Archived: Hasland Medical Centre

Updated 7 April 2016

Hasland Medical Centre is located in the south east of Chesterfield in North Derbyshire.

The practice is run by a partnership of two GPs (one male and one female). The practice employ a part-time salaried GP, a part-time nurse practitioner, two part-time practice nurses, two part-time health care assistants (HCAs) and a phlebotomist. The clinical team is supported by a practice manager and a team of five administrative and reception staff. The practice use winter pressure funding provided by the CCG to contract an additional part-time locum nurse practitioner to increase capacity to see patients during busy periods.

The registered practice population of 4,352 are predominantly of white British background, and. the practice deprivation score is slightly higher than the CCG average. The practice age profile has higher percentages of patients under 18 at 23% of the total registered patients, compared to the CCG average of 18%. It has lower percentages of patients over the age of 55. This can be explained by its proximity to recent housing developments in the area. The list size has grown by an average of 5% each year over the last four years.

The practice opens from 8am until 6.30pm Monday to Friday. GP morning appointments times are available from 8.30am to 11.20am approximately, and afternoon surgeries run from 3pm to 6.30pm, apart from one Wednesday afternoon each month when the practice is closed for training. Extended hours opening is available on a Monday evening until 8pm

The practice has opted out of providing out-of-hours services to its own patients. When the practice is closed patients are directed to Derbyshire Health United (DHU) via the 111 service.

The practice holds a Personal Medical Services (PMS) contract to provide GP services which is commissioned by NHS England. A PMS contract is one between GPs and NHS England to offer local flexibility compared to the nationally negotiated General Medical Services (GMS). The practice also offers a range of enhanced services including minor surgery commissioned by their local CCG.

Updated 7 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hasland Medical Centre on 25 February 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 we saw evidence that learning was applied from events to enhance patient care and safety.
• There was a clear leadership structure and staff felt supported by management. The partners and practice manager worked collaboratively with other local GP practices and made an active contribution to Clinical Commissioning Group (CCG) workstreams.
• 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, and clinicians had lead areas of responsibility.
• Feedback from patients about their care was positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Most patients said they found it easy to make an appointment with a GP, and usually this was with a GP of their choice. Routine appointments could usually be booked within one week, and demand for appointments was actively monitored so that additional consultations could be made available in periods of high demand. Urgent appointments were available the same day.

• The practice used clinical audits to review patient care and took action to improve services as a result.

• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice worked effectively with the wider multi-disciplinary team to plan and deliver high quality and responsive care to keep vulnerable patients safe.
• The practice had an active Patient Participation Group (PPG) and worked with them to review and improve services for patients.
• The practice made changes to the way it delivered services as a consequence of feedback from patients. For example, further to comments made on the NHS Choices website regarding telephone access, an additional phone line had been installed.
• Information about services and how to complain was available and easy to understand.

We saw three areas of outstanding practice:

• The practice reviewed all deaths to ensure care had been delivered appropriately and to consider any learning points. This included sharing learning with other providers including care homes. For example, if the patient had remained in their preferred place of care; if medicines had been prescribed to anticipate coping with pain at short notice; and checking if follow-up bereavement support been offered.

• The practice had adapted a computer template used for childhood vaccinations to ensure this could not be accessed until the child reached the required age for the immunisation. This prevented vaccinations being administered too early, and had been implemented as a learning point from a significant event.
• The practice had ensured the requirements of vulnerable patients had been fully assessed and adapted to meet their individual needs comprehensively. For example, all patients with a learning disability had received an annual health check, and had a personal care plan in place. The practice provided information in a format that patients with a learning disability would understand such as letters with picture prompts, and a DVD aimed to help them to understand the cervical screening process.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 April 2016

• All patients with a long-term condition had a named GP and nursing staff had lead roles in chronic disease management. For those patients with the most complex needs and associated risk of hospital admission, the practice team worked with health and care professionals to deliver a multidisciplinary package of care.

• A recall system ranging from six to 12 months was in place to ensure patients received a regular review of their condition. This included reviews being done on home visits by the practice nurse.

• The practice had a low prevalence for long-term conditions due to the lower percentage of registered older people. The exception was asthma, which was slightly higher than local and national figures due to the higher proportion of younger patients at the practice.

• QOF indicators for asthma were higher than CCG and national averages. For example, 73.4% of patients with asthma received a review in the preceding 12 months, compared to the CCG average of 66.2% and the national average of 69.7%. This was achieved with a lower rate of exception reporting.

• The achievement for QOF indicators related to the management of diabetes at 93% was in-between local and national averages (96.7% and 89.2% respectively). The practice had established a pre-diabetes register, and routinely tested bloods for patients with a long-term condition to assess any risks of them developing the disease. This enabled patients to be directed to support to reduce the risk of them going on to develop diabetes.

• Patients with diabetes were referred into the ‘Diabetes and You Programme’ to provide patients with advice and education to help manage their condition.

• The GP partners had lead clinical roles for the CCG for patients with diabetes and breathing problems. This facilitated collaborative working and being kept updated on local and national developments.

Updated 7 April 2016

• The practice had a higher percentage of patients within this population group compared with local averages. For example, 23% of patients were under 18 (CCG average 18%).

• Urgent appointments were available on the day to accommodate ill children.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk. Monthly liaison meetings were in place between the practice and the midwife and health visitor to discuss any child safeguarding concerns.

• Immunisation rates were high for all standard childhood immunisations. For example, vaccination rates for children ranged from 96.9% to 100%, compared against a CCG average ranging from 95.2% to 99.1%. The practice achieved 100% vaccination rates in ten of the 15 immunisation categories for two and five year olds.

• The practice referred children and young people into an age-specific counselling service. This helped younger people manage traumatic experiences including bereavement.

• Contraceptive services and advice was available, and the female GPs provided a service to fit coils and contraceptive implants. Sexual health support was available for younger people, and the practice provided chlamydia self-testing kits.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals. Appointments with the practice nursing team were available outside of school hours.

• The practice provided baby changing facilities, and could accommodate mothers who wished to breastfeed on site. A designated area was available for children to sit quietly with a drawing book and crayons.

Updated 7 April 2016

• Patients over the age of 65 accounted for 12.6% of the total registered practice population. This was significantly lower than the average figure of 21.7% across the CCG. However, the practice ensured it still prioritised care for their older patients and offered proactive, personalised care to meet the needs of older people. Care plans were in place for older patients with complex needs. All patients had a named GP.

• It was responsive to the needs of older people, and offered home visits either from a GP or nurse practitioner. Urgent appointments were available for those with enhanced needs.

• Monthly meetings were held with the wider multi-disciplinary team to support patients to live in their own homes and ensure they were kept safe, and had their individual needs met.

• The practice accessed the Single Point of Access to organise additional support for patients, for example input from the community rehabilitation team, to meet their needs and avoid an admission into hospital. The practice ensured that patients in need of social support were referred into the voluntary single point of access (VSPA) to access a range of voluntary services to support them to live in their homes.

• The practice provided primary medical services to the majority of the 45 residents at a local nursing and residential care home. The GP or nurse practitioner undertook a weekly ward round at the home. All the patients received a full assessment at the first visit and care plans were formulated. We spoke to a manager from the home who was highly satisfied with the level of care provided by the GPs, and described the relationship with the practice as extremely positive. They told us the practice were responsive and caring, that they accommodated the individual needs of their patients, and the practice achieved good outcomes for their residents.

• The practice nurse provided a home INR service for housebound patients to monitor safety in those patients using warfarin to prevent their blood from clotting.

• An audiology service was provided at the practice each fortnight for patients aged over 55.

• Flu vaccination rates for the over 65s were 80.7% which was higher than the national figure of 73.2%. Saturday morning clinics were held to increase uptake.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure were in line with or above local and national averages.

• The practice did not perform annual reviews for all patients aged over 75. However, 81% of these patients were included on a long term condition register and 100% of these patients had received an annual review.  The practice were reviewing their current approach and were considering providing health checks with the health care assistant for the remaining patients aged over 75.

Updated 7 April 2016

• The practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. This included good access to appointments including telephone consultations. An extended hours surgery was available on a Monday evening until 8pm.

• The practice offered online access for patients to book GP appointments, request repeat prescriptions, and to view their summary care record (this record enables healthcare staff in emergency and out of hours services to access key clinical information, for example, medicines being prescribed)

• The practice’s uptake for the cervical screening programme was 88.1% which was above the CCG average of 83.9% and the national average of 81.8%.

• NHS Health checks were available to patients and 64% of eligible patients had attended for a check since the service became available.

• The practice had a priority on women's health issues in recognition of the demographics of their registered patients. The nurse had undertaken additional training to support the provision of a well-women clinic on site.

Updated 7 April 2016

• The practice achieved 96.2% for mental health related indicators in QOF, which was 1.9% below the CCG and 3.4% above the national averages, although the rate of exception reporting was generally higher.

• 82% of patients with ongoing serious active mental health problems had received an annual health check during 2014-15 at the time of our inspection. The practice were trying to encourage the remaining patients to attend for their review before the QOF year-end date of 31 March 2016.

• 77.4% of people diagnosed  with dementia had received a review of their care in a face-to-face consultation in the last 12 months. This compared CCG average and national average of 83%

• 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 a room available that could be booked by community based mental health services to offer counselling when patients found it difficult to attend other locations.

• It carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health and patients with dementia about how to access various support groups and voluntary organisations. Leaflets were available in the waiting area on a range of services available for patients and carers.
• Staff had a good understanding of how to support people with mental health needs and dementia.

Updated 7 April 2016

• The practice had carried out annual health checks for people with a learning disability, and 100% had attended for an annual review during 2014-15. All these patients had supporting care plans. The practice offered longer appointments for people with a learning disability.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.

• Homeless people could register with the practice. The partners informed us how they had instigated urgent action to provide support for a patient who had been made homeless.

• The practice also enabled other vulnerable groups to register at the practice without an address, including those who had been subject to domestic violence.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people and informed patients how to access various support groups and voluntary organisations.

• The practice ensured that patients in need of support were referred into the voluntary single point of access (VSPA) to access a range of voluntary services to support them to live in their homes.

• 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.

• The practice provided good care and support for patients at end of life, and worked within nationally recognised standards of high quality end of life care. Patients were kept under close review by the practice in conjunction with the wider multi-disciplinary team.

• The practice adopted a supportive approach to patients with a learning disability. This included reminding patients in the morning about their appointment; providing letters in a format which patients would understand; and providing an appointment at a time which best suited each individual.

• The practice had signed up to be a safe haven for vulnerable people. Any person in need could enter the practice as a point of refuge until they could be safely collected by relatives or carers.