John Ryle Medical Practice

Updated 20 October 2016

John Ryle Medical Practice provides primary medical services to approximately 6300 patients through a general medical services (GMS) contract. The practice is located in the Clifton area of Nottingham, approximately five miles from the city centre.

The practice was formed in the 1950s and has been running for over 60 years. It is located in a purpose built centre on a lease from NHS Property Services. The centre incorporates another GP practice, community healthcare teams and social care facilities.

The level of deprivation within the practice population is above the national average. The practice is in the second most deprived decile meaning that it has a higher proportion of people living there who are classed as deprived than most areas. Data shows number of people aged over 65 years registered at the practice is significantly higher than the CCG average but in line with the national average, and the proportion of people aged below 18 years old is slightly higher than the CCG and national averages.

The medical team comprises of four GP partners (one female and three males), three practice nurses and three health care assistants. They are supported by an administration team of ten members, some of whom have dual roles, and a practice manager. It is a teaching practice for first, second and fifth year university medical students as well as allied health professionals.

The practice is open from 8am to 6.30pm on Mondays, 8.30am to 6.30pm on Tuesdays, Wednesdays and Friday; and 8am to 12.30pm on Thursdays. Appointment times start at 8.30am and the latest appointment offered at 6pm daily. The practice does not provide the extended hours service.

When the surgery is closed, including Thursday afternoons, 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 20 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at John Ryle Medical Practice on 16 August 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.

• The practice used proactive methods to improve patient outcomes. For example, education courses were offered to patients with long term conditions such as diabetes and working with the local diabetes specialist nurse to improve the wellbeing of patients. There was evidence of improved engagement with patients who have diabetes.

• Feedback from patients about their care was consistently positive. Data from the national GP survey was consistently high and this included confidence in care provided by GPs, where 98% of patients surveyed said they had confidence and trust in the last GP they saw or spoke to.

• There was evidence of 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.
• The practice actively reviewed complaints to see if there were any recurrent themes, and identified issues where learning could be applied to improve patient experiences in the future.

• The practice had a clear vision which had improving health and wellbeing as its top priority. There was strong and visible clinical and managerial leadership with effective governance arrangements, and staff told us that they were well-supported and felt valued by the management.

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

• The provider should consider providing opportunities for all staff to meet.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 October 2016

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

• Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The practice achieved 92% on QOF in 2014/15. This was in line with the CCG average of 92% and the national average of 95%. The practice told us they their QOF performance had improved to 96% for 2015/16 but this data was not yet verified and published. The practice staff attributed their success to their recall system for people with long term conditions. A structured annual review was carried out to check their health and medicines needs were being met. 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.

• QOF achievement on indicators for diabetes was in line with or above CCG averages. For example, the percentage of patients with diabetes, on the register who had their blood pressure taken within the preceding 12 months was 76%, compared to a CCG average of 74% and national average of 78%. The practice worked collaboratively with a community specialist diabetes nurse on their more complex patients with a diabetes diagnosis, and referrals were made to diabetic retinopathy screening to improve outcomes for the patients.

• QOF achievement on indicators for atrial fibrillation and chronic obstructive pulmonary disease were above national averages. The practice achieved 100% on atrial fibrillation, compared to a CCG average of 98% and the national average of 99%.

• There were a large number of leaflets providing education and self-care advice and patients were directed to online resources. The practice actively encouraged patient education sessions for patients with conditions such as diabetes, for example a type 2 diabetes insulin course.

• The practice promoted self-referral to services such as podiatry, physiotherapy and psychological therapies, whose clinics were offered within the premises.

• Longer appointments and home visits were available and offered when needed to aid the management of long term conditions.

Updated 20 October 2016

The practice is rated as good for the care of families, children and young people.

• The practice worked closely with midwives, health visitors and family nurses attached to the practice. 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 Accident and Emergency (A&E) attendances.

• The practice held meetings every three months with the health visitor, and also reviewed any children on a child protection plan at their clinical meetings. Feedback from the health visitor was positive about the practice involvement and supportive staff.

• Immunisation rates were above the CCG averages for standard childhood immunisations. Vaccination rates for children under two years old ranged from 97% to 99% compared against a CCG average ranging from 91% to 96%. Vaccination rates for five year olds ranged from 96% to 100%, compared to the CCG average of 87% to 95%.

• Appointments were available outside of school hours with urgent appointments available on the day for children and babies. Additionally, staff liaised with the paediatricians based in the same building on patients under their care.

• Joint appointments with the GP and practice nurse were offered for the eight week post-natal check. This allowed mothers and babies to have their post-natal check, baby check and first immunisation done in one visit.

• The practice offered a full range of 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 20 October 2016

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

• The practice had a significantly high elderly population with approximately 17% aged over 65 years, compared to the CCG average of 11%. They offered proactive, personalised care to meet the needs of the older people in their population.

• GPs were responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. Staff told us they made use of their close proximity with the district nurses to communicate daily on patients under their care.

• The practice provided medical services to elderly patients resident in care homes. Feedback from a care home where approximately eight residents are registered patients indicated that GPs carried out review visits and responded to urgent requests promptly when needed. They told us the GPs worked effectively with other healthcare teams to ensure patient needs were met and referrals to other services were made promptly.

• All patients aged over 75 years old had a named GP for continuity of care.

• Data from 2014/15 showed 71% of eligible patients aged over 65 years were given flu vaccinations.

• Staff told us they noted low admission rates relating to elderly patients, despite high elderly population of the practice. They attributed their success to the care and easy access to services offered to by the practice.

Updated 20 October 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 unlimited same day appointments. However, there were limitations to the opening hours the practice could offer patients due to the lease of the building which restricted times they could open and close, with no weekend opening allowed.

• The practice was proactive in offering additional online services such as online prescription requests, appointments, and accessing medical records to view test results.

• Practice supplied data indicated 342 patients had been invited for NHS health checks targeted at people aged 40 to 74, and of these 30% had attended a review.

• There was a full range of health promotion and screening information in the practice that reflects the needs for this age group. Self-referral was encouraged for accessing psychological services, podiatry and physiotherapy.

• The practice’s uptake for cervical screening for eligible patients was 82%, which was the same as the CCG average and national average of 82%. They attributed their success to their reception staff’s active recall and follow up system.

• Breast and bowel cancer screening data was broadly in line with or higher than CCG and national averages. For example, the proportion of patients who were screened for bowel cancer within six months of invitation was 56%, compared with a CCG average of 50% and a national average of 55%.

• Data from 2014/15 showed 76% of patients aged over 15 years old recorded as current smokers were offered support and treatment within the preceding 24 months.

Updated 20 October 2016

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

• Practice supplied data showed that in 2015/16, 91% of patients diagnosed with complex mental health conditions who had their care reviewed in a face to face meeting in the preceding 12 months.

• In 2014/15, 81% of patients diagnosed dementia had their care reviewed in a face to face meeting in the preceding 12 months, compared to the CCG and national average of 84%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. Staff had a good understanding of how to support patients with mental health needs and dementia.

• The practice carried out advance care planning for patients considered at risk of mental health conditions.

• The practice had told patients experiencing poor mental health about how to access various support groups and local 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.

• A psychotherapy service held counselling clinics at the practice.

Updated 20 October 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 homeless people, travellers and those with a learning disability. There were 580 people identified as vulnerable (9% of the practice population).

• Practice supplied data indicated in 2015/16 there were 28 patients on the learning disabilities register, and 25 of them had been reviewed in a face to face consultation. The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. Feedback from the community matron was positive about coordinating patient care, with joint visits carried out by the GPs and the community matron where necessary.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• 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.

• Staff told us they were aware of how to access interpreting and text talk services for their patients with hearing impairment, and an interpreter could be arranged for those who could not speak in English through Language Line translation service.

• The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 58 patients as carers (1% of the practice population), and staff told us they were continually working towards identifying more carers, including young carers.