22 July 2016
Abbey Medical Centre provides primary medical services to approximately 5050 patients through a general medical services contract (GMS). Services are provided to patients from a single site in Beeston just outside of the City of Nottingham. The practice had occupied purpose built premises for twenty years.
The level of deprivation within the practice population is similar to the national average, however it is higher than the CCG average. Income deprivation affecting children and older people is higher than the CCG average and national average.
The clinical team comprises three GP partners (two male and one female) and three female salaried GPS. The nursing team comprises two practice nurses. The clinical team is supported by a full time practice manager, reception manager, audit clerk, three secretaries, five reception staff and a clinical note summariser.
The practice is open between 8am and 6.30pm Monday to Friday. Appointment times for the morning sessions start at 8:30am until 11:15am or until everyone is seen and afternoon appointments start at 2pm until 6:30pm. The practice operates a ‘sit and wait’ session every morning where patients can attend the practice and be seen by a GP in turn.
The practice has opted out of providing out-of-hours services to its own patients. This service is provided by Nottingham Emergency Medical Services (NEMS).
22 July 2016
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Abbey Medical Centre on 16 March 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.
- 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.
- Risks to patients were assessed and well managed. The practice reviewed policies and identified changes based on audit and updates.
- Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
- Feedback from patients about their care was consistently positive and data from the GP survey was consistently above local and national averages. For example,100% of patients said they had confidence and trust in the last GP or nurse they saw or spoke to.
- Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
- The practice actively reviewed complaints for trends and how they were managed and responded to, and made improvements as a result.
- Patients said they found the appointment system easy to navigate and praised the ‘sit and wait’ morning clinics as convenient and efficient and said it was easy to make an appointment with a named GP.
- 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.
We saw areas of outstanding practice:
- The practice had held several ‘golden years’ events were local people attended to practice to listen to music and support, aimed at patients with a diagnosis of dementia and their carers was available.
- A patient in very vulnerable and uncertain circumstances had presented at the practice hungry and in need of help. The practice staff provided food and drink and organised accommodation support. When the patient failed to return later that evening some staff went searching for the patient with extra clothing as it was a particularly cold night and with the offer of shelter.
Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice
22 July 2016
The practice is rated as good for the care of people with long-term conditions.
- GPs and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Care plans were in place for the patients identified as being at risk of admission.
- Patients were supported to come to terms with, cope and effectively manage their condition and treatment.
- A ‘clinical events calendar’ was on display in the reception area so patients could plan and attend relevant clinics such as diabetes or lung disease clinics.
- The practice regularly reviewed patients and were in line with, or above local and national average in relation to their performance in supporting patients with long term conditions in most areas, for example:
- The practice had assessed 95% of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months, compared to a national average of 88%.
- A list of patients who were not at risk of admission was monitored and staff were aware of the developing needs of those patients, i.e. patients with Parkinson’s or multiple sclerosis (MS).
- A named nurse was allocated to some patients with long term conditions to assist in management and treatment of their condition.
- The practice had a high level of engagement with community teams such as heart failure and lung disease community nurses, to provide convenient care to patients at home and as a source of training for staff keeping up to date on best practice.
- Patients on the palliative care register were reviewed regularly in multi-disciplinary team (MDT) meetings.
- Longer appointments and home visits were available when needed.
- The practice had held a multi-disciplinary diabetes event which was developed into a CCG wide program for patients with type II diabetes, during which patients received support and education to manage their condition.
22 July 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, children and young people who had a high number of A&E attendances.
- Immunisation rates were in line with or above the local are for all standard childhood immunisations. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 97% to 100% compared to a local average of 96% to 98%.
- Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
- If patients wished to attend an appointment without their child a chaperone would provide child care in a dedicated room for the duration of the appointment.
- Appointments were available outside of school hours and the premises were suitable for children and babies. Urgent appointments were always available on the day.
- We saw good examples of joint working with midwives and health visitors.
- A female GP provided a service to fit intra-uterine devices (coils) and contraceptive implants.
22 July 2016
The practice is rated as good for the care of older people.
- It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
- The practice offered proactive, personalised care to meet the needs of older people in its population.
- The practice worked effectively with the multi-disciplinary teams to identify patients at risk of admission to hospital and to ensure their needs were met. Support was coordinated with charities such as Age concern and Red Cross crisis team where appropriate.
- A named GP was allocated to patients at risk of admission and those aged over 75 to ensure continuity of care.
- Each care home where patients lived had a dedicated GP who liaised with staff about the care of patients and visited on a regular basis to provide reviews and appointments.
22 July 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 results by phone or texting service if patients had opted in.
- The practice was proactive in offering online services and GP appointments, and access to basic patient records and prescriptions were offered through the online booking system
- Health promotion and screening was provided that reflected the needs for this age group and was in line with local and national averages, for example:
- Number of patients screened for bowel cancer in the preceding 30 months was 62% compared to a local average of 64% and a national average of 58%
- The practice’s uptake for the cervical screening programme was 81% which was comparable with the CCG and national averages.
22 July 2016
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).
- 98% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months which was above the CCG average of 86% and national average of 84%. This had been achieved with an exception rating of 3.9% which was 3% below the CCG average.
- The practice ran a proactive register for patients who were not eligible to be included in a QOF indicator group so that the practice could manage and recall them, for example patients experiencing poor mental health who did not meet the criteria for inclusion.
- The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
- The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. In addition the practice had held several ‘golden years’ events were local people attended to practice to listen to music and support, aimed at patients with a diagnosis of dementia and their carers was available.
- It had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
- Patients who had failed to attend previous appointments were offered a reminder call the day before for all upcoming appointments.
22 July 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 those with a learning disability.
- They offered longer appointments for people with a learning disability in addition to offering other reasonable adjustments.
- The practice held a register of patients identified as vulnerable but not on a QOF register as they had no chronic illness, so they could be reviewed and support offered when required.
- Patients who failed to attend appointments were followed up and those who were not contactable by phone were followed up with a home visit by a nurse or GP if appropriate.
- The practice worked closely with, and was able to allocate food parcels with the local food bank enabling them to allocate food parcels when appropriate. They were very caring towards patients in vulnerable circumstances. For example a patient in very vulnerable and uncertain circumstances had presented at the practice hungry and in need of help. The practice staff provided food and drink and organised accommodation support. When the patient failed to return later that evening some staff went searching for the patient with extra clothing as it was a particularly cold night and with the offer of shelter.
- The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
- A GP had a specialist interest in drugs and alcohol misuse and the practice worked closely with a local homeless shelter to provide care and support when required. Many had become full time patients and were registered with the shelter as their home address to aid in communication.
- A room was available in the reception area for patients who wanted to discuss confidential matters, for privacy whilst waiting for appointments or for informal discussions with clinicians.
- Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff 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. They had also undergone training to help spot signs of domestic abuse and how to offer to support to patients when required.