Castle Medical Group

Updated 20 October 2017

Castle Medical Group is a GP practice providing primary medical services under a General Medical Services (GMS) contract to around 14,400 patients within Ashby-de-la-Zouch and surrounding villages. The practice’s services are commissioned by West Leicestershire Clinical Commissioning Group (WLCCG).

The practice is located on Burton Road, Ashby-de-la- Zouch and is on a main bus route which connects the surrounding villages.

The practice is situated in a modern, wheelchair accessible, two storey building with ample car parking which incudes designated disabled parking spaces.

The service is provided by three-full time and three part-time GP partners, a part-time salaried GP, two part-time nurse practitioners three part-time practice nurses, and three part-time health care assistants. They are supported by a management team consisting of a practice manager, an assistant practice manager, an IT manager, a facilities manager and a reception manager. Local community health teams support the GPs in provision of maternity and health visitor services. The GP’s provide a total of 53 sessions per week. The practice is a training practice and at the time of our inspection there were five trainee GP’s at the practice providing a further 32 sessions per week. There were both male and female GPs available.

The practice is open from 7.30am to 12.30pm and 1.30pm to 5.45pm Monday to Friday with the exception of Wednesday when they are open until 8pm. Appointments are available from 7.30am to close of sit and wait clinic every morning and from 1.30pm to 5.50pm on Mondays, Tuesday, Thursday and Friday and from 1.30pm to 7.50pm on Wednesdays.

When the practice is closed patients are able to contact the duty doctor by mobile telephone and after 6.30pm patients are able to contact the out-of-hours services which are provided by Derbyshire Health United (DHU) via the NHS 111 service. Patients are directed to the correct numbers if they phone the surgery when it is closed.

Updated 20 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Castle Medical Group on 30 August 2017. 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 had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• 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. The practice had been pro-active in implementing changes to improve access via telephone and to appointments to improve patient satisfaction.
• On the whole the results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a named GP and 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.

• The practice had a system for the secure storage and monitoring of blank prescriptions but this did not incorporate logging blank prescriptions received into the practice in order to provide a clear audit trail through the practice. This was amended on the day of our inspection and stock recorded appropriately.

• The practice had arrangements to respond to emergencies and major incidents. On the day of our inspection we found that the oxygen cylinder was too large to be immediately accessible in all circumstances. Following our inspection the practice provided evidence that the cylinder had been replaced with two portable oxygen cylinders.
• The provider was aware of the requirements of the duty of candour.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 October 2017

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

• Clinical staff had lead roles in long-term disease management and nurses were multi-skilled so able to deal with chronic obstructive pulmonary disease, asthma, diabetes, chronic heart disease, stroke and hypertension.

• Performance for diabetes related indicators was higher than the CCG and national averages. For example the percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less was 82% compared to the CCG average of 77.1% and the national average of 77.6%.

• All these patients had a named GP and there was a system to recall patients for 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.

• The practice carried out integrated recalls for joint reviews of multiple long term conditions to avoid patients having excessive visits to the surgery.

• The practice were proactive in screening for long term conditions which resulted in higher prevalence than the CCG average in all areas.

• There were close links with community pharmacists to ensure safe and effective prescribing for patients with long term conditions. The practice employed two prescribing clerks who helped to co-ordinate repeat prescribing, repeat dispensing, pill packs, post-discharge medicine reconciliation and deal with prescription queries from patients and pharmacists. The also followed up on medications which had not been collected by patients.

• There was regular close liaison with specialist community heart failure nurse, respiratory nurse and diabetes nurse.

• The practice held monthly multi-disciplinary team (MDT) end of life and palliative care meetings and also regular MDT meetings with community nurses, virtual ward and Macmillan team to discuss complex cases.

Updated 20 October 2017

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

• There were systems 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 (A&E) attendances.
• Immunisation rates were high for most standard childhood immunisations.
• Appointments were available outside of school hours.

• Antenatal care was provided in house by midwives and there was close liaison between GPs and health visitors.
• The practice carried out in-house six week child health surveillance checks and had high immunisation rates for babies.
• There were monthly multi-disciplinary meetings with health visitors to discuss at risk children, looked after children or any children they were concerned about and there were good relationships with school nurses.
• A range of contraceptive services were available in house; coils, implants, contraception appointments with nurses and nurse practitioners including emergency contraception.
• There were links on the practice website for self-referral to mental well-being services for teenagers.

Updated 20 October 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital with a reconciliation of medications or referral on to any other services and ensured that their care plans were updated to reflect any extra needs.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible
• The practice had a named GP and named nurse for each care or nursing home and undertook regular reviews of care home patients with their relatives and active care planning. A weekly ward round was carried out at the nursing home. All new care home patients received a GP visit with family invited as required throughout the year but also an annual review.
• The practice made high usage of the virtual ward (a multi-disciplinary team assessment by community nurse, physiotherapist, occupational therapy and social services) and discussion of patients on the virtual ward occurred at monthly multi-disciplinary team meetings.

Updated 20 October 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example; availability of daily 7.30am appointments and an extended surgery with a GP, healthcare assistant and nurse available every Wednesday evening until 8pm.

• Telephone consultations were available for patients in both the morning and afternoon enabling patients to make and receive calls in their workplace.

• The practice provided online booking and repeat prescribing as well as repeat dispensing

• NHS health checks were available and promoted.

• Patients were offered a choice of provider when being referred to other services.

• There was a comprehensive website with self-referral and signposting to a variety of services.

• There was opportunistic flu vaccination and health promotion in areas such as smoking cessation, blood pressure checks and cervical smears.

Updated 20 October 2017

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

• The practice carried out advance care planning for patients living with dementia.
• The percentage of patients diagnosed with dementia whose care plan has been reviewed in a face-to-face review in the preceding 12 months was 91%, which was higher than the CCG and national average.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• GPs and the in-house mental health practitioner undertook annual reviews of patients with complex mental health needs.
• There were nurse and GP led dementia reviews including for patients in care homes.
• The practice had a high referral rate to psychological therapy services which were held in-house.
• Staff had received training to assess and respond to risk for patients experiencing mental illness including suicide risk.
• There were links on the practice website for self-referral to mental well-being services.
• There was a dedicated Dementia Champion in the practice to liaise with external agencies.
• All practice staff had received external training from the Dementia Society in dealing with dementia sufferers so that they were better equipped to understand the condition, recognise and effectively deal with patients with dementia.

Updated 20 October 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 those with a learning disability.

• The practice offered longer appointments for patients with a learning disability and carried out nurse and GP led annual learning disability health checks including home visits if necessary.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff we interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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 prioritised children, young people and families living in disadvantaged circumstances, looked after children, children of substance abusing parents and young carers and held regular meetings with health visitors.

• The practice were able to offer communication via pdf to a personal email address so it could be read using the ‘read aloud’ function via the pdf software for patients that would find this helpful.
• There was a PPG led carer’s committee and a carer’s drop in-clinic.