Archived: Haven Medical Centre

Updated 6 June 2016

Haven Medical Centre is located in Osmaston, Derby. DE24 8GT. The current site was formed following the merger of two practices in July 2011 and currently has over 11,000 patients. The main site is situated on Osmaston Roadwith a branch surgery at Keldholme Lane in Alvaston. Patients are able to attend either one of the locations, however, as bus routes between the two sites are difficult, most patients tend to make most use of the site nearest to where they live.

Both surgeries have a bus stop near to the site and a small car park.

The practice currently has a list size of approximately 11,500 patients and holds a General Medical Services (GMS) contract which is a contract between general practices and NHS England for delivering primary care services to local communities. The practice provides GP services commissioned by NHS Southern Derbyshire Clinical Commissioning Group.(CCG)

The practice is situated in an area of very high socio-economic deprivation, and an income deprivation affecting children and older people which is significantly higher than the national average. It has a population of babies and children under the age of 18 which is significantly higher than the national average and the number of working aged people who are unemployed is twice the CCG and national averages.

The practice displays a mission statement informing people that they are committed to providing high quality, evidence-based patient care in a caring and supportive environment. Staff are enthusiastic about their work being patient centred and the practice values team work.

There are two GP partners, both male and three salaried GPs, two female and one male. There is a large nursing team consisting of two advanced nurse practitioners, two practice nurses, one health care assistant and one health care support worker.

The clinical team is supported by the community clinical team, including a community matron, health visitor, midwives, district nurse, MacMillan nurse, practice pharmacist and a care coordinator.

The practice is supported by a practice manager, assistant practice manager and a team of administration and reception staff.

The practice is open between 8am and 6.30pm Monday to Friday and an extended opening time on Mondays until 8pm.

Appointments are available at the main site in Osmaston road from 8.30 until 6.30 each day and has an extended hours clinic on Mondays until 8pm.

Appointments are available at the branch surgery in Keldholme Lane from 8am to 6.30pm each day and has an extended hours clinic on Mondays until 8pm.

When the surgery is closed, patients are directed to the out of hours service via the 111 telephone service. Details can be found on the practice’s website.

Updated 6 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Haven Medical Centre on 19 April 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. Learning from events and safety incidents was shared with practice staff.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. The practice was committed to staff training and development and the practice team had the skills, knowledge and experience to deliver high quality care and effective treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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 were able to make an appointment with a GP or nurse for the following week, but that it was often difficult to make an appointment with their preferred GP. Urgent appointments were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• There was an active Patient participation Group (PPG) which liaised regularly with the practice to make improvements.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• The practice should ensure that their processes for storing prescription pads is adhered to and monitored.
• The practice should proactively encourage relevant patients to attend for bowel cancer screening so that uptake is in line with CCG and national averages.
• The practice should be proactive in identifying patients who are also carers

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 June 2016

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

• The practice was committed in supporting the training of clinical staff to deliver chronic disease management and was supporting a nurse to complete a nurse prescribing course. Nursing staff had lead roles in chronic disease management and were supported by the GPs to provide structured annual reviews which incorporated a medicines review and advanced care planning where required. More frequent reviews were provided for those who needed this. There was a dedicated administrator who contacted patients who failed to attend for their appointment. 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.
• QOF achievements for clinical indicators relating to chronic disease were higher than CCG and national averages. For example, the practice achieved 95% for diabetes related indicators, which was above the local and national averages of 93% and 89% respectively. However, exception reporting was 18% which was 5% higher than the CCG average and 8% higher than the national average. The practice told us that patients whose condition was poorly controlled were being cared for by a local provider which meant that those patients did not attend for regular checks at the practice. These were included in the exception figures.
• They had provided influenza vaccination for 97% of people with diabetes compared to the national average which was 94%.
• 94% of patients with diabetes had had a foot examination in the preceding year which was higher than the national average of 88%
• The practice proactively carried out audits of blood test results and medicine usage to identify patients who may be at risk of developing a chronic disease. Patients who had been identified as being at risk of developing a cardiovascular disease (CVD) were regularly monitored. Telephone advice was provided regarding lifestyle and diet to help prevent long term conditions developing.
• Longer appointments and home visits were available when needed.
• Uptake for cancer screening was lower than the CCG and national averages, whilst the number of newly diagnoses cases was similar to both CCG and national averages. However, the practice held a weekly clinical meeting where they discussed any new cancer diagnoses.

Updated 6 June 2016

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

• 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.
• Immunisation rates were relatively high for all standard childhood immunisations. For example; attendance for under 24 months ranged between 96% and 99%. Where a child has not attended, the parents are contacted by a health visitor.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• Appointments were available outside of school hours and the premises were suitable for children and babies. A protocol was in place that ensued that all children requesting an appointment were seen by a clinician on the day.
• We saw positive examples of joint working with midwives, health visitors and school nurses. Regular meetings were held to discuss families requiring extra support.
• Antenatal clinics were held three days per week over both sites and postnatal checks were provided for new mothers which included advice on contraception.
• There was an advanced nurse practitioner ( ANP) who provided contraceptive advice and implanon (contraceptive implant) surgeries in-house for patients. There were plans for the ANP to complete a refresher course on IUCD fitting (contraceptive coil) to increase the capacity to deliver this service.
• There was an in -house triage protocol that had been developed for all patients and had an additional section for ‘red flag’ symptoms for children. This was to support the reception team in identifying urgency of an appointment. Reception team had also undergone Patient In Need training.

Updated 6 June 2016

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

• The practice had higher disease prevalence and higher levels of deprivation affecting their older population. The practice was aware of this and adjusted their services to account for the increased demand for this population.
• The practice cared for 53 patients in two nursing homes where they provided weekly ward rounds for acute and routine reviews of patients. All new patients admitted to the homes were reviewed within one week of registering at the surgery.
• The practice used The Gold Standards Framework (GSF) to plan care for older patients at the end of their life. (GSF is a model that enables good practice to be available to all people nearing the end of their lives, irrespective of diagnosis.) Meetings took place on a quarterly basis with community support services, including District Nurses, Community Matrons, Macmillan Nurse, Care Coordinator and Nursing home managers to plan and monitor care. The care co-ordinator tracked patients who had been discharged from hospital to plan their care and co-ordinate services including referral to social care, and voluntary services when required.
• The practice used RightCare plans to provide clear information on individual needs which were shared with out of hours’ services and other agencies so that care could be coordinated and this helped to reduce the number of unnecessary hospital admissions. The RightCare plans were reviewed annually as a minimum.
• The practice worked with the CCG pharmacist to review patients medicines and an appointment was arranged annually with a GP for those who were taking more than eight medicines concurrently.
• All people over 75 had a named GP and routine home visits were provided for housebound patients where required.

Updated 6 June 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.
• Extended hours surgeries were available and telephone advice via the on call clinician each day during for people who were unable to attend during the usual opening hours.
• Patients were also able to view their records online and contact the surgery via email.
• The practice was proactive in offering online services for booking and cancelling appointments and for requesting repeat prescriptions.
• A full range of health promotion and screening was available that reflects the needs for this age group. For example, there was information regarding breast screening and bowel screening. Health information leaflets were also available for patients to read.
• Cervical cancer screening had been performed for 81% of eligible women which was 3% below the CCG average and the same as the national average. Exception reporting was 4%.
• There was a surgery newsletter that kept people up to date with surgery improvements and news.

Updated 6 June 2016

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

The practice had a population whereby 0.7% of the population had a diagnosis of dementia. Many of these were patients in two local care homes affiliated to the practice which specialised in caring for people with dementia.

• 86% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the CCG average and 2% higher than the national average.
• The practice had a high number of patients receiving care and treatment for complex mental health disorders including alcohol and substance misuse. They had achieved 100% of their QOF points in mental health related indicators which was 3% better than the CCG average and 7% better than the national average, however, the exception reporting across these indicators was 17%. This was the same as the CCG average and 6% higher than the national average.
• 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, taking account of their best interests, and included carers where relevant.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• 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 6 June 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 homeless people, those with a learning disability and those with a mental health condition or dementia, carers and people who were receiving palliative care. All vulnerable people on their registers were invited for an annual health check, apart from those who were receiving palliative care, who were reviewed more frequently as required.
• The practice offered longer appointments for patients with a learning disability, those with a mental health condition and others who required this.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients. Meetings were held quarterly with the multi-disciplinary team which was led by the care coordinator to review patients progress and to enable continuity of care.
• The practice informed vulnerable patients 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. Patients records alerted staff to when a patient was at risk. The practice had a high number of patients on their at-risk register.