Archived: Clarence Road Surgery

Updated 4 July 2016

Clarence Road Surgery provides primary medical services to approximately 3,900 patients living in the Normanton, Peartree, Littleover, Sinfin, Sunnyhill, Mickleover, Stenson Fields and Heatherton areas of Derby. The practice population is culturally diverse with over 90% of patients fromAsian or Eastern European backgrounds. The common languages spoken are English (46%), Urdu (27%) and Punjabi (21%). Patients have access to an onsite translator for Urdu and Punjabi; and access to other languages such as Slovakian, Czech and Polish via interpreters.

Clarence Road Surgery is registered to provide: diagnostic and screening procedures; family planning; treatment of disease, disorder or injury; surgical procedures; and maternity & midwifery regulated activities from 63-65 Clarence Rd, Derby DE23 6LR.

The clinical team comprises two GP partners, a part-time practice nurse and an advanced nurse practitioner employed on an “ad hoc” basis. The two GPs deliver a total of 18 clinical sessions per week and patients have a choice of seeing a male or female doctor. Both of the GPs are multi-lingual, speaking Punjabi and Urdu. The non-clinical team includes a locum practice manager, an assistant practice manager and eight administrative / reception staff.

The practice is open between 8am and 6.30pm Monday to Wednesday, and 8am to 7.30pm Thursday and Friday. GP appointments are from 9am to 12pm every morning and 3pm to 6pm daily. Extended hours surgeries are offered between 6.30pm and 7.30pm on Thursday and Friday. A range of practice nurse clinic times are offered excluding Wednesday afternoon and all day Friday when no clinics are held.

The practice has opted out of providing out-of-hours services to their own patients. Information available on the website and on the practice answer phone advises patients to ring 111 outside of practice opening hours. Staff told us the out of hours service is provided by Derby Health United (DHU).

Updated 4 July 2016

We carried out an announced comprehensive inspection at Clarence Road Surgery on 22 September 2015. Overall the practice is rated as inadequate.

Specifically, we found the practice inadequate for providing safe and well-led services. Improvements were also required for providing effective and responsive services. The concerns which led to these ratings apply to all the population groups we inspected. The practice was good for providing caring services.

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

• Patients were at risk of harm because the systems and processes in place did not always ensure the safety of people using and / or accessing the service. For example, the premises had not been regularly maintained to protect people from harm and some of the identified actions to address concerns with infection control practices and health and safety had not been implemented.

• The practice premises did not have suitable facilities to treat patients and meet their needs.

• Staff understood and fulfilled their responsibilities to raise concerns and to report significant events and near misses. However, information about safety was not always recorded, monitored, appropriately reviewed and addressed.

• Most patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• Urgent appointments were usually available on the day they were requested. Some patients said they sometimes had to wait a long time for non-urgent appointments and that it was difficult to get through the practice when phoning to make an appointment in the morning.

• Nationally reported data showed most of the patient outcomes were comparable or above average locally and nationally.

• Clinical audits were driving improvements to patient outcomes.

• Non-clinical staff had received training that was appropriate to their roles and further training needs had been identified and planned.

• However, not all practice nurses were supported with formal supervision and appraisal.

• Information about services and how to complain was available and easy to understand.

• The practice had a virtual patient participation group in place. However engagement was limited to the practice survey, results and discussions around patient demand for appointments.

• The overarching governance framework in place did not always operate effectively or support the delivery of good quality care.

The areas where the provider must make improvements are:

• Ensure action is taken to address identified concerns related to the premises and infection prevention and control practices. This includes staff training, immunisation status and audits.

• Ensure formal governance arrangements are robust and implemented in practice. This includes systems for assessing and monitoring health and safety risks and the quality of the service provision.

• Ensure there is a clear vision, detailed and realistic strategy as well as leadership capacity to deliver all the improvements.

• Ensure all staff are supported with induction, supervision and appraisal.

• Ensure serial numbers are recorded for prescriptions kept in the doctor’s bag.

The areas where the provider should make improvement are:

• Ensure all staff undertaking chaperoning duties receive refresher training and are fully aware of their responsibilities.
• Improve processes for phone access and making non-urgent appointments.
• Ensure patient records are scanned and accessible from the electronic system in a timely way.

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 4 July 2016

The provider was rated as inadequate for safe and well-led and requires improvement for effective and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Nationally reported data showed 12 out of 20 clinical indicators for people with long-term conditions were at or above the local and national averages. This included care for diabetes, asthma, chronic kidney disease and stroke.

Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. GPs worked with relevant health and care professionals to deliver a multi-disciplinary package of care for people with the most complex needs. These patients were offered a structured annual review to check that their health and medication needs were being met.

Updated 4 July 2016

The provider was rated as inadequate for safe and well-led and requires improvement for effective and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

There were systems in place to identify and follow up children living in disadvantaged circumstances and those who were at risk, for example, children and young people who had a high number of accident and emergency (A&E) attendances. Immunisation rates were relatively high for all standard childhood immunisations.

We saw good examples of joint working with midwives and health visitors. Same day appointments were offered for children under the age of five or in need of urgent medical attention. Afternoon appointments were available outside of school hours.

Updated 4 July 2016

The provider was rated as inadequate for safe and well-led and requires improvement for effective and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The practice nurse’s treatment room was located upstairs and some of the older people we spoke with felt the premises were not suitable for their mobility. Longer appointments and home visits were available for older people when needed, and this was acknowledged positively in feedback from patients.

Nationally reported data showed that outcomes for conditions commonly found in older people were comparable to local and national averages. Staff had a good understanding of the needs of older people from the Asian population group. This included cultural and language differences and the support required in reading and understanding written information.

Updated 4 July 2016

The provider was rated as inadequate for safe and well-led and requires improvement for effective and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Some of the services offered by the practice had been adjusted to meet the needs of the working age population, those recently retired and students. For example, the practice offered online services as well as a full range of health promotion and screening that reflects the needs for this age group. However, screening rates for bowel and breast cancer were below the local and national averages.

• 67.6% of females aged 50 to 70 were screened for breast cancer in the last three years compared to a CCG average of 78.5% and national average of 72.2%.

• 35.2% of patients aged 60 to 69 were screened for bowel cancer in the last 2.5years compared to a CCG average of 61.4% and 58.3%.

The practice offered extended opening hours for appointments on Thursday and Friday, however patients could not book early morning appointments as the GPs started their consultations at 9am.

Updated 4 July 2016

The provider was rated as inadequate for safe and well-led and requires improvement for effective and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The practice regularly worked with the mental health and psychiatry teams in the case management of people experiencing poor mental health and those with dementia. Patients and their carers had access to various support groups and voluntary organisations. A system was in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

The data we reviewed indicated a variable performance in respect of patients experiencing poor mental health.

• Practice supplied data for 2015/16 showed 17 out of 21 (80.96%) patients experiencing poor mental health had a care plan in place and

• Nationally reported data showed the practice dementia diagnosis rate was 56.4%. This was below the CCG average of 95.6% and national average of 93.4%.

Eight out of 11 staff members had received training on the Mental Capacity Act and deprivation of liberty. 

Updated 4 July 2016

The provider was rated as inadequate for safe and well-led and requires improvement for effective and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The practice held a register of patients living in vulnerable circumstances including those with a learning disability. Twenty seven patients were on the learning disability register and they had all been offered an annual health check and longer appointments to complete them. Sixteen out of 27 patients (59.26%) had received a health check and had an action plan in place.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. Patients were told 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.