The Calow and Brimington Practice

Updated 20 July 2016

The Calow and Brimington Practice is run by a partnership of four GPs. The main practice is in Foljambe Road, Brimington near Chesterfield, with a branch surgery at Calow approximately 2.5 miles away. The Calow surgery is a dispensing practice to approximately 650 patients. We inspected the dispensing service as part of this inspection.

The Calow and Brimington Practice provides primary medical services to just under 7,000 patients. It is located in a former coal mining area, and has areas of higher deprivation. The partners own the premises. Brimington Practice was purpose built in the early 1990’s, and Calow Practice was originally a detached dwelling house built in the 1970’s, which has been converted and extended to a GP Surgery.

The practice team includes administrative staff, three practice nurses, an apprentice, two health care assistants/care coordinators, a care administrator, a dispenser, an office manager, a business manager and a finance manager, one salaried GP and four partners (four female, one male). Most of the staff work across the two surgeries.

The practice holds the Personal Medical Services (PMS) contract to deliver essential primary care services. The practice is open between 8am and 6.30pm Monday to Friday. Appointments at the main practice are generally available from 8.30am to 11.30am and 3pm to 5pm daily.

Extended hour surgeries are usually offered from 7am to 8am three mornings a week, and from 6.30pm to 7.30pm at least once a month. The surgeries are held on different days.

The practice does not provide out-of-hours services to the patients registered there. During the evenings and at weekends an out-of-hours service is provided by Derbyshire Health United. Contact is via the NHS 111 telephone number.

Updated 20 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Calow and Brimington Practice on 12 April 2016. Overall the practice is rated as good. Our key findings across all the areas we inspected were as follows:

• Feedback from patients was consistently very positive about the care and services they received. They described the staff as friendly, caring and supportive and said that they were treated with dignity and respect.
• Patients told us they were able to access care and treatment when they needed it, and nearly all patients said that they could access appointments and services in a way and at a time that suits them.

• The practice was well equipped to treat patients and meet their needs. The services were delivered in a way to ensure flexibility, choice and continuity of care.
• Comprehensive systems were generally in place to keep patients safe, including the arrangements for managing medicines. The security of medicines and the system for recording and managing medicine incidents have been strengthened.   
• Staff were motivated and inspired to offer kind and compassionate care. There was effective teamwork and a commitment to improving patient experiences. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• The practice worked in partnership with other services to meet patients’ needs, and used innovative ways to improve outcomes for patients.
• The culture and leadership promotes the delivery of high-quality, person-centred care. The leadership had been strengthened by the appointment of new business, finance and office managers. The systems for monitoring the quality of services, identifying and managing risks and driving improvements, were being strengthened to ensure the services were well-led.
• The practice sought the views of patients and staff, which it acted on to improve the services. People felt able to raise concerns as the staff were approachable. Complaints were effectively managed and reviewed to ensure that appropriate learning and improvements had taken place.

The provider should:

• Monitor the system for reporting and recording medicine errors including incorrect picking of dispensed medicines, to ensure trends are identified and monitored and that patients receive safe treatment. 
• Monitor the security of medicines to ensure they are only accessible to authorised staff.
• Further identify patients who are carers to ensure they receive appropriate support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 July 2016

• The practice held a register of people with long term conditions.
• Various clinical staff had lead roles in managing long-term conditions having received extensive training.
• Patients with long term conditions and other needs were reviewed at a single appointment where possible. Longer appointments and home visits were available where needed.
• The practice provided an in-house anticoagulation service to monitor patient’s blood to determine the correct dose of their medicine. This enabled patients to be treated locally.
• High importance was placed on patient empowerment and enabling them to self-manage their condition. For example, certain working patients on anti-coagulant medicine had received training and had a support plan in place, to enable them to self-monitor their blood clotting ratio and manage their medicine.
• A GP at the practice was part of a team of consultants and GPs who ran an angina management programme for patients across North Derbyshire. Patients at the practice benefited from this expertise, which focussed on empowerment and education. Data showed that the programme had improved the quality of life of patients involved, and helped reduce the number of A & E visits and hospital admissions across practices in North Derbyshire.  
• The practice provided insulin initiation (teaching patients how to inject and manage their insulin regime) for patients with diabetes, whose body doesn't produce enough insulin to function properly.
• The practice nurses had also received specific training to initiate a group of medicines (glucagon-like peptide-1), that can be used to treat patients with Type 2 Diabetes.
• The practice worked closely with the heart failure, diabetes and respiratory specialist nurses, and referred appropriate patients to pulmonary rehabilitation and angina management programmes.
• Patients were offered a structured annual health review and interim reviews when required, which included education and strategies to enable them to manage their conditions effectively.
• The number of patients who had received an annual health review in the last 12 months was high. For example,378 out of 391(97%) patients with diabetes, and 247 out of 330 (75%) patients with asthma had received a review.

Updated 20 July 2016

• Priority was given to appointment requests for children; they were seen the same day if unwell.
• Appointments and telephone consultations were available outside of school and college hours.
• The premises were equipped and suitable for children and young people.
• The practice worked in partnership with midwives and health visitors to provide shared maternity and child development care.
• Systems were in place to identify and follow up children at risk of abuse, or living in disadvantaged circumstances. The practice held a register of children at risk of abuse or harm, and held monthly meetings with their health visitor and midwife to discuss their needs.
• Children and young people had access to a counselling and support service.
• The practice offered a range of sexual health and family planning services including contraceptive implants and intrauterine devices.
• Chlamydia testing kits were available to young people at the practice.
• Immunisation rates for all standard childhood vaccinations were high. 

Updated 20 July 2016

• The practice provided personalised care to meet patients needs.

• Patients over 75 years and palliative care patients had a named GP for continuity of care and to oversee their needs.
• The practice was responsive to the needs of older people, and offered urgent appointments and home visits for those who needed them.
• The practice was signed up to the unplanned admissions enhanced services, and maintained a register of 2.8% of patients over 18 years, which was 0.8% above the service requirement of 2%. All vulnerable and older patients at risk had a care plan in place to ensure they received appropriate care and support, t o help avoid unplanned admissions to hospital. 
• The practice worked in line with recognised standards of high quality end of life care. 
• The practice maintained a palliative care register, and end of life care plans were in place for those patients it was appropriate, which set out their wishes and plans for future care. 
• The practice held monthly multidisciplinary and palliative care meetings to discuss and review patients’ needs.
• The care co-ordinators at the practice provided support to older people, and contacted them on discharge from hospital to assess if they required more help.  
• The 2014-2015 flu vaccination rates for people 65 and over was 77%, compared to the national average of 72.8% and the local average of 75.9%.

Updated 20 July 2016

• 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 and flexible.

• Patients were able to book appointments around their working day by telephone or on line. They also had access to telephone consultations. The practice used text reminders to confirm appointments.
• In response to requests from patients some appointments could be booked up to three months in advance.
• Repeat prescription requests were available on line, which patients could collect from their preferred pharmacy.
• Extended hour surgeries were generally offered three early mornings a week for working people and those unable to attend during the day. An evening surgery was also offered at least once a month. The days varied when the surgeries were held.
• The practice was proactive in offering online services as well as health checks and screening that reflects the needs for this age group. There was a high uptake for both health screening and checks. For example, data showed that 82.6% of women aged 25 to 64 had attended cervical screening (compared to the CCG average of 79% and national average of 74.3%).

Updated 20 July 2016

• The practice held a register of patients experiencing poor mental health, including people with dementia.
• Patients were invited to attend an annual health check; 37 out of 40 eligible patients (97.5%) on the register had received a check in the last 12 months. Three patients did not respond to invites to attend. All patients had a comprehensive care plan in place. 
• The practice worked with multi-disciplinary teams in the case management of people with poor mental health, including those with dementia.
• Systems were in place to follow up patients discharged from hospital or who had attended the accident and emergency department, where they may have been experiencing poor mental health.
• Patients had access to the local mental health team, the alcohol advice service and therapists. A counsellor held a weekly surgery at the practice.
• The practice actively screened appropriate patients for dementia, to support early referral and diagnosis where indicated.
• All staff had received training in dementia care, and were working towards becoming a ‘dementia friendly’ practice.

Updated 20 July 2016

• The practice was responsive to the needs of people whose circumstances may make them vulnerable. Patients were offered longer appointments or home visits where needed.
• Patients were informed about how to access various support groups and voluntary organisations.
• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
• The practice worked with multi-disciplinary teams to meet the needs of vulnerable people, and to safeguard children and adults from abuse or harm.
• All staff had received training on safeguarding vulnerable children and adults including learning disabilities, and knew how to recognise and respond to signs of abuse and how to contact relevant agencies.
• 1.5% of the practice population had a learning disability. Various information and letters were available in picture and easy to read form that patients could understand.
• The practice had achieved a high uptake of annual health checks for patients with a learning disability; 86% of eligible patients had received a health check in the last 12 months and ten patients had declined this. 
• The practice supported two main care homes providing nursing for people with learning disabilities. An established named GP carried out at least monthly visits to review patients’ needs and ensure continuity of care. The GP was also involved in various best interest meetings for patients, the most recent was in regards to the annual influenza immunisation.
• The practice also supported a further two care homes providing personal care for people with learning disabilities.

• The practice worked with relevant local services to support a homeless person who was registered with the surgery.