Eastwood Primary Care Centre

Updated 23 September 2016

Dr Exley and Partners, also known as Church Street Medical Centre, provides primary medical services to approximately 8,355 patients through a general medical services (GMS) contract, this is a nationally agreed contract with NHS England.

Services were provided from a surgery located in purpose built premises in the heart of Eastwood, at 11b Church Street, Eastwood, Nottingham NG16 3BS. The main surgery has car parking, parking for the disabled and is accessible by public transport. All consulting rooms are on the ground floor.

The practice has a higher number of registered patients aged over 65. For example, 23.8% of the practice populations are aged 65 and above, compared to the CCG average of 20.4%, and the national average of 17.1%.The level of deprivation within the practice population is in line with the national average. Income deprivation affecting children and older people is slightly above the local average, however in line with national averages.

The clinical team comprises of six GP partners (three male and three female), two practice nurses, a health care assistant and dispensary staff. The clinical team is supported by a reception manager and a range of reception and administrative staff.

The practice may dispense medicines to patients who live more than one mile from the nearest pharmacy. We inspected the dispensing service as part of this inspection.

The practice is an accredited training practice for GP registrars. At the time of the inspection there were three 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 on Monday to Friday. In addition the practice opens at 7am on a Wednesday for early appointments. Consulting times are from 8.30am to 12.30pm and from 4.30pm to 6pm Monday to Friday.

The practice has opted out of providing out-of-hours services to its own patients. This service is provided by Nottingham Emergency Medical Services (NEMS).

Updated 23 September 2016

Letter from the Chief Inspector of General Practice

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

• The practice demonstrated an open and transparent approach to safety. There were systems in place to enable staff to report and record significant events. Learning from significant events was shared with relevant staff.

• 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 was provided for staff to ensure they had the skills and knowledge required to deliver effective care and treatment for patients.
• Regular clinical audits were undertaken within the practice to drive improvement and future audits planned on identified needs.
• 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 and that staff would always accommodate them where possible.
• 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.

We saw areas of outstanding practice which included

• Patients were treated as active partners in their care. Staff overcame obstacles to deliver a high level of care for example; staff were proactive in identifying and supporting carers and had established a local network with monthly meetings to reduce isolation. This had developed into a carer’s community involving carers from outside the practice and led by the carers champion through meetings, development of a website and close working with the carer’s federation to develop the support available.

• The management team used innovative methods to audit the way the practice was run. This ensured the service was constantly improved and the effectiveness of the practice challenged to ensure this had a positive impact. Feedback and changes were reviewed by the staff as group to ensure full involvement.This had led to greater ownership of the practice amongst staff who told us they felt very much involved in the development of the practice and empowered to suggest and drive change as a team.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 September 2016

The practice is rated as outstanding 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 stroke related indicators was 100% which was 2% above the CCG average and 3% above the national average. The exception reporting rate for stroke related indicators was 7.8% which was slightly below the CCG average of 8.2% and the national average of 9.7%.

• 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 more complex needs, the named GP worked with relevant health and social care professionals to deliver a multidisciplinary package of care. The practice worked closely with the community care coordinator to ensure support was in place for patients who required it.

Updated 23 September 2016

The practice is rated as outstanding 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 a deputy lead and staff were aware of who these were.

• We saw positive examples of joint working with midwives, health visitors and school nurses with regular meetings being held to discuss children at risk.

• Extended hours appointments were offered one morning a week, to ensure appointments were available outside of school hours.

• A full range of contraception services were available including coil fitting and contraceptive implants.

• There were cleanable toys in reception and a private area available for breast feeding if required.

• Vaccination rates for childhood immunisations were above local averages.

Updated 23 September 2016

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

• Each patient residing in a residential or care home had a printed copy of a summery care record kept locked away with care plans which helped with assessments from out of hours and ambulance service staff. This was updated regularly to ensure its usefulness.

• 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 provided for older people as required.

• The practice worked closely with community teams and charities to ensure there was good provision of care and support was in place when needed.

Carers were well supported and events organised to ensure there was a forum to reduce isolation in their role.

Updated 23 September 2016

The practice is rated as outstanding 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 one morning a week 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.

• The practice took a number of steps to ensure working age people received appropriate screening including offering cervical screening during extended hours and seeking direct patient feedback on screening to make the recall systems more effective.

• The practice’s uptake for the cervical screening programme was 84%, which was above the CCG average of 78% and slightly above the national average of 82%.

• 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 23 September 2016

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

• Performance for mental health related indicators was 100% which was 1.6% above the CCG average and 7.2% above the national average. The exception reporting rate for mental health related indicators was 7% which was below the CCG average of 11% and the national average of 11%.

• The dispensary team provided weekly medication dosettes to patients with memory problems to increase compliance with their medicines.

• A system was in place to monitor patients with poor mental health, ensuring they requested prescriptions regularly and if an order has not been made within a week their normal GP was tasked to follow them up.

• The practice encouraged the use of online resources for these patients which included Mood Gym, Living Life to the Full and Mindless.

• Monthly multidisciplinary meetings were held within the practice to ensure the needs of these patients were being met.

• The practice had a system in place to follow up patients who had attended A&E who may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 23 September 2016

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

• All staff had received domestic violence training from ‘Identify and Referral to Improve Service’ (IRIS) who were able to utilise a room to see patients experiencing domestic violence to improve the likelihood of engagement with the service.

• The practice saw a high number of patients with substance misuse problems. One of the GPs had a special interest in this area and continued to provide support and refer to appropriate services when needed.

• The standard of care provided to patients whose circumstances may make them vulnerable was reviewed through questionnaires and audits to ensure it was as effective as possible.

• In order to effectively support vulnerable patients, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• 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 offered longer appointments for patients with a learning disability where required.

Information was available which informed vulnerable patients about how to access local and national support groups and voluntary organisations.