Millview Surgery

Updated 4 July 2016

Millview Surgery provides primary medical services to approximately 8300 patients through a personal medical services contract (PMS).

The practice is located in purpose built premises close to Mansfield town centre. The practice has car parking, parking for the disabled and is accessible by public transport.

The level of deprivation within the practice population is above the national average. Income deprivation affecting children and older people is similar to the national average.

The clinical team comprises six GP partners (three male and three female), three practice nurses, and two healthcare assistants. The clinical team is supported by a full time practice manager, a reception manager, an IT coordinator and a team of reception and administrative staff.

The practice is an accredited training practice for GP registrars and Foundation Year Two doctors. At the time of the inspection there were two GP registrars working in the practice. (A GP registrar is a qualified doctor who is training to become a GP through a period of working and training in a practice).

The surgery opens from 8am to 6.30pm Monday to Friday. Consulting times are from 8.30am to 11.30am each morning and from 3pm to 6pm each afternoon. Extended hours appointments were offered most mornings from 7am to 8am. The practice closed one afternoon per month for staff training.

The practice has opted out of providing out-of-hours services to its own patients. This service is provided by Central Nottinghamshire Clinical Services (CNCS) and is accessed via 111.

Updated 4 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Millview Surgery on 5 May 2016. Overall the practice is rated as good.

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

• The practice demonstrated an open and transparent approach to safety. There were robust systems in place to enable staff to report and record significant events. Learning from significant events was shared widely.
• Risks to patients were assessed and well managed. There were arrangements in place to review risks on an ongoing basis to ensure patients and staff were kept safe.
• Staff delivered care and treatment in line with evidence based guidance and local guidelines. Training had been provided for staff to ensure they had the skills and knowledge required to deliver effective care and treatment for patients.
• There was a demonstrated understanding of performance within the practice. Systems were in place to support staff in undertaking regular clinical audits. Clinical audits were relevant to recent training, significant events and new guidelines.
• Feedback from patients was that they were treated with kindness, dignity and respect and were involved in decisions about their care.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they generally found it easy to make an urgent appointment but that they sometimes had to wait to see a named GP.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Adjustments had been made to the premises to ensure these were suitable for patients with a disability.
• There was a clear leadership structure which all staff were aware of. Staff told us they felt supported by the partners and management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

There was one area where the provider should make improvements:

• The provider should ensure that there are robust systems in place to record action taken in response to medicines and patient safety alerts received into the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 July 2016

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

• Clinical staff had lead roles in managing patients with long-term conditions and those patients identified as being at risk of admission to hospital were identified as a priority.
• Performance for diabetes related indicators was 90.8% which was 9.2% above the CCG average and 1.6% above the national average. The exception reporting rate for diabetes indicators was 11.6% which was in line with the CCG average of 11.8% and the national average of 10.8%.
• Longer appointments and home visits were available when needed to facilitate access for these patients.
• All these patients had a named GP and were offered regular reviews to check their health and medicines needs were being met.
• For patients with the most complex needs, the named GP worked with relevant health and social care professionals to deliver a multidisciplinary package of care. In addition to formal multidisciplinary meetings being held on a monthly basis, the practice hosted smaller multidisciplinary meetings on a weekly basis to ensure they maintained oversight of vulnerable patients.

Updated 4 July 2016

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

• Systems were in place to identify children at risk. The practice had a dedicated child safeguarding lead and staff were aware of who this was. We saw positive examples of joint working with midwives, health visitors and school nurses.
• Extended hours appointments were regularly offered from 7am to 8am to ensure appointments were available outside of school hours.
• Vaccination rates for childhood immunisations were in line with or above local averages.

Updated 4 July 2016

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

• Personalised care was offered by the practice to meet the needs of its older population. The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. Longer appointments were also provided for older people on request.
• Services were provided to a number of older people in nursing homes. We spoke with managers from two nursing homes who were positive about the level of care provided by the practice.
• Nursing staff undertook home visits to elderly housebound patients to ensure they received chronic disease reviews, annual flu and shingles vaccinations and anticoagulation services.

Updated 4 July 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 offered services which were accessible and flexible. For example extended hours appointments were offered most days from 7am to 8am to facilitate access for working patients.
• The practice was proactive in offering online services including appointment booking and online prescription services.
• A range of health promotion and screening services were offered and promoted that reflected the needs of this age group. Uptake rates for cervical cancer screening, bowel cancer screening and breast cancer screening were above local and national averages.
• Fitting of coils and contraceptive implants was offered at the practice.
• A range of services were offered at the practice to facilitate patient access including minor surgery and joint injections.
• Text messaging was used to confirm appointments and issue reminders.

Updated 4 July 2016

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

• Performance for mental health related indicators was 99% which was 7.9% above the CCG average and 6.2% above the national average. The exception reporting rate for mental health related indicators was 15.2% which was in line with the CCG average of 14.9% and above the national average of 11.1%.
• 87% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was 3.7% above the CCG average and 3% above the national average. This exception reporting rate for this indicator was 18.2% which was above the CCG average of 8.4% and the national average of 8.3%.
• Weekly and monthly multidisciplinary meetings were held within the practice to ensure the needs of these patients were being met.
• Feedback from local nursing homes who cared for patients with dementia was positive and aligned with our findings.
• 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 4 July 2016

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

• The practice added flags to the records of patients living in vulnerable circumstances including homeless people and those with a learning disability.
• Homeless people and those living in the vulnerable circumstances were registered with the practice. For example, the practice provided services to all women and their families who were resident at a local refuge.
• The practice offered longer appointments for patients with a learning disability and had adapted their appointment structure for learning disability reviews to enable input from a GP and the practice nurse. This, in conjunction with adapted written communications, had resulted in the practice completing learning disability health checks for 91% of its eligible patients.
• Information was available which informed vulnerable patients about how to access local and national support groups and voluntary organisations. In addition the practice participation group (PPG) was arranging a wellbeing event which would be attended by a range of local organisations.
• Translation services were provided where these were required and various pieces of information and signage were available in more than one language.
• In order to effectively support vulnerable patients, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care. In addition to formal multidisciplinary meetings being held on a monthly basis, the practice hosted smaller multidisciplinary meetings on a weekly basis to ensure they maintained oversight of vulnerable patients.
• 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. Safeguarding concerns were regularly discussed at the weekly multidisciplinary meetings.