Archived: Dr Naomi Phillips Also known as Dr N Phillips - Radford Health Centre

Updated 9 August 2016

Dr Naomi Phillips is a single handed GP providing care to 3 558 patients through a primary medical service (PMS) contract. Dr Phillips has been providing this service for 16 years. The practice is located in Radford Health Centre which is shared with three other GP practices and is close to Nottingham city centre. The practice has car parking facilities and is accessible by public transport.

The registered practice population is predominantly of Black and Ethnic Minority (BAME) background (70.5%). Some staff are bilingual and speak other languages such as Hindi and Urdu; which are spoken by some of the patients. The practice is ranked in the second highest decile for deprivation status; and the level of income deprivation affecting children and older people is significantly above the national averages.

Dr Naomi Phillips (female GP) works closely with the clinical team comprising of two regular locum GP locums (male) and two practice nurses. The clinical team is supported by a practice manager and a team of administrative and reception staff, including a medical secretary. One of the reception members of staff had a dual role as a health care assistant.

The practice opens from 8.30am to 6.30pm Monday to Friday with the exception of Thursdays when the practice closes at 1.30pm. GP appointments and telephone consultations for the morning surgery are available from 8.30am to 1.30pm daily. Afternoon surgeries start from 4pm to 6.30pm. Extended hours GP appointments had been stopped from April 2016 due to security issues at the health centre.

The practice has opted out of providing out-of-hours services to its own patients. When the practice is closed patients are directed to Nottingham Emergency Medical service (NEMS) via the 111 service.

We previously inspected Dr Naomi Phillip’s practice on the 30 October 2013 and all five standards inspected were found compliant.

Updated 9 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Naomi Phillips on 15 June 2016. Overall the practice is rated as good.

• There was an open and transparent approach to safety and a system was in place for managing significant events and patient safety alerts. However, the recording and dissemination of this information needed to be strengthened.

• Risks to patients were assessed and well managed. This included arrangements for safeguarding vulnerable adults and children, recruitment checks and medicines management.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance; and clinical audits were completed.

• Published data for the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the local and national averages.

• Most staff had undertaken additional training to improve their skills, knowledge and experience.

• The ethos and culture of the practice prioritised providing a caring and responsive service and all staff were clear about their roles and responsibilities.

• Feedback from patients was positive and complimentary of the care received. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

• Most patients 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.

• Staff took into account the diversity and cultural issues impacting the health needs of the practice population. Specifically patients from black and minority ethnic groups who comprised 70.5% of the practice population, asylum seekers and refugees.

• Learning was shared with staff and / or improvements were made to the quality of care as a result of complaints and concerns. Information about services and how to complain was available.

• 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 patient participation group (PPG) had started to be active from May 2016 and they had identified opportunities to improve the services delivered by the practice.

The areas where the provider should make improvements are:

• Consider what steps can be taken to improve telephone access for patients.
• Proactively identify carers and ensure they are supported with information and advice relevant to their needs.
• Continue to recruit patient participation group members to take account of the views and feedback from patients in shaping service provision.
• Review the systems for ensuring training is completed by all staff.
• Strengthen the system of record keeping in relation to the management of the service.
• Continue to take proactive steps to monitor the health needs of patients with diabetes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 August 2016

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

• Data from the 2015-16 Quality Outcomes Framework (QOF) showed the practice was performing at or above local and national averages for most long term conditions with the exception of diabetes for example.

• The practice worked closely with the community diabetes specialist nurse to monitor patients’ health needs and followed up patients who had not attended appointments.

• All these patients had a named GP and structured annual reviews were offered 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 multi-disciplinary package of care.

• 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.

Updated 9 August 2016

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

• Records reviewed showed positive joint working arrangements with the midwife and health visitors to support and improve the care of children and family members.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and those at risk of abuse or deteriorating health needs.

• Immunisation rates were relatively high for all standard childhood immunisations. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 91.5% to 100% compared to the local average of 91.9% to 96.3%.

• Patient feedback confirmed children and young people were treated in an age-appropriate way and were recognised as individuals.

• Mothers had access to ante-natal and postal natal care, baby changing facilities and contraception advice.

• Appointments were available outside of school hours and on the same day if needed.

Updated 9 August 2016

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

• All patients aged 75 years and over had a named accountable GP.

• Older patients at risk of hospital admission were discussed at monthly multidisciplinary meetings hosted by the practice.

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

• Data reviewed showed clinical outcomes for conditions commonly found in older people were above local and national averages. This included osteoporosis and rheumatoid arthritis.

Updated 9 August 2016

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

• The needs of this population group had been identified and the practice had adjusted the services it offered to ensure flexibility. For example, the practice offered telephone consultations and on-line booking for appointments and requests for repeat prescriptions.

• Patients had access to national screening programmes for breast, bower and cervical screening. The practice’s uptake rates were comparable to local and national averages. For example, approximately 74% of females aged between 25 and 64 years had a record of cervical screening within the target period compared to a CCG average of 75% and national average of 74%.

• Staff supported patients to live healthier lives by advising and / or signposting to them to support services for weight management, smoking cessation and to help reduce alcohol intake.

• The practice offered NHS health checks for patients aged 40 to 74 and treatment room services such as phlebotomy and vaccinations.

Updated 9 August 2016

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

• The practice undertook reflective learning with two other GP practices using case studies based on patients who had attempted suicide or self-harmed.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. This included supporting patients to access emergency care and treatment when experiencing a mental health crisis. A system was also in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

Data showed:

• 85.7% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, and this was above the local average of 83.9% and national average of 84%. This was achieved with no patients being exception reported compared to a local and national exception rate of 8%.

• 93.1% of patients diagnosed with a mental health need had a comprehensive care plan in the last 12 months. This was above the CCG average of 83.6% and the national average of 88.3%. This was achieved with an exception reporting rate of 12.1% which was 0.9% above the CCG average and 0.5% below the national average.

Updated 9 August 2016

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

• There was an increased awareness by staff to accommodate the diversity and cultural issues impacting the health needs of the practice population. Specifically patients from black and minority ethnic groups who comprised 70.5% of the practice population, asylum seekers and refugees.

• Translation and interpretation services were available for patients and longer appointments were provided for those who needed them to ensure effective communication of their health needs.

• The practice held a register of 26 patients with a learning disability. A total of 20 out of the eligible 24 (83%) patients had received an annual review and care plans were in place.

• The practice worked with other health and social care professionals in the case management of vulnerable patients. This included sharing key information about their health needs with the out of hour’s service.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities to safeguard patients and raise concerns with the GP lead and relevant agencies.

• Following our inspection, improvements had been made or were planned for to ensure vulnerable patients such as carers had to access various information on support groups and voluntary organisations.