Hucknall Road Medical Centre

Updated 9 December 2016

Hucknall Road Medical Centre provides primary medical services to approximately 13000 patients through a general medical services (GMS) contract. This is a locally agreed contract with NHS England.

The practice was formed in 1947 and has been running for over 60 years. The practice has been based in its current purpose built premises since 2000 and this includes 14 clinical rooms. It is located approximately three miles from Nottingham city centre and close to the Nottingham University Hospitals’ City Hospital campus.

The level of deprivation within the practice population is above the national average. The practice is in the third most deprived decile meaning that it has a higher proportion of people living there who are classed as deprived than most areas. Data shows the number of people aged over 65 years registered at the practice is slightly higher than the CCG average but lower than the national average, and the proportion of people aged below 18 years old is slightly higher than the CCG and national averages.

The medical team comprises of seven GP partners and six salaried GPs (four male and nine female doctors), four practice nurses and three health care assistants. They are supported by an administration team of 21 members, a practice manager and an assistant practice manager. It is a teaching practice for first, second and fourth year university medical students. Training support is also offered to non-medical prescribers such as pharmacist and nurse practitioners.

The practice is open from 8am to 6.30pm on Monday to Friday with extended opening hours from 7.30am to 8am Monday to Friday and 8am to 12 noon on Saturdays. Appointment times start at 7.30am and the latest appointment offered at 5.50pm daily. Patients from another practice in the area can be seen at Hucknall Road on Saturdays as part of a locally agreed arrangement.

When the surgery is closed, patients are advised to dial NHS 111 and they will be put through to the out of hours service which is provided by Nottingham Emergency Medical Services.

Updated 9 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hucknall Road Medical Centre on 20 September 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events and near misses, and we saw evidence that learning was applied.

• The practice had effective safeguarding procedures in place, with the safeguarding lead having protected time to review all patients on their safeguarding registers. There was active involvement of other healthcare professionals and agencies to mitigate risks and safeguard children.

• GPs showed a caring approach to patient care. Full health checks, including blood tests and chest x-rays, were provided to patients identified as asylum seekers when they first joined the practice.

• The practice used innovative and proactive methods to improve patient outcomes. This included developing information packs for patients newly diagnosed with type 2 diabetes, referrals to education courses and joint working with the local diabetes specialist nurse to improve the wellbeing of patients.

• Feedback from patients about their care was consistently positive. Data from the national GP survey showed 98% of patients surveyed said they had confidence and trust in the last GP they saw or spoke to.

• There was evidence of planned and co-ordinated patient care with the wider multi-disciplinary team to plan and deliver effective and responsive care to keep vulnerable patients safe.
• The practice actively reviewed complaints to see if there were any recurrent themes, and identified issues where learning could be applied to improve patient experiences in the future.
• A range of extended opening hours were offered every morning from Monday to Friday and for four hours on Saturday mornings for the convenience of working patients. These included GP and nurse appointments.
• The practice was awarded the ‘You’re Welcome’ status for meeting the criteria for young people friendly health services.
• The practice had a clear vision which had improving health and wellbeing as its top priority. There was strong and visible clinical and managerial leadership with effective governance arrangements.
• Staff told us that they were well-supported and felt valued by the management.

We saw some areas of outstanding practice:

• One of the GPs organised two evening meetings at one of the care homes to provide families with the opportunity to meet the doctor and nurses with a representative from Age UK in attendance. This was an unpaid initiative outside of their normal working hours and it resulted in ongoing improved involvement of relatives in the care of patients and aided advance care planning. There was positive feedback from staff and patients’ relatives which was shared with the CCG in order for them to consider including the visits as part of the paid local enhanced service for care homes.

An area where the provider should make improvements is:

• The provider should take steps to identify more carers registered with them in order to support them where appropriate.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 December 2016

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

• The practice maintained long term conditions registers, including a register of patients with multiple long term conditions who were offered combined reviews in single appointments.

• GPs had lead roles in chronic disease management, with a lead nurse and administrative lead for each long term condition, an arrangement which encouraged ownership in driving improvements in each disease area. This was achieved by avoiding duplications in recalling patients, designing appointments to suit and keeping up to date with local and national clinical guidance for their allocated disease area. There was evidence of improved outcomes, for example, improved glycaemic control measures for patients with diabetes.

• Patients at high risk of hospital admission were identified as a priority and entered on a case management register with a named GP. They were reviewed at monthly multi-disciplinary meetings attended by the doctors, community matron and district nursing team. Feedback from the community matron was positive about the supportive collaborative manner in which the meetings are held.

• The practice structured annual reviews were carried out for most patients 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 worked collaboratively with a community specialist diabetes nurse who ran monthly clinics from the premises to enable the effective management of complex patients with a diabetes diagnosis.

• The practice worked with New Leaf to promote smoking cessation in patients with long term conditions such as asthma, stroke, and chronic obstructive pulmonary disease (COPD). The practice wrote to a proportion of the patients to find out if they were interested in stopping smoking and offered referrals where appropriate.

• There were a large number of leaflets providing education and self-care advice and patients were directed to online resources. The practice promoted self-referral to services such as physiotherapy and psychological therapies, whose clinics were offered within the premises.

Updated 9 December 2016

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

• The practice worked closely with midwives, health visitors and family nurses attached to the practice. 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 (A&E) attendances.

• The practice held monthly meetings with the health visitor, and also reviewed any children on a child protection plan at their clinical meetings. We saw evidence of detailed discussions including engagement with other local agencies and healthcare professionals such as paediatricians in the care of their patients.

• Immunisation rates were broadly in line with CCG averages for standard childhood immunisations. For example, v

• Pregnant women were offered flu and whooping cough vaccinations. Smoking cessation advice was given to those identified as smokers.

• Appointments were available outside of school hours with urgent appointments available on the day for children and babies.

• Coordinated appointments were offered where possible for the six week post-natal check and immunisations. Newborn checks were offered following early discharge from hospital.

• The practice offered a full range of family planning services including fitting of intra-uterine devices (coil) and contraceptive implant fitting. The service was extended to patients registered at other surgeries.

• The premises were suitable for children and babies. Baby changing facilities were available and the practice accommodated mothers who wished to breastfeed.

• The practice was awarded the ‘You’re Welcome’ status for meeting the criteria for young people friendly health services.

Updated 9 December 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in their population. GPs were responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Joint care home visits were carried out with community geriatricians to carry out joint medication reviews and use their specialist skills in providing holistic care to patients.

• There were joint home visits with the Dementia Outreach team for patients over 65 years old with dementia, resulting in coordinated reviews of patients on antipsychotics and specialist support for those on more complex medicines.

• The practice provided medical services to elderly patients resident in three care homes. Two nominated GPs carried out three sessions per week in the homes carrying out comprehensive reviews of the patients. The GPs held monthly meetings with the care home managers to address any ongoing concerns.

• One of the GPs organised two evening meetings at one of the care homes to provide families with the opportunity to meet the doctor and nurses with a representative from Age UK in attendance. This was an unpaid initiative outside of their normal working hours. There was positive feedback from staff and patients’ relatives which was shared with the CCG in order for them to consider including the visits as part of the paid local enhanced service for care homes.

• In addition, GPs made contact with the families of the patients to discuss concerns and initiate advanced care planning where appropriate, aimed at improving end of life care for patients.

• GPs were proactive in managing patients in care homes by initiating a GP visit book in which any patient in need of input from other health professionals had entries made detailing the required intervention. This assisted the visiting GP in ensuring care tailored to patient needs.

• There was regular engagement with specialist care home nurses and the local community falls team to prevent avoidable hospital visits, including multi-disciplinary meetings held at care homes. Practice supplied data indicated this had resulted in reduced admissions to hospital and accident and emergency (A&E) attendances from patients in the care homes. For example, emergency admissions from one of the care homes fell from 11 admissions in 2014/15 to 8 admissions in 2015/16 (27% reduction).

• All patients aged over 75 years had a named GP for continuity of care.

• Practice supplied data for 2015/16 showed 70% of eligible patients aged 65 years and over were given flu vaccinations, in line with the CCG average of 71%.

Updated 9 December 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. This included access to telephone appointments, pre-bookable appointments up to four weeks in advance and urgent same day appointments.

• Appointments could be booked online and they became available at 10pm the night before. Other online services included prescription requests, viewing test results and accessing medical records. The surgery used the electronic prescribing service which allowed patients to collect their prescriptions from their chosen pharmacy.

• Early morning appointments were offered from 7.30am Monday to Friday and 8am to 12 noon on Saturdays with a GP and nurse available to allow patients who work or study to access appointments. Flu clinics were offered on weekdays and Saturdays to accommodate working patients.

• The practice was signed up to provide services such as phlebotomy, ear syringing and treatment room services to patients not registered with them.

• Practice supplied data for 2015/16 indicated 447 patients aged 40 to 74 had been invited for NHS health checks, over the threshold target of 345, and of these 48% had attended a review.

• The practice’s uptake for cervical screening for eligible patients was 78%, which was in line with the CCG average of 77% and national average of 76%. The practice team attributed their success to their reception staff’s active recall and follow up system.

• Breast and bowel cancer screening data was broadly in line with or higher than CCG and national averages. For example, the proportion of patients who were screened for breast cancer within six months of invitation was 78%, compared with a CCG average of 76% and a national average of 73%.

Updated 9 December 2016

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

• The practice demonstrated a holistic approach in managing patients with poor mental health by incorporating physical health checks to improve patient outcomes. They participated in a pilot scheme called the Enhanced Physform service where longer appointments were offered to patients to include enhanced physical health checks.

• Published data for 2015/16 showed 90% of patients diagnosed with complex mental health conditions had their care reviewed in a face to face meeting in the preceding 12 months compared to a CCG average of 87% and national average of 89%. The exception reporting rate was 26%, 15% higher than the CCG average and 14% higher than the national average. The practice was actively refining their recall system to encourage patient attendance. For example, a patient on the mental health register had previously missed appointments offered by writing to them. Practice staff telephoned the patient to arrange appointments and then called him again the day before to remind them, resulting in improved engagement.

• 82% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the preceding 12 months, compared to the CCG and national average of 86%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. Staff had a good understanding of how to support patients with mental health needs and dementia and one of the nurses is a ‘Dementia Friend’ who provides support to patients.

• Advance care planning was carried out for patients considered at risk of mental health conditions. The practice had told patients experiencing poor mental health about how to access various support groups and local voluntary organisations. Practice supplied data indicated their referral rate to psychological therapies in 2015 was 72%, which was higher than the CCG average of 67%.

Updated 9 December 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 homeless people, asylum seekers and those with a learning disability.

• The practice had 54 patients listed on the learning disabilities register. A total of 52 patients were offered a health check and 40 of them had been reviewed in a face to face consultation.

• The practice offered longer appointments for patients with a learning disability which consisted of combined nurse and GP appointments.

• There were 45 patients identified as asylum seekers (0.3% of the practice population). Full health checks were provided to them when they first joined the practice. These included blood tests and chest x-rays.

• 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, and demonstrated knowledge of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

• Staff told us they were aware of how to access interpreting and text talk services for their patients with hearing impairment, and an interpreter could be arranged for those who could not speak in English through Language Line translation service.

• The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 88 patients as carers (0.7% of the practice population), and staff told us they were continually working towards identifying more carers.