Castle Healthcare Practice

Updated 21 January 2016

Castle Healthcare Practice is a merger of Ludlow Hill Surgery, Trent Bridge Medical Practice, Compton Acres Medical Centre and Southview Surgery, which opened on 13 October 2014. It is located on Wilford Lane in West Bridgford, an area of Nottinghamshire.

A free bus service to the practice is available between 8am and 4.30pm Monday to Friday. This was funded by the practices as part of the development and relocation.

Services are provided from a purpose built primary care centre co-located with another GP practice, a (with an extended 100 hour licence) and physiotherapy service. There are also extended services co-located with Castle Healthcare Practice such as weekly access to an ultra-sound service, diabetic retinopathy, telephone dermatology and abdominal aortic aneurysm (AAA) screening.

The practice had a patient list size of 17642 at the time of our inspection. The practice holds a Personal Medical Services (PMS) contract to provide GP services which are commissioned by NHS England and Rushcliffe Clinical Commissioning Group (CCG).

The practice employs a total of 66 staff and the organisational structure includes:

• Three executive GP partners (management, financial and human resources)
• Seven GP partners, a salaried GP and a consultant in primary care.
• One nurse manager, two nurse prescribers, six nurses, three healthcare assistants and two phlebotomists.
• One business manager and a financial administrator
• One reception duty manager and a team of 17 receptionists
• A practice manager and IT systems manager
• A senior secretary and three secretaries
• Three members of staff undertaking note summarising and data entry; and an administrator.

Castle Healthcare Practice is a training practice and is accredited as research ready by the Royal College Of General Practitioners. There was one GP trainee placed at the time of our inspection.

The practice is open 8am to 8pm Monday to Friday, beyond its PMS and extended hours contracted commitment. Patients have access to GPs, nursing staff and the reception team during these hours.

Patients with urgent health care needs can access appointments on Saturday and Sunday mornings between 8.30am and 12.30pm. This service is provided from another local practice and Castle Healthcare practice participates in the CCG-led weekend service.

When the practice is closed patients are directed to the out of hours’ service provided by Nottingham Emergency Medical Services at (NEMS) via the 111 service.

Updated 21 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Castle Healthcare Practice on 22 September 2015. Overall the practice is rated as good.

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

• We inspected the practice within 11 months of being registered with the Care Quality Commission and found significant achievements had been made within a short time to provide a responsive and patient focused service.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. All opportunities for learning from internal and external incidents were maximised.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• Staff had the skills, knowledge and experience to deliver effective care and treatment.

• The practice used proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, they had a robust and patient focussed approach to reviewing the health needs of older people, patients on high risk medicines and people experiencing poor mental health.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet people’s needs.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Urgent appointments were usually available on the day they were requested. However, patient feedback was mixed in respect of telephone access, availability of routine appointments and waiting times.
• 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.
• The practice had excellent facilities and was well equipped to treat patients and meet their needs.
• Information about how to complain was available and easy to understand.
• The practice had a clear vision which had quality and safety as its top priority. The strategy and business plans to deliver this vision were regularly reviewed and discussed with staff.
• There was a clear leadership structure and staff felt supported by management. High standards were promoted across all roles.

An area of outstanding practice:

• The patient participation group promoted short walks on most Tuesdays leaving the surgery waiting area at 10.30am and again at 11.30am. This was aimed at promoting activity for people who may not otherwise go out for a walk alone and to create friendship opportunities.

However there were areas where the provider should make improvements:

• Improve multi-disciplinary working and communication to ensure patients receive timely and well-coordinated care.
• Improve processes for making appointments including the availability of non-urgent appointments and reducing waiting times.

• Take steps to improve the number of annual health checks undertaken for people with learning disabilities.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 21 January 2016

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

Nationally reported data showed outcomes for patients with long term conditions were mostly in line with and or above the local and national averages. This was achieved through:

• Effective systems in place to assess, review and monitor the outcomes for patients. The GPs and nursing staff had lead roles in chronic disease management and the monitoring of patient outcomes.

• Patients at risk of hospital admission were identified as a priority and suitable care planning arrangements were in place to reduce avoidable admissions.

• Regular and structured reviews were undertaken to check that patient’s health and needs were met and their medicines remain suitable. The named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care for people with the most complex needs. However, improvements to multi-disciplinary arrangements were required to ensure all patients received timely and coordinated care.

• Longer appointments and home visits were available when needed.

Updated 21 January 2016

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

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.

There were systems in place to safeguard children from abuse and to follow up children living in disadvantaged circumstances. Joint working arrangements were in place with midwives, health visitors and school nurses. However these needed to be strengthened to ensure effective communication and coordination of patients care. Immunisation rates were relatively high for all standard childhood immunisations.

The practice offered responsive services to young people. This included engagement with sixth form students at a local school, teenage immunisations and being signed up to the C-Card scheme. This scheme offers one to one consultation for young people aged 13 –24 to get free condoms and advice about sex and relationships.

One of the GPs also had a special interest in teenage health and worked as a school doctor and shared their expertise with staff. Another GP had initiated the Public Health adolescent strategy within the local area; and this included reducing obesity.

Updated 21 January 2016

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

The leadership of the practice had a thorough understanding of the needs of older people and were engaging this patient group and other stakeholders to improve the service. Specifically,

• One of the GP leads was the clinical commission group (CCG) lead for the enhanced care home service provision which aimed to improve the quality of care for older people by reducing unplanned admissions, ambulance transfers, length of inpatient stays and falls. Data reviewed showed positive outcomes had been achieved and this included reduced hospital admissions from nursing homes within the local area.

• The practice offered proactive, personalised care to meet the needs of the older people in its population. Weekly visits were carried out by dedicated GPs for three local care homes to ensure continuity of care. Joint visits were also undertaken with a pharmacist advisor to review the medication of the residents.

• Another GP was the CCG lead for frail elderly persons and within their role they had facilitated the implementation of the carer support service offered within the local area and joint working arrangements with the community geriatrician.

The practice offered proactive and personalised care to meet the needs of the older people in its population. Home visits and urgent appointments for patients with enhanced needs were available when needed. Patients aged 75 and over had a named GP.

Some areas requiring strengthening included:

• Outcomes for patients diagnosed with Osteoporosis. For example, 66.7% of people aged over 75 with a fragility fracture were being treated with a bone-sparing agent compared to a CCG average of 78.6% and national average of 79.3%.

Updated 21 January 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

A strong feature of the practice was the strategic work related to health and well-being. For example, one of the GP executive partners was the clinical commissioning group (CCG) lead for the health and wellbeing board and a member of the obesity steering group. They had contributed to the design of referral forms for patients to receive support with weight management; and these were used by GPs within the CCG area.

The practice was instrumental in the establishment of this service which is commissioned by Public Health. The practice had referred 120 patients to date and 368 patients were receiving the weight management services within Nottinghamshire.

The patient participation group (PPG) also promoted short walks on most Tuesdays leaving the surgery waiting area at 10.30am and again at 11.30am. This was aimed at promoting activity for people who may not otherwise go out for a walk alone and to create friendship opportunities.

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. For example,

• patients could access appointments and telephone consultations between 8am and 8pm Monday to Friday; and urgent appointments on a Saturday and Sunday morning from another local practice.

• engagement with patients via text messaging with their consent and

• access to both female and male GPs.

The practice was proactive in offering online services and this included booking appointments and ordering repeat prescriptions. A full range of health checks, screening programmes and health promotion advice was offered.

Updated 21 January 2016

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

The practice regularly worked with multi-disciplinary teams in the case management and care planning of people experiencing poor mental health and those with dementia. Patients and or their carers were informed about how to access various support groups and voluntary organisations.

The practice had 148 patients listed on their dementia register. Data showed 85.2% of people had their care reviewed in a face to face meeting within the last 12 months.

A system was in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

Robust systems were in place for the in house drug monitoring of high risk medicines such as lithium and clozapine. The practice had lower than local average rates for anti-depressant prescribing.

Staff had a good understanding of how to support people with mental health needs and dementia. They were supported by one of the GP partners who was the clinical commissioning group lead for mental health. They had a strategic overview of local mental health service provision and led on development work to improve patient care.

Updated 21 January 2016

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

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. The practice worked with multi-disciplinary teams in the case management of vulnerable people; and improvements were needed to improve communication and coordination of care.

The practice held a register of patients living in vulnerable circumstances including those with a learning disability and patients receiving palliative care. It offered annual health checks for people with a learning disability. However, follow-up of these patients needed strengthening to ensure attendance.

The practice premises were new and purpose built with reasonable adjustments made for people with disabilities and impairments. For example, braille signage, hearing loop; automated doors and adjustable beds. Vulnerable patients had access to information on various support groups and voluntary organisations.