Dr Maxwell-Jones and Partners

Updated 21 April 2016

The Surgery at Clifton road, Ashbourne provides primary medical services to approximately 7878 patients through a general medical services contract (GMS). The practice is located in the town of Ashbourne which is a popular tourist area within Southern Derbyshire.

The level of deprivation within the practice population is one third lower than the national average and income deprivation affecting children and older people is below the national average.

The clinical team comprises four GPs who are partners (two male and two female), three salaried GPs, four practice nurses and two healthcare assistants.

The clinical team is supported by a full time practice manager, administrative staff and reception staff.

The practice opens from 8am to 6.30pm Monday to Friday. Routine appointments are offered at varying times each day. Generally these are available each morning from 8.20am to 11.30am. Afternoon appointments are offered from 2.30pm to 6pm. The practice offers emergency appointments each day which are bookable by contacting the surgery at 8am. The practice provides extended hours surgeries for four hours each week. The days when extended hours are available are variable and are advertised in the waiting room and on the website.

The practice has opted out of providing out-of-hours services to its own patients. This service is provided by Derbyshire Health United (DHU).

Updated 21 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the surgery on 8 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 which were reviewed regularly at clinical meetings and learning was shared across the practice.
• Risks to patients were assessed and well managed.
• 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 very positive. Patients said they were treated with compassion, dignity and respect; and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand and learning from complaints was shared across the practice.
• Patients said they found it easy to make an appointment with a GP or nurse and that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The practice had a Patient Participation Group (PPG) and worked with them to review and improve services for patients.
• The provider was aware of and complied with the requirements of the Duty of Candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 April 2016

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

• The nursing team had roles in chronic disease management and worked with the GPs and local specialists to provide care and regular monitoring. Patients with more than one chronic condition were seen at one longer appointment.
• Home visits were provided for housebound patients who required health reviews and blood tests , for example those who were taking anticoagulant medicines. (anticoagulants are medicines to thin the blood and requires regular testing and adjustments to dosage)
• The percentage of patients with diabetes, on the register, in whom the last blood test for HbA1c was 75 mmol/mol or less in the preceding 12 months was 92%, which was 4% above CCG average and 4% above national average. (By measuring HbA1c, clinicians are able to get an overall picture of a patients average blood sugar levels over a period of weeks or months).
• The practice had provided an asthma review for 78% of the patients on their register in the last 12 months. This was 3% above national average. The practice supplied data which showed they had achieved 81% in the current year.
• A total of 89% of patients diagnosed with diabetes had received an influenza immunisation
• Patients who were diagnosed withy atrial fiblrillation but had selected not to take anticoagulation medicnes were regularly reviewed.
• There were close links with specialists in chronic disease management in the locality. For example; specialist nurses in heart failure, diabetes, epilepsy, and parkinsons disease.

Updated 21 April 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 those who were at risk. For example, children and young people who had a high number of A&E attendances.
• Immunisation rates were relatively high for all standard childhood immunisations. For example; rates for children under 24 months was between 94% and 98% which was comparable with the CCG average of between 94% and 96%
• Same day appointments were always available for children.
• 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.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses who also attended monthly multi-disciplinary team meetings.
• Sexual health clinics were available and free contraception was provided.

Updated 21 April 2016

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

• It offered proactive, personalised care to meet the needs of older people in its population. There were personalised care plans for 2% of the older population

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. Regular visits to a local care home were also provided. If a patient had been scheduled a home visit and called back due to their condition worsening, the visit was prioritised.
• Influenza and shingles immunisations were offered
• They worked closely with the CCG pharmacy lead to review patients medicines annually.
• All patients discharged from hospital were reviewed in multi disciplinary team meetings which included a care coordinator. Patient’s individual care plans and treatment were also reviewed.

Updated 21 April 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. Early morning and late evening appointments were available
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• A self service blood pressure monitoring device was available in the surgery to encourage opportunistic screening. Patients who reported high blood pressure readings were followed up by a GP.
• Saturday influenza immunisation clinics were available.
• Cardiovascular disease screening was offered for all patients over 40.
• They had provided cervical screening for 83% of eligible patients which was 2% above CCG average and 5% above national average.

Updated 21 April 2016

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

• Eightly six percent (86%) of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is 1% higher than the CCG average and 2% higher than the national average.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in the record, in the preceding 12 months was 92%. This is the same as the CCG average and 4% above the national average. 100% of these patients also had a face to face review in the last 12 months including a blood pressure check. This is 10 % higher than the CCG average and 7% higher than the national average.The exception reporting rate for this indicator was 11% which was 2% below the CCG average and 2% above the national average.
• 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.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health. This had resulted in a 13% attendance rate at accident and emergency (A&E) which was lower than the national average of 15%
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 21 April 2016

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

• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• The practice liased closely with two local pharmacies and were informed when vulnerable patients failed to collect their prescribed medicines.
• 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.
• Alerts were used on the practice’s computer system to highlight important information.