Archived: DRHC Ltd Also known as Grange Farm Medical Centre

Updated 31 October 2016

Grange Farm Medical Centre provides primary medical services to approximately 3,500 patients through an alternative provider medical services (APMS) contract, set up by the Derby Road Health Centre practice.

Grange Farm Medical Centre is located in the Bilborough area of Nottingham city centre, approximately four miles from the city centre. It is located within purpose-built premises rented by the practice, built in 2011 when the practice was formed.

The practice deprivation scores indicate people living in the area were significantly more deprived than the CCG and national average. Data shows the proportion of patients aged 18 years and below registered at the practice, is significantly above the CCG and national average. The proportion of patients aged 65 years and above is significantly above the national average but in line with the CCG average.

The medical team comprises of three GPs, an advanced care practitioner, a practice nurse and a health care assistant. They are supported by nine members of the management and administration team. Some staff members including one GP and the management team also work at Derby Road Health Centre, located approximately three miles away. There are two female GPs and one male GP.

The practice is open between 8am and 6.30pm Monday to Friday. Appointment times start at 9am and the latest appointment offered at 5.50pm daily. There is a daily drop in clinic with the nurse practitioner where patients presenting before 11.30am are guaranteed to be seen within the morning. The practice provides the extended hours service, closing at 8pm on Wednesdays.

When the surgery is closed, 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 31 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Grange Farm Medical Centre on 20 July 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.

• There was easy access to appointments for patients with a range of appointments on offer, including a daily morning drop in clinic with an advanced nurse practitioner and telephone consultations, reducing waiting times for patients. This was evident from the above average patient satisfaction results from the national survey.

• The practice responded to the needs of their patients by offering services which were no longer commissioned locally, such as a non-fee paying toe nail cutting service for the elderly in need of foot care.

• The practice supported patients to live healthier by offering a weekly Lifechangers Class, a weight management and healthy eating clinic. Feedback from patients indicated they had achieved positive outcomes from the class.

• The practice planned and co-ordinated patient care with the wider multi-disciplinary team to deliver effective and responsive care to keep vulnerable patients safe.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group (PPG).
• 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 quality and safety as its top priority. The strategy to deliver this vision was documented and reviewed by the management on a regular basis and staff told us that they were well-supported and felt valued by the partners.

We also found some outstanding features as follows:

• The practice is rated Outstanding for caring. There was evidence of a caring approach to patients through offering various support groups for patients and carers on site, such as the support group for relatives of patients with Alzheimer’s and the Admiral Nurses clinics.

• The practice was awarded the ‘You’re Welcome’ status for meeting the criteria for young people friendly health services. Teenage patients were actively encouraged to use online services to book their own appointments to ensure they were involved in their healthcare.

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

• Consider enhancing the security arrangements for signed uncollected prescriptions out of hours, and arrangements for regular monitoring of patients who have not collected them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 31 October 2016

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

• The practice had a recall system for patients with long term conditions, audited on a monthly basis to identify patients who are due for a review. Patients were sent reminders in the month of their birthday to attend an annual check, which incorporated a review of their long term conditions, and those who did not attend were followed up to book another appointment.

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

• 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.

• There was evidence of coordinated care with multi-disciplinary teams between the nursing staff and community matrons, diabetic specialist nurses, respiratory specialist nurses and care coordinators to improve the outcomes for the patients, with most of the allied health professionals using the practice rooms for their clinics.

• There were a large number of leaflets providing education and self-care advice and patients were directed to online resources. A specialist diabetes nurse visited the practice regularly to review more complex patients and provide support to the nursing staff.

• QOF (Quality Outcomes Framework) achievement on indicators for diabetes was consistently in line with CCG averages. For example, the percentage of patients with diabetes on the register who had influenza immunisations in the preceding 12 months was 93%, compared to a CCG average of 93% and national average of 94%.

• Longer appointments and home visits were available and offered when needed.

• The practice provided weight management clinics with referrals offered to local gyms for exercise. They promoted self-referral to services such as acupuncture, podiatry, physiotherapy and psychological therapies, some of which had clinics offered in the practice premises.

Updated 31 October 2016

The practice is rated as outstanding 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 A&E attendances.

• The practice held meetings every six weeks with the health visitor and midwife, and also reviewed any children on a child protection plan at their clinical meetings.

• The health visiting service held weekly drop in clinics on Wednesday afternoons from the practice which ran concurrently with the midwife’s antenatal clinic. This was used as an opportunity for the different agencies to share information and coordinate care. In addition, the health visitors delivered the ‘Baby, Birth and Beyond’ antenatal course from the practice premises.

• Immunisation rates were in line with the CCG averages for standard childhood immunisations. Vaccination rates forchildren under two years ranged from 81% to 100%, compared a gainst a CCG average ranging from 91% to 96%.

• The premises were suitable for children and babies. Baby changing facilities were available and the practice accommodated mothers who wished to breastfeed.

• Appointments were available outside of school hours with urgent appointments available on the day for children and babies.

• The practice was awarded the ‘You’re Welcome’ status for meeting the criteria for young people friendly health services. Teenage patients were actively encouraged to use online services to book their own appointments to ensure they were involved in their healthcare.

• There was a full range of family planning services offered to patients of the practice and those registered elsewhere, which included fitting of intra-uterine devices (coil), contraceptive implant fitting and emergency contraception. Urgent same day sexual health appointments were available.

• A common childhood illnesses booklet was available in the waiting area, which contained information for parents and carers of children on managing health at home and using the various health services.

Updated 31 October 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population. They offered home visits, same day telephone appointments and urgent appointments for those with enhanced needs. Phlebotomy, ear syringing, joint injections and chronic disease monitoring.

• Home visits were offered to housebound patients.

• The practice provided an in-house toe nail cutting service which was not funded by the NHS, to enable better foot care in the elderly. Seven 30 minute appointments were provided weekly, and there was no fee charged to patients using the service.

• The GPs discussed elderly patients who may be at risk of being vulnerable with multi-disciplinary teams including district nurses, social workers and local care coordinators, to ensure patient needs were met and referrals to other services were made promptly.

• All over 75s had a named GP for continuity of care. There were 227 patients aged 75 years and over, 75% of whom had been invited for annual health checks in the preceding 12 months as part of the chronic disease management recall system.

• Practice supplied data showed 55% of eligible patients were given flu vaccinations and these included patients over 65 years old.

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

• There were two GPs experienced in providing joint injections at the practice, with additional support provided by a GP with specialist training at their ‘sister practice’ Derby Road Health Centre, reducing the need to go to hospital for the service.

• The practice had good access for wheelchairs and height adjustable couches for patients who may need them.

• We saw evidence of collaborative working with the district nurses and community matrons, particularly for palliative patients using the Gold Standard Framework (GSF). The Nottinghamshire Electronic Palliative Care Co-ordination Systems (ePaCCs) register and Special Patient Notes were used to ensure effective communication between agencies including the Ambulance Service and out of hours GP service.

Updated 31 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 appointments after 5pm every day and telephone appointments. The practice opened until 8pm on Wednesdays.

• Online appointments services included booking and cancelling appointments, and ordering prescriptions. Additionally, there was a 24 hour automated telephone booking and cancelling of appointments service. Mobile phone text reminders were used for appointments, including the option to cancel an appointment via text.

• There was a full range of health promotion and screening information in the practice that reflects the needs for this population group. Services provided from the premises included phlebotomy, sexual health, dermatoscopy and minor surgery provided by the practice in-house at Derby Road Health Centre, and physiotherapy, smoking cessation, and counselling provided by commissioned services.

• The practice supported patients returning to work after illness through referrals to the Fit for Work service, with self-referrals encouraged. Practice supplied data indicated six patients had been referred by the practice to the service.

• The practice’s uptake for cervical screening for eligible patients was 88%, higher than the CCG average of 81% and the national average of 82%. Breast cancer screening was marginally lower than the CCG and national averages, and bowel cancer screening data was higher than the CCG and national averages. They were aware of their performance and offered more opportunistic testing to improve uptake rates.

• There were services tailored to the needs of younger patients. For example, the practice provided a meningitis vaccination for students going to university for the first time up to 25 years old, sexual health screening and C cards, which is a scheme for the provision of free condoms.

Updated 31 October 2016

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

• Data showed in 2014/15 there were 75% of patients diagnosed with severe mental health condition who had a comprehensive agreed care plan documented in their records in the last 12 months, compared to the CCG average of 84% and national average of 88% in 2014/15.

• In 2014/15, 56% of patients diagnosed with dementia had been reviewed in a face to face review in the preceding 12 months, compared to the CCG and national average of 84%. The practice had reviewed their patient lists and noted the majority of patients had reviews carried out but had not been coded appropriately on the computer system. Practice supplied data indicated this had improved to 69% in 2015/16.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. The practice carried out advance care planning for patients with dementia.

• There was a nominated dementia champion in the practice who had personal experience of caring for someone experiencing the condition. They offered support to patients and their carers about how to access various support groups and voluntary organisations. There were leaflets for mental health wellbeing support services available in the reception area.

• Staff had a good understanding of how to support people experiencing poor mental health, including young patients who may be at risk of self-harm and require urgent access to see the GPs. Patients were encouraged to self-refer to counselling services. Staff told us they routinely flag patients who have had recent poor mental health episodes and contact them for support.

• The practice had participated in a research project on young people at risk of harm, which involved local practices engaging in audits and peer discussions.

Updated 31 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 those with a learning disability. In addition to this register, there was a ‘Tender Loving Care’ list for people who needed extra support, for example, people at risk of harm due to illness and those newly diagnosed with cancer. Patients on this list had a code entered on their medical records to ensure all staff were aware of their needs. They were offered ‘open’ appointments to attend the practice whenever they felt they needed to see a healthcare professional, in addition to having a named GP or nurse who saw them on a regular basis.

• Practice supplied data indicated there were 22 patients on their learning disabilities register, and 15 had been reviewed in a face to face appointment in 2015/16.

• There were 6 patients registered with the practice who were resident in a local care home for people with learning disabilities. Feedback from one care home indicated a named GP carried out regular review visits and responded to urgent requests promptly when required to ensure continuity of care.

• The practice offered longer appointments for patients with a learning disability and for those who required it.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. Formal monthly multidisciplinary meetings were held to discuss patients at high risk of admission to hospital. In addition, palliative patients were reviewed at weekly GP meetings.

• 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.

• All staff had received training in domestic violence and one of the GPs had specialist training in drug misuse. They told us they informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff told us they were aware of how to access interpreting and text talk services for their patients with hearing impairment and there was a hearing loop in the practice. An interpreter could be arranged for those who could not speak in English through Language Line.

• Staff told us they were high referrers to a local social organisation which encourages social interaction to reduce isolation.

• The practice adapted their facilities to ensure they were accessible to disabled patients. Staff told us they were awarded a five-star rating for their access by an independent provider of access information for disabled people.

• The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 43 patients as carers (1.2% of the practice list).