Archived: Church Walk Surgery

Updated 19 November 2015

Church Walk Surgery provides primary medical services to 11 600 patients living in Eastwood, Giltbrook, Kimberley, Nuthall, Langley Mill and Brinsley. It also provides care to eight care homes (residential and nursing) for older people and those with learning disabilities. The practice holds a Primary Medical Services contract and provides GP services commissioned by NHS Nottingham West Clinical Commissioning Group.

The practice is based in an ex-mining community with a high prevalence of respiratory and long term conditions. Data showed that the practice serves a population with higher levels of deprivation than the England average and that a higher than average number of children and adults are affected by income deprivation.

The clinical team comprises six GP partners, two salaried GPs and two GP registrars. This includes an equal mix of female and male GPs to provide patients with choice. The practice is a teaching and training practice; offering placements for medical undergraduate students and trainee GPs. Two of the GPs are GP trainers.

The nursing team includes one advance nurse practitioner, six practice nurses, one health care assistant and two phlebotomists.

The management team includes a managing partner, practice manager, an administration manager and a reception manager. They are supported by three medical secretaries, 12 receptionists, two data summarisers and two apprentices.

The practice is open between: 7am and 7.30pm on Monday; 7am and 6.30pm on Tuesday and 8am to 6.30pm Wednesday to Friday. Extended hours surgeries were offered between 7am and 8am on Monday and Tuesday; and 6pm to 7.30pm on a Monday.

GP surgeries are held throughout the day between: 7am to 7.20pm on Mondays and 9am to 6pm Tuesday to Fridays. Appointments with nurses, health care assistants and phlebotomist are available from: 7am to 7pm on Monday; 7am to 6pm on Tuesdays and 8am to 6pm from Wednesday to Friday.

Church Walk Surgery has opted out of providing out-of-hours services to its own patients at night and during weekends. The out-of-hours service is currently provided by Nottingham Emergency Medical Services (NEMS).

Updated 19 November 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Church Walk Surgery on 25 August 2015. Overall the practice is rated as outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses. Information about safety was reviewed and addressed; although it was not always accurately recorded.
• Risks to patients were assessed and mostly well managed, with significant improvements made to areas such as infection control.
• Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet people’s needs.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, the design and implementation of care pathways specific to long term conditions prevalent within the community.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and the Patient Participation Group (PPG).
• The PPG was proactive in arranging and coordinating health promotion and screening events to promote better health for patients, as well as local support groups for people with long term conditions and carers.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand
• The practice had a clear vision which had quality and safety as its top priority. A business plan was in place and this was monitored and reviewed.

We saw several areas of outstanding practice including:

• There was a strong focus on continuous learning and improvement at all levels within the practice. The practice team was forward thinking and took part in local pilot schemes to improve outcomes for patients in the area. For example, the partners had taken a lead role in the design of care pathways for a range of long term conditions and the development of the local GP provider company (primary integrated community services limited). As result, community services were developed to treat and manage conditions such as respiratory conditions, heart failure and cardiology, pain and non-malignant palliative care. Outcomes achieved for patients included services being delivered closer to home, reduction in secondary care referrals and hospital admissions.
• The patient participation group (PPG) had strong links with the local community through facilitating health promotion events and local support groups for lung related health needs and carers. Additionally, the PPG worked in collaboration with two other PPGs to ensure the wider community benefited from the activities they held. Patient feedback showed patients had enjoyed the informative events and received useful information on healthy lifestyle advice.

However there were areas of practice where the provider needs to make improvements.

Importantly, the provider should:

• Improve the availability of non-urgent appointments with a named GP and waiting times.
• Ensure completed cycles of clinical audits related to minor surgery in line with best practice guidance.
• Strengthen the systems for assessing and monitoring risks and the quality of the service provision. This includes maintaining accurate and detailed records in relation to the management of regulated activities, practice and clinical meeting minutes and infection control practices.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Updated 19 November 2015

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

All clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. Longer appointments and home visits were available when needed.

For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. The practice’s involvement in service design for care pathways related to specific conditions such as chronic obstructive pulmonary disease, palliative care needs and heart failure was an outstanding feature.

The practice was very responsive in ensuring appropriate care and support packages were offered to patients. This included support groups’ patients could attend and patient education to promote self-management of one’s health. Data showed the majority of clinical and public health outcomes achieved by the practice were above the local CCG and national averages.

Updated 19 November 2015

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

Immunisation rates were relatively high for all standard childhood immunisations. Children under the age of five had same day access to a GP. Appointments were available outside of school hours and the premises were suitable for children and babies.

We saw good examples of joint working with midwives, health visitors and school nurses. There were systems in place to identify and follow up children living in disadvantaged circumstances and those at risk of abuse. For example, children and young people subject to protection plans and those who had a high number of accident and emergency (A&E) attendances.

The practice provided a family planning service and a range of options for contraception including a coil fitting service. Other provisions included phlebotomy services for children over the age of two, teenage vaccinations, a travel clinic and the practice was also a registered yellow fever centre.

Updated 19 November 2015

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

Patients aged 75 years and over had a named GP for continuity of care. Nationally reported data showed the practice performed well against indicators relating to conditions commonly found in older people. Monthly multi-disciplinary care meetings were held to ensure integrated care for older people with complex health care needs.

The practice had the second highest number of older people within the clinical commissioning group (CCG) area. It offered proactive and personalised care to meet the needs of the older people in its population. This included a range of enhanced services, for example, preventing unplanned admissions into hospital, in dementia and end of life care. The practice had worked with one of the patients to establish a local exercise class for patients with Parkinson’s disease. This is undertaken on a weekly basis at the church hall adjacent to the surgery.

The practice was responsive to the needs of older people. It offered rapid access appointments for older people with enhanced needs and home visits including in care homes. A range of health promotion and screening that reflects the needs for this age group were offered. This included breast screening for female patients aged 70 and over, influenza and shingles vaccinations.

Updated 19 November 2015

The practice is rated as outstanding for the care of the 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 providing extended hours on a Monday morning between 7am to 8am and Monday evening between 6.30pm to 7.30pm.

The practice was proactive in offering a range of online services including access to medical / summary care records, requesting repeat medicines and booking and cancelling of appointments. Telephone consultations and text reminders for appointments and health promotion campaigns were also offered.

A full range of health promotion and screening that reflects the needs for this age group were offered. This included travel vaccinations, NHS health checks for patients aged 40 to 74, cytology screening for women aged 25 to 64, and blood checks. Data showed high uptake rates were consistently achieved. For example, the 2014/15 uptake rate for aortic aneurysm screening was 85.6% compared to a CCG average of 83.3% and national average of 79.5%.

Updated 19 November 2015

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

The practice had robust systems in place to ensure patients were offered an annual review of their health needs and medicines. Nationally reported data showed outcomes for patients experiencing poor mental health and dementia were good.

The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health and those with dementia. Patients were supported to access emergency care and treatment when experiencing a mental health crisis; and staff followed up patients who had attended accident and emergency (A&E). Patients were: prescribed self-help books; referred to counselling and talking therapy services; and told of various support groups and voluntary organisations.

The practice held a register of 145 patients diagnosed with dementia. The practice’s dementia diagnosis rate was 83.3% compared to a local average of 76.8% and national average of 58.14%. Effective systems were in place to proactively identify and assess signs of dementia in patients. The practice carried out advance care planning in line with the patient’s wishes to ensure their individual needs were met. Some staff had received training on how to care for people with mental health needs and dementia.

Updated 19 November 2015

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

The practice held a register of patients living in vulnerable circumstances including carers, people living in residential and nursing care homes, and those with a learning disability. It had carried out annual health checks for people with a learning disability offered longer appointments for people with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people to ensure their needs were reviewed. 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.

Patients and carers had access to various information leaflets, support groups and voluntary organisations. In conjunction with another neighbouring practice, staff offered support through information events and talks to carers at the local church.