30pm. Appointments are available Mondays and Tuesdays from 9.30am to 11.00am, 4.00pm to 5.30pm with an extended hours surgery open from 6.30pm to 8.30pm on Mondays. Wednesday appointments are available from 11.15am to 12.15pm and between 3.30pm to 5.00pm. Thursday appointments are available from 11.30am to 12.30pm and on Fridays from 9.00 to 10.30am and between 2.30pm to 4.00pm. The practice is closed during weekends.

The Clifton site is open from 8.45am to 6.30pm on Mondays, Tuesdays, Wednesdays and Fridays and on Thursdays from 8.45am to 12.30pm. Appointments are available Mondays from 9.30am to 11.30am and between 3.30pm to 5.30pm, Tuesdays from 9.30am to 12.00pm and between 2.00pm to 6.00pm. Wednesday appointments are available from 9.00am to 11.00am, 2.30pm to 6.30pm with an extended hours surgery open until 8.30pm. Thursday appointments are available from 9.00am to 10.30am and on Fridays from 12.00pm to 2.00pm and between 2.00pm to 6.00pm. The branch is closed during weekends.

The practice has opted out of providing GP services to patients out of hours such as nights and weekends. During these times GP services are provided currently by Nottingham Emergency Medical Services. When the practice is closed, there is a recorded message giving out of hours details.

Updated 14 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sunrise Medical Practice on 15th September 2015. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. We found an open and transparent culture where staff felt supported. A robust system was in place where information about safety was recorded, monitored, appropriately reviewed and addressed. Lessons were shared to make sure action was taken to improve safety in the practice.
• Risks to patients were assessed and well managed. This included health and safety considerations such as fire risk assessments, checks that equipment was safe to use, infection control measures and appropriate standards of cleanliness and hygiene. Medicines management kept patients safe.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. The practice adopted stringent measures to ensure their patients’ health records were accurate, up to date and care plans updated if necessary. Patients we spoke with felt involved in decision making about their care. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. This was shown in patient feedback about the practice.
• Information about services and how to complain was available in some areas and easy to understand. Complaints we looked at were addressed and handled effectively in a timely way with an apology given to the patient if required.
• Patients said they found it easy to make an appointment with a GP and that there was continuity of care, with urgent appointments available the same day.
• 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 external specialists which it acted on to improve the service in place.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 January 2016

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 at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a named GP which they could change if required and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. The practice had a small number of patients on its palliative care register, five at the time of our inspection. End of life care pathways were in place.

Updated 14 January 2016

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 those who were at risk, for example, children and young people who had a high number of accident and emergency (A&E) attendances. Whilst the practice had a low number of babies and young children, 41 children aged between 0 to 4 years at the time of our inspection, 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. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of multidisciplinary team working.

The practice had received the You’re Welcome Accreditation, which was aimed at making health services for young people friendly.

Updated 14 January 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 was part of an enhanced service for diagnosis and support for people with dementia. Older patients were invited to attend for health checks on an annual basis. Health assessments included whether patients had long term conditions, mental health problems or whether they were a carer.

The practice had a low number of older people on its register, 15 people aged 75 and over at the time of our inspection. The practice knew each of their older patients at the practice. The practice was part of an initiative to reduce unplanned hospital admissions, and had created a register of those considered most at risk, which included older people. Care plans were created for those and tailored to the needs of each patient. The practice was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.  The practice performance in relation to seasonal flu vaccines administered to those aged 65 or over was higher than the national average.

Updated 14 January 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. In response to patient feedback, the practice introduced a sit and wait appointment system on Monday mornings at its Clifton site and reviewed the effectiveness of this service. The practice offered extended hours opening one evening a week at both of its sites.

The practice actively sought to engage with students by their attendance on campus during freshers week, and worked in collaboration with the university to run roadshows on relevant issues such as sexual health screening. The roadshows attracted approximately 700 to 800 students.

The practice targeted their student population with other information including the meningitis vaccination, sexual health screening, mental health services and domestic violence.

The practice offered a level 1 sexual health service which offered asymptomatic STI screening for under 25’s as well as C – Card registration which offered free condoms to patients who registered with the service.

Information was provided to help patients understand the care available to them in formats they were comfortable with such as the NHS Nottingham City App which was a guide for choosing the right service. It also utilised text messaging for health promotion purposes and to remind patients about appointments made and how they could be cancelled if required.

The practice was proactive in offering online services, and were part of the initiative of remote care monitoring which was designed to assist students when away from university. A local collection point for pharmacy items prescribed and dispensed was based at the university campus to negate the necessity for student travel to a pharmacy.

Updated 14 January 2016

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

74% of people experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

The practice had estimated from a review of a sample of appointments with GPs that around one third of the consultations with a clinician were regarding mental health issues. It had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. The practice had undertaken shared learning with peers regarding patients who self harmed or were at risk of suicide. The practice held positive relationships with university staff which ensured patients identified at risk were seen quickly and had effective continuity of care.

The practice was actively involved in a Talk About Self Harm project (TASH) jointly run by two local universities which sought to improve self help strategies for people who self harmed.

Staff had received training on how to care for people with mental health needs and dementia. We found nursing staff at the practice had undertaken additional training into self harm and suicide.

The practice had worked in partnership with the CCG and two local universities in a pilot to tackle eating disorders. The practice had offered a weekly drop in clinic to signpost and provide brief interventions for patients with mild to moderate eating disorders. The service had continued to be delivered from the local university site by another provider following a tender exercise.

Updated 14 January 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. The practice recorded 3 patients as having a learning disability. It had carried out annual health checks for 2 of those people and were in the process of removing the third patient from the register as they were no longer eligible to remain on it. The practice offered longer appointments for those people with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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. The practice staff had participated in a pilot which involved domestic abuse project training. (known as IRIS)

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.