Archived: Dr Langridge and Partners Also known as Keyworth Medical Practice

Updated 15 June 2016

Dr Langridge and Partners is also known as Keyworth Medical Practice. The practice provides primary medical services to approximately 10,870through a general medical services contract (GMS). The practice is located in the heart of Keyworth and people living in the surrounding villages access this service.

Most areas covered by the practice are affluent and the level of deprivation is the lowest compared to other areas nationally. The practice has a significantly higher proportion of people of pensionable age (about 30%) compared to a Rushcliffe average of 21% and national average of 19%. The practice has a higher than national average disease prevalence in long term conditions such as atrial fibrillation, asthma, dementia and hypertension.

The clinical team comprises :

• Nine GPs of whom six GPs are partners and three are salaried GPs (four female and five male).

• Two locum GPs are currently covering maternity leave and dermatology.

• Four practice nurses and six healthcare assistants.

The clinical team is supported by an acting operations manager, an assistant practice manager, three secretaries, eight receptionists, five administrative staff, four dispensers and an apprentice.

A dispensary service was offered to patients who live further than a mile away from the practice (pharmacy with an extended 100 hour licence).

Dr Langridge and Partners is an approved teaching practice for medical students in their first, second and fourth years.

The practice is open between 8am to 6.30pm Monday to Friday. Appointments are available from 8:30am to 11am and from 4pm to 6.10pm daily. Extended surgery hours for GP and nurse appointments are offered between 7am and 8am on some days; and an early health care assistant clinic is offered from 7am on Thursdays. The practice also offers 48 hour appointments to meet the demand of routine appointments needed at short notice (each doctor provided four to five extra appointments each day that were made available from 8am, two days before); and a same day “doctor first” service if a patient could not wait for a routine appointment or a 48 hour appointment.

When the practice is closed patients are directed to the out of hours’ service provided by Nottingham Emergency Medical Services at (NEMS) via the 111 service.

The practice was inspected under the previous inspection methodology on 30 December 2013. At this inspection we inspected five outcomes in response to concerns. The provider was found compliant in all areas inspected (respecting and involving people who use services, care and welfare of people who use services, management of medicines, supporting workers and assessing and monitoring the quality of service provision).

Updated 15 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Langridge and partners on 5 April 2016. Overall the practice is rated as outstanding.

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

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. For example the practice had been involved in the design, delivery and implementation of the community gynaecology and dermatology services.

• The practice used innovative and proactive methods to improve patient outcomes, and worked with other local providers to share best practice. For example GPs could access the Nottingham clinical navigator service which enabled them to obtain specialist advice regarding a patient’s specific health condition from an appropriate consultant based at the Nottingham University Hospital (NUH) Trust.

• The patient participation group proactively reached out to the community and worked constructively with other organisations to improve patient outcomes. This included health promotion, patient education and supporting the emotional needs of the patient population.

• There was an open and transparent approach to safety and an effective system in place for reporting, recording and investigating significant events. Risks to patients were assessed and well managed.

• Staff had the skills, knowledge and experience to deliver effective care and treatment. Some clinical staff had undertaken additional training to enhance their skills and had developed areas of special interest to support them in taking lead roles within the practice.

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

• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day. The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients.

• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision was regularly reviewed and discussed with staff.

  We saw several areas of outstanding practice including:

• The practice demonstrated innovative patient participation group (PPG) working to help support the emotional needs of its patient population. The practice had empowered and supported the PPG in setting up a bereavement self-help group. This group was open to the whole community and meetings were held monthly in the Keyworth primary care centre.PPG members we spoke with and records reviewed showed the bereavement group had made a positive impact on patients’ mental wellbeing.

• The practice team actively engaged with other health organisations including the Nottingham University Hospitals NHS Trust to develop and provide community based services which reduced the use and burden on hospital services. The benefits to patient care included: care being delivered closer to home; reduced hospital attendances and admissions; as well as early supported discharges. For example:

• The practice was involved in the design and provision of specialist community services in surgical dermatology (for the greater Nottingham health district) and gynaecology (for Rushcliffe residents).

• The senior GP partner had worked with four local GPs and a community matron in the design and provision of the hospital in reach service (into the health care of older people wards) service at Nottingham University Hospital. This service aims to manage admissions to the older people wards and ensure timely and safe discharges for patients

• The practice proactively reached out to the community and worked constructively with other organisations to improve patient outcomes. For example, the practice held an annual flu day on the first Saturday of October and records reviewed showed over 2000 patients were vaccinated on the day. A total of 4233 patients were invited for flu vaccinations in 2015 and 3513 (83%) patients had received them.

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

• Ensure robust processes are implemented in the checking of single use medical consumables to ensure they are in date.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 June 2016

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

• The management of patients with long term conditions was based on evidence based guidance and relevant assessment tools to ensure good care for patients.

• The GPs and nursing staff had lead roles in chronic disease management and the review of patients’ health and medicine needs was facilitated by a robust recall system.

• Patients at risk of hospital admission were identified as a priority.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.

• Nationally reported data showed patient outcomes for long term conditions were comparable to the local and national averages.

• The practice was signed up to the Rushcliffe GP enhanced specification for long term conditions monitoring and management. This covered clinical areas such as shared care for monitoring prescribed medicines, diabetes, prostate cancer testing and anticoagulation therapy.

• A total of 149 patients had been provided with an anticoagulation service including warfarin monitoring since 2015. This included home visits for patients that were unable to attend the practice.

• The practice provided a home delivery service and dossette boxes for patients registered with the dispensary service.

• The appointment system was flexible and allowed patients to choose an appointment that suited them.

• The practice website had a comprehensive range of self-help and health promotion information.

Updated 15 June 2016

The practice is rated as outstanding 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 those at risk of ill-health or abuse. For example, the practice held regular meetings with the health visitor and school nurse to discuss vulnerable children and families.

• A flexible appointment system was in place and this ensured children and young people could be seen on the same day when this was needed. Appointments were also available outside of school hours.

• The premises were suitable for mothers, children and babies. This included baby changing and breast feeding facilities, and a range of toys and books for children.

• One of the GPs had specialist paediatric experience and offered advice and support to colleagues.

• The practice provided a full range of contraceptive services and routine health checks for expectant and new mothers. This included: preconception advice and care during pregnancy, post-natal checks and eight week baby checks.

• Immunisation rates were in line with local averages for all standard childhood immunisations.

Updated 15 June 2016

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

• The practice was committed to working collaboratively with other stakeholders in the development and implementation of efficient ways to deliver more joined up care. For example:

• The practice was engaged in the Rushcliffe health care of older people “in- reach” pilot, to facilitate appropriate and timely hospital discharges. The senior GP partner worked alongside four local GPs, a community matron, hospital consultants and staff working in the older people’s wards at Nottingham University Hospital. Benefits to older people included a coordinated and holistic approach to the management of their care and reduced lengths of inpatient stay.

• The practice provided a GP service to residents living in two care homes as part of an enhanced support service which aimed to improve the quality of care for older people by reducing unplanned admissions, emergency department attendances and risk of falls for example. Data reviewed reflected these aims were being achieved.

• We received positive and complimentary feedback from a care home provider in respect of continuity of care, responsiveness to urgent requests for home visits and the caring nature of staff.

• The GPs, clinical commissioning group pharmacist and care home staff met regularly to undertaken medicine reviews for patients and discuss any changes required.

• Nationally reported data showed patient outcomes for conditions commonly found in older people were comparable to local and national averages. We however noted high exception reporting rates for conditions such as osteoporosis and rheumatoid arthritis at 25% and 45.6% respectively. The practice accessed the consultant led Rushcliffe virtual osteoporosis service to obtain management advice for patients following scans

• Patients aged 75 and over had a named GP and a range of enhanced services were offered. For example shingles and immunisations.

• The practice offered proactive and personalised care to meet the needs of older people. This included identification and care planning for frail and vulnerable patients, and those at risk of hospital admission. Monthly multi-disciplinary meetings were held to plan and deliver care appropriate to their needs.

• The practice was responsive to the needs of older people, and offered urgent appointments for those who needed them and home visits from GPs, nurses (long term condition reviews) and healthcare assistants (phlebotomy and blood pressure monitoring). The practice’s home visit checklist included identifying carers, checking medication compliance and stockpiling, and obtaining consent for information sharing.

Updated 15 June 2016

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

• An outstanding feature of the practice included the development and delivery of community clinics for gynaecology and dermatology in response to the specific needs of its community. This enabled patients within the wider Rushcliffe area to receive care closer to home.

• The practice and patient participation group were consistent in supporting people to live healthier lives through a targeted and proactive approach to health promotion and prevention of ill-health. This included hosting an annual event where over 2000 patients received a flu jab and educational talks on specific health needs.

• 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 and flexible. For example, 90 patients were registered with the practice under the out of area registration scheme in line with their preferences and to ensure continuity of care.

• The virtual patient participation group comprised of 120 patients and this enabled them to inform service delivery through their preferred correspondence (email).

• The practice offered good access to clinical appointments and this included face to face and telephone consultations. Patients gave positive feedback about their experience in obtaining an appointment at a time that was convenient to them.

• An early morning extended hours surgery was provided each week by the GPs, nurses and health care assistants.

• The practice was proactive in offering online services and this included appointment booking and signing up to prescribing services.

• A text messaging service was used to remind patients of their appointments and patients could also cancel their appointments. This was used to help reduce non-attendance for appointments.

Updated 15 June 2016

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

• The practice was signed up to the enhanced service specification for facilitating timely diagnosis and support for people with dementia. It had the third highest number of patients diagnosed with dementia within the CCG and the diagnosis rate was 77.4% as at September 2015. Staff also made appropriate referrals to the older age mental health team after a cognitive test was undertaken.

• Comparative data showed:

  - 81% of people diagnosed with dementia had their care reviewed in a face to face meeting in 2014/15 compared to a CCG average of 88.5% and national average of 84%.

  - 96.6% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan in place compared to a CCG average of 93.3% and national average of 88.3%

• Practice supplied data for 2015/16 showed improvement although this was yet to be verified. For example a total of:

  - 23 out of 25 (92%) patients listed on the mental health register had received a face to face review and had a care plan in place.

  - 116 out of 135 (85.93%) patients on the dementia register had received a face to face review.

• The practice worked with multi-disciplinary teams in the management of people experiencing poor mental health, including those with dementia. This included the mental health crisis team to ensure patients experiencing acute difficulties received urgent assistance to manage their condition, the dementia outreach team, care home staff and the county alcohol service.

• The practice told patients experiencing poor mental health and patients with dementia about how to access services including talking therapies, counselling services and various support groups and voluntary organisations.

Updated 15 June 2016

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

• The practice offered a range of services to support people whose circumstances may make them vulnerable. This included:

• Hosting a monthly bereavement self-help group for people experiencing grief and loss. This group was facilitated by the patient participation group and was open to the whole community. Meetings were held every last Tuesday of the month between 10.30am and 12pm in the Keyworth primary care centre.

• A total of 2% of the practice population were carers and they were signposted to relevant services.A representative from the Carers Federation attended the practice on the first Monday of every month to provide information and support to patients and unpaid carers.

• The practice identified patients requiring end of life care and used the electronic palliative care co-ordination system (EPaCCS) to record and share people’s care preferences.

• We received positive patient feedback in respect of advance care planning, prescribing of anticipatory medications; and some of the GPs were described as offering a caring and personalised service. Feedback from one care home provider showed the GPs provided good quality end of life care and were proactive in ensuring the needs of patients were regularly reviewed and met.

• Staff worked with multi-disciplinary teams in the case management of vulnerable people and they knew how to recognise signs of abuse in vulnerable adults and children.

• The practice had carried out cervical cytology screening for women with learning disabilities, were consent had been obtained.

• A total of 24 out of 27 patients with a learning disability had received an annual health check and review. Three patients were under the age of 16 years and their reviews are carried out by a paediatrician.

• Reasonable adjustments had been made to ensure ease of access for these patients. This included access to interpreting services, longer appointments and home visits where needed.