Background to this inspection
Updated
5 January 2018
Darley Dale Medical Practice (www.darleydalesurgery.co.uk) is registered with the CQC as a GP partnership with four GP partners. The practice has a population of approximately 8000 registered patients, the majority of whom are over the age of 45. The practice has a higher proportion of patients aged 65 and above in comparison to local and national averages.
The surgery provides primary care medical services commissioned by NHS England and North Derbyshire Clinical Commissioning Group (CCG). The practice covers a predominantly rural area and lies north of Matlock within the Derbyshire Dales district.
The premises have a main site within Darley Dale with two branch surgeries situated in the nearby villages of Winster and Youlgreave. The premises at Darley Dale are approximately 30 years old and offer limited opportunities for expansion, and the provider has started building a new practice in the same vicinity which is expected to be completed by September 2018.
The main site is located at 2 Columbell Way, Two Dales, Darley Dale, Matlock, Derbyshire. DE4 2SA.The branch sites are Winster Surgery, Leacroft Road, Winster, Matlock, Derbyshire. DE4 2DL; and Youlgreave Surgery, Alport Road, Youlgreave, Bakewell, Derbyshire. DE45 1WN.
As part of our inspection, we visited the main site and one of the branch sites (Youlgreave Surgery). The practice offers dispensing services from the two branch sites to those patients on the practice list who live more than one mile (1.6km) from their nearest pharmacy.
The practice team consists of the four GP partners and four salaried GPs (two males and six females). One of the salaried GP is part of the GP retention scheme which aims to offer greater flexibility to support GPs to remain in practice, for example, by working a set number of sessions each year). There are five practice nurses, one of whom works as the nurse manager and three healthcare assistants. In addition, there is also an advanced nurse practitioner who works as a locum, but provides regularly input at the practice for two days each week. The clinical team is supported by a strategic business manager and operations assistant. Each of the three surgeries has a designated lead manager with a team of fourteen reception and administrative staff working across the three sites (some roles incorporate combined duties such as working as a phlebotomist or dispenser). Both branches have a practice dispensary with an identified dispensary manager. The practice employs an audit facilitator and a care coordinator. Two cleaning staff who work at the branch sites are also directly employed by the practice.
The provider is a teaching GP practice and accommodates GP registrars and F2 doctors. There was one GP registrar and one F2 doctor working at the practice at the time of our inspection. A GP registrar is a qualified doctor who has chosen to specialise in general practice, and a F2 doctor is a recently qualified doctor who has yet to decide on their preferred specialty.
The practice serves a relatively affluent population, and is ranked in the second lowest decile for deprivation.
The practice opens from 8am until 6.30pm Monday to Friday, with extended opening hours on a Tuesday morning from 7.15am, and until 8pm on a Wednesday evening. Scheduled GP appointment times are available each morning and afternoon, apart from on one afternoon most months when the practice closes for staff training. Extended hours GP appointments are available every Tuesday morning from 7.30am until 8.30am and on a Wednesday evening from 6.30pm until 7.30pm.
Updated
5 January 2018
Letter from the Chief Inspector of General Practice
This practice is rated as good overall. (At the previous inspection undertaken in October 2014, the practice received a good overall rating, with an outstanding rating for providing responsive services)
The key questions are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? - Good
As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:
Older People – Good
People with long-term conditions – Good
Families, children and young people – Good
Working age people (including those recently retired and students – Good
People whose circumstances may make them vulnerable – Good
People experiencing poor mental health (including people with dementia) - Good
We carried out an announced comprehensive inspection at Darley Dale Medical Centre on 1 November 2017. This inspection was carried out under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
At this inspection we found:
- The partners invested high levels of funding in their practice team to provide sufficient capacity, and ensure there was adequate and trained administrative support to relieve pressures on clinical time.
- There was strong clinical leadership and we saw how this impacted positively upon the quality of the service. For example, the GP prescribing lead had overseen cost effective prescribing, and lower rates of antimicrobial prescribing.
- The practice had a live strategy which focussed on the new challenges faced by general practice. This was supported by the appointment of a strategic business manager, and a new premises development to provide an environment to respond to local patients’ needs.
- We spoke with community based health, social and care home staff who overwhelmingly provided us with positive feedback about their interactions with the practice team, In particular, we observed that the relationship with social care was driving responsive and compassionate care for patients, including keeping those at risk from harm safe.
- The practice had received the Derbyshire Dignity Award in 2013 and continued to aspire to maintain this achievement. At the time of our inspection, the practice had submitted an application to the county council as part of the biennial renewal which focused on their work with local care homes.
- Results from the latest national GP patient survey showed that the practice had performed above local and national averages in the majority of the questions about patient experience. This was particularly evident in relation to GP access and comments regarding being cared for in a dignified and respectful manner.
- Patients who responded that they were satisfied with the practice’s opening hours was marginally below the local and national averages. The practice was proactively looking to address this via a collaborative approach with other practices to implement an 8am-8pm hub service locally.
- The practice encouraged and supported staff to report incidents and near misses. When incidents did happen, the practice learned from them and improved their processes. Positive events were also recorded in recognition that sharing best practice was an equally valid means of learning, and a way to celebrate success.
- The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
- Care planning was embedded within the practice to reflect individual’s patients’ needs and their own wishes. We saw that 8% of patients had at least one care plan in place at the time of our inspection.
- There was a strong focus on continuous learning and improvement at all levels of the organisation. Staff training records were up to date, and regular appraisals encouraged development at all levels.
- The practice had an established quality improvement programme. This included involvement in research.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice