Archived: The Nelson Practice

Updated 5 July 2016

The Nelson Practice is located in Scawthorpe on the outskirts of Doncaster. It has a branch surgery at Newton Medical Centre, Newton Lane, Sprotbrough, Doncaster, DN5 8DA. The practice provides services for 3,955 patients under the terms of the NHS Personal Medical Services contract. The practice catchment area is classed as within the group of the fourth less deprived areas in England. The age profile of the practice population is similar to other GP practices in the Doncaster Clinical Commissioning Group (CCG) area. 

The practice has two male GP partners, a female practice nurse, three healthcare assistants a business manager, assistant practice manager and a team of administrative staff. 

The practice is open between 8am to 6.30pm Monday to Friday at  both sites with Sprotborough closing at 3pm on Friday when the phones were diverted to Scawthorpe. The practice offers ed evening appointments with a GP and practice nurse at the Scawthorpe site on Wednesdays until 7.30pm.   Appointments with GPs, practice nurse and the healthcare assistants are available during the surgeries opening hours.

In addition to pre-bookable appointments that could be booked up to twelve weeks in advance, urgent appointments were also available for people that needed them. 

When the practice is closed calls were answered by the out-of-hours service which is accessed via the surgery telephone number or by calling the NHS 111 service. 

Updated 5 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Nelson Practice on 12 April 2016. 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 report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, a GP at the practice held regular minor surgery sessions which included vasectomies to the male population of Doncaster. This negated the need for patient’s registered at the practice and other practices in Doncaster to travel to the hospital for the procedure to be performed. 
• Feedback from patients about their care was consistently positive.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure they met patients’ needs. For example, t he practice had developed a care pathway for patients who resided in care homes. A copy of the care plan was kept with the resident and at the practice and updated accordingly. Staff told us it  promoted consistency in the support and care offered and enabled them to provide patient centred care as the patient's preferences were noted. It included details of next of kin, preferences for admission to hospital and acute care plans to follow if the resident's condition changed.  It had also been adopted by other practices in the area.
• 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, following feedback from the patient participation group the practice introduced a triage system with the GPs for patient's requesting same day appointments.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they were 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 strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw some areas of outstanding practice including:

• The GPs told us they would contact carers regularly, particularly when they were aware conditions or situations changed. They would routinely ask how they were doing and if there was anything the practice could do to offer help and support. Carer's told us this helped them feel 'cared for' and gave them the opportunity to reflect on their own needs.
• The practice had identified an additional 49 patients who staff perceived may be vulnerable due to their circumstances. These patients may not have been necessarily reviewed on a regular basis as they may not have a long term condition. They were offered three monthly reviews with a GP or practice nurse and any attendance at accident and emergency or other healthcare provider would be followed up by making contact with the patient and reviewing their circumstances. If the patient contacted the practice staff had access to their care plan within the patient record and would offer them an appointment with either the named GP or practice nurse.

However there was one area of practice where the provider should make improvements:

• Consider how to notify patients of the practice complaints process.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 5 July 2016

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

• Practice nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The practice had developed a care pathway for patients who resided in care homes. A copy of the care plan was kept with the resident and at the practice and updated accordingly. Staff told us it promoted consistency in the support and care offered and enabled them to provide patient centred care as the patient's preferences were noted. It included details of next of kin, preferences for admission to hospital and acute care plans to follow if the resident's condition changed. It had also been adopted by other practices in the area.
• Performance for diabetes related indicators was 0.5% below the CCG and 6% above the national average.
• 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 5 July 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 who were at risk, for example, children and young people who had a high number of accident and emergency 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 above the CCG and the national average of 82%.
• Staff told us wherever possible they would schedule appointments outside of school hours for children and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• A GP at the practice held regular minor surgery sessions which included vasectomies to the male population of Doncaster. This negated the need for patient’s registered at the practice and other practices in Doncaster to travel to the hospital for the procedure to be performed.

Updated 5 July 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.
• The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs.
• All these patients had a named GP.

Updated 5 July 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 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.

Updated 5 July 2016

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

• During 2014/15 72% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was below the national average of 77%. This had improved to 91% for the year 2015/16.
• 94% of patients experiencing poor mental health had a comprehensive care plan in place which was above the national average of 77%.
• The practice regularly worked with multidisciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice carried out advance care planning for patients living 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 5 July 2016

The practice is rated as good for the care of people who circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• The practice had identified an additional 49 patients who staff perceived may be vulnerable due to their circumstances. These patients may not have been necessarily reviewed on a regular basis as they may not have a long term condition. Staff told us they would be offered three monthly reviews with a GP or practice nurse and attendance at accident and emergency or other healthcare provider would be followed up by contacting the patient and reviewing their circumstances. If the patient contacted the practice staff had access to their care plan within the patient record and would offer them an appointment with either the named GP or practice nurse.
• The practice offered longer appointments for those who needed them.
• 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.

• The practice had an 'RSVP' scheme which  offered a volunteer visiting scheme and transport scheme for socially isolated patients. The scheme organised a Christmas meal for some patients which we were told was very popular and well attended. Patient's told us it was opportunity for them to socialise with members of their local community. Members of the patient participation group were in the process of taking over the scheme due to the bereavement of the previous coordinator.