Wollaton Park Medical Practice

Updated 27 June 2016

The practice is located in Wollaton Park suburbs of Nottingham with a list size of approximately 7800. There are two schools in the area, and it is within easy distance to the University of Nottingham main campus, the university’s Jubilee campus and the Queens Medical Centre hospital.

There are two care homes for older people near the practice, and they currently have two registered patients in one of them. The practice population is very mixed with a significant number of older people who are not in residential care, graduates from the university and their families as well as young people with a disability. It is ethnically diverse with many patients from Pakistani, Eastern European and Middle Eastern origins. Data shows number of 20-29 year olds registered at the practice is lower than the national average and the number of patients aged 0-14, 40-44 and 80-85+ years old is higher than the national average.

The practice operates from a building built in 2007 with a number of clinical and non-clinical rooms. There is easy access to all rooms for both patients and staff and facilities include minor operations suite, breast feeding room, disabled access toilets, isolation room, parking and a pharmacy just outside the practice doors.

The practice team comprises seven GP partners, three practice nurses, two healthcare assistants, a practice manager and the administrative/reception team. There are five female GPs and two male GPs. It is a training practice and currently has two trainee GPs.

The practice is open between 8am and 6.30pm Monday and Wednesday, 7am to 6.30pm on Tuesday and Friday, 8am to 5pm on Thursday. Appointment times vary throughout the day to meet demand, with the earliest appointment starting at 8am and the latest appointment offered at 5.50pm daily. Extended hours appointments are offered from 7am to 8am every Tuesday and Friday as pre-bookable appointments only. There is a pharmacy located next to the practice.

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 27 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wollaton Park Medical Practice on 25 April 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. Staff were actively encouraged to report significant events including positive ones.

• There was easy access to appointments for patients whose circumstances made them vulnerable, for example patients from the traveller community. They were assured of an appointment on the day when they presented to the practice without a booked appointment.

• Feedback from patients about their care was consistently positive. Data from the GP survey was consistently high and this included confidence in care provided by GPs, where 92% of patients surveyed said they had confidence and trust in the last GP they saw or spoke to.

• The practice 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, particularly the end of life care patients.
• Suggestions for improvements were implemented and changes were made to the way it delivered services as a consequence of feedback from patients and from the patient participation group.
• The practice actively reviewed complaints for trends and how they were managed and responded to, and made improvements as a result.
• There was 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, and staff told us that they were well-supported and felt valued by the partners.

• The practice developed a bespokerecall system for patients with long term conditions which enabled them to view a patient’smultiple conditions in one summary and manage their problems in single appointments. This system improved compliance with appointments because patients did not need to make multiple appointments.

• The practice staff were responsive to the needs of the local community and often saw school age children from the neighbouring schools if they fell ill at school and assisted with medical emergencies.

However, the areas where the provider should make improvements are:

• Ensure safe patient care by identifying risk and doing all that is possible to mitigate this by developing a system for the management of MHRA alerts in the practice so there is clear responsibility of actions and a log is kept of actions taken.

• Carry out health and safety assessments regularly.

• Ensure recruitment checks at the point of offering employment are robust and any risk assessments undertaken should record the actions taken to mitigate risks.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 June 2016

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

• The practice actively managed its annual recall system, recalling patients in the month of their birthday and followed up non-attenders to check their health and medicines needs were being met. The practice had a bespoke system which was updated with current data every month and addressed all of the patients long term conditions in one go. The system enabled patients to be seen by the most appropriate member of staff.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority, ensuring they had care plans in place.

• Nursing staff worked collaboratively with other community healthcare teams such as the care coordinator, district nursing team, respiratory team and heart failure team to improve outcomes for the patients.

• QOF achievement on indicators for chronic obstructive pulmonary disease was consistently above CCG averages. For example, the percentage of patients with the condition who had a review undertaken by a health professional within the preceding 12 months was 86%, compared to a CCG average of 80.5% and national average of 79.9. The exception reporting rate for the practice was 5.3%, which was lower than the CCG average of 9.4% and also lower than the national average of 11.1%.

• QOF achievement on indicators for asthma and heart failure were broadly in line with national averages. We saw evidence of an asthma protocol used by the nursing team for the effective management of patients with the condition.

• Longer appointments and home visits were available and offered when needed and every patient had a named GP for continuity of care.

Updated 27 June 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, all child A&E attendances were reviewed by a GP and discussed with the health visitor if appropriate.

• The practice held regular safeguarding meetings and the health visitor held clinics every Tuesday at the practice. There was an assigned midwife who saw patients at home and worked closely with the surgery. The practice offered newborn checks and six week postnatal checks.

• Immunisation rates were mostly above the CCG averages for standard childhood immunisations. Vaccination rates for children under two years old ranged from 93.2% to 98.1% compared against a CCG average ranging from 91.1% to 96.3%. Vaccination rates for five year olds ranged from 81.3% to 92.3%, compared to the CCG average of 86.9% to 95.3%.

• Appointments were available outside of school hours with urgent appointments available on the day for children and babies. The practice staff were responsive to the needs of the local community and often saw school age children from the neighbouring schools if they fell ill at school and assisted with medical emergencies. Staff told us the practice had seen children attending without booked appointments during a diarrhoea and vomiting outbreak at one of the schools.

• The practice offered family planning services including fitting of intra-uterine devices (coil) and contraceptive implant fitting.

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

Updated 27 June 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 has a significant elderly population with 17.8% aged over 65, compared to a CCG average of 11.1% and national average of 17.1%.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. This included patients resident in care homes who were offered annual health reviews as appropriate.

• They worked effectively with multi-disciplinary teams to identify patients at risk of admission to hospital to ensure their needs were met. For example, the practice coordinated care with the district nurses, social workers, care coordinators and community matron service to ensure that complex patients had care plans recorded and their records reviewed regularly to improve their outcomes.

• The practice offered annual health checks to elderly patients aged 75 and over who had a medical condition or were on regular medications in the month of their birth to discuss their health needs and review their medication. The practice worked closely with a community pharmacist who carried out medication reviews for patients on multiple medications.

• All over 75s had a named GP for continuity of care. Longer appointments were offered if needed.

• The practice reported the flu vaccination uptake for 2015/16 was over 1400 patients, which was 60% of eligible patients. The practice reported this was achieved by offering home visits for the vaccinations.

Updated 27 June 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 and triage, text reminders and the availability of early morning appointments from 7am to 8am every Tuesday as pre-bookable appointments only. Appointments with the health care assistant were available from 7am on Tuesdays and Fridays

• The practice was proactive in offering online services such as online prescription requests, appointments and access to clinical coded medical records.

• There was a full range of health promotion and screening information in the practice and online that reflects the needs for this age group such as cervical and bowel screening, with a system in place to check the uptake of services. Other services included travel clinics, NHS health check, well man and well woman checks.

• The practice’s uptake for cervical screening for eligible patients was 83.2%, which was in line with the CCG average of 81.5% and the national average of 81.8%.  

Updated 27 June 2016

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

• The practice provided a dementia screening enhanced service which encouraged early identification of patients at risk of dementia and offered them an assessment opportunistically. Advanced care planning was in place for patients diagnosed with dementia.

• 82% of patients diagnosed with dementia had their care plan reviewed in a face to face meeting in 2014/15. This was in line with the national average of 84%.

• The practice achieved 98% for mental health related indicators in QOF, which was 9.3% above CCG average and 5.2% above national average.

• Staff told us that there were 38 patients on the mental health register in 2015/16, and 94% had care plans, and there were 65 patients on the dementia register and 85% had a care plans in place.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. Annual reviews which included physical assessments were offered to patients.

• Staff had a good understanding of how to support patients with mental health needs and dementia by referring them to counselling and support groups. Staff had received training on mental health, dementia awareness and working together with crisis teams, carers, dementia outreach team and social care.

Updated 27 June 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 those with a learning disability.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. There were nominated GPs for safeguarding within the practice. Staff were aware of their responsibilities regarding information sharing and how to contact relevant agencies in normal working hours and out of hours.

• A telephone triage system was in place for identifying patients in need of urgent appointments so that arrangements were made to see them quickly. The practice worked with a care coordinator to organise medical and social care that may be required urgently.

• The practice provided good support for end of life care patients, keeping them under close review in conjunction with the community matrons through monthly review meetings.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations. For example, the practice informed patients about Last Orders service if concerns about alcohol abuse were identified at registration with the practice.

• There was a vulnerable adults policy and procedure in place for the registration of homeless and traveller patients. Staff understood that compliance with appointments may be difficult for these patients and would make efforts to find appointments for them if they presented to the practice in need of medical care. Homeless patients were encouraged to use the practice address for their correspondence and they would be telephoned to collect their letters.

• The practice had 28 patients on their learning disabilities register, and 93% of them had received a health review in the last year. Longer appointments including home visits were offered to them.

• There were 13 patients on the palliative care register and not all of them had cancer, showing that the practice included all patients with life limiting conditions to ensure they had access to high quality palliative care.

• Staff told us they were aware of how to access interpreting and text talk services for their patients with hearing impairment, and language line for patients who need an interpreter. Patients using these services would be offered longer appointments if needed.