Southwell Medical Centre

Updated 20 February 2018

Southwell Medical Centre provides primary medical services to approximately 12,152 patients. The practice has a website giving information about the services it provides; www.southwellmedicalcentre.co.uk

The practice is registered with the Care Quality Commission to provide services at The Ropewalk, Southwell, Nottinghamshire NG25 0AL which we visited to carry out our inspection. The practice provides a dispensing service for registered patients who live more than one mile (1.6km) from their nearest pharmacy.

The overall practice population is similar to local CCG averages, although with a greater number of patients in the age ranges above 65 years and low levels of deprivation.

Updated 20 February 2018

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection 25 February 2015 – Good).

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students) – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) – Good

We carried out an announced comprehensive inspection at Southwell Medical Centre on 13 December 2017 as part of our inspection programme.

At this inspection we found:

• Some of the systems in place to support the appropriate and safe handling of medicinesrequired review and improvement.

• Significant events and incidents were appropriately identified, recorded and acted on. When any incidents happened, the practice learned from them, improved their processes and ensured staff relevant information was shared with staff.

• There was a consistent approach to quality and improvement within the practice, which brought about positive changes. This included using audits to help drive improvement and evidence of reflective learning as a result of these.

• End of life care was delivered in a coordinated way with detailed care plans in place to describe the needs and care arrangements for each of these patients and help ensure that their wishes were respected.

• The practice supported a nearby university campus and were very proactive in this. They encouraged new students to register as patients and liaised with the university student support team to ensure that they were aware of any particular health issues for this patient group.

• Patients felt staff were very professional, helpful and caring and could access appointments or other support from the practice when they needed to.

• Results from the latest national GP patient survey showed that the practice was in line with local and national averages across all questions about patient experience.

• There was strong clinical leadership which impacted positively upon the quality of the service.

• Staff throughout the practice felt well supported and able to raise any concerns. They had confidence that any worries they had would be listened to and acted on.

• The views and concerns of patients and staff were encouraged, heard and acted on to help improve services

• The practice had an active, well organised patient participation group (PPG) which played a key role in representing the views of patients and helping to improve the services offered by the practice.

The areas of practice where the provider should make improvement are;

• Implement the practice recruitment policy reliably so that all appropriate checks are completed when staff are recruited.

• Review arrangements for the receipt and review of all safety alerts to be able to demonstrate appropriate action is taken to protect patients from risk.

• Consider how to best support a greater proportion of patients with a learning disability to access an annual review of their health needs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 August 2015

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

Longer appointments and home visits were available when needed. All these patients had a named GP using the ‘usual doctor’ system and a structured annual review to check that their health and medication needs were being met. Nationally reported QOF data showed that the practice was performing above local and national averages for a range of long term conditions, for example;

• Asthma – 100% compared to CCG 98%– and National – 97% averages
• COPD– 100% compared to CCG 97% – and National – 95% averages

The practice provided a base for specialist nurse practitioners in specialities such as heart failure and diabetes. This enabled faster assessment and access to care for patients with the most complex needs.

Updated 13 August 2015

The practice is rated as good for the care of families, children and young people. Immunisation rates were higher than local and national averages for all standard childhood immunisations.

Patients we spoke with told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

Appointments were available at convenient times and the premises were suitable for children and babies, with a designated children’s waiting area. The practice was a base for midwives, health visitors and school nurses which enabled joint working, good communication and positive outcomes for patients.

GP partners attended safeguarding case conferences in person for children and families who may be at risk of harm and robust safeguarding and protection systems were in place.

Updated 13 August 2015

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

The practice population had a much higher percentage of older people than local and national averages. However nationally reported QOF data showed that outcomes for patients were good for conditions commonly found in older people when compared to local CCG and national averages. For example stroke (99.95 % compared to CCG and National figures of 97% and 95%) and heart failure (100% compared to CCG 100% and National 97%).

The practice provided personalised care to meet the needs of all patients including the older people in its population by using a ‘usual doctor’ system. This system involved one GP looking after their nominated patients. Patients were able to see any GP, but all tasks, results, secretarial work, follow ups and problems, were dealt with by the patient’s ‘usual doctor’ to ensure continuity of care.

Regular visits were carried out to three care homes and support and advice was provided to patients and staff. A range of enhanced services, for example, in dementia and end of life care were provided. The practice was responsive to the needs of older people, and offered home visits and longer appointments when required.

Updated 13 August 2015

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. For example the dispensary and administration offices were open on Saturday mornings to enable patients to collect prescriptions, medicines and test results if they could not attend the practice during the working week

Appointments and repeat prescriptions could be booked in person, via telephone or online via the practice website.

The practice had made efforts to ensure that students were aware of how access GP services by attending at the nearby university campus to advise students how best to use the practice. Additionally the practice had identified that due to its isolated rural location students living on this campus could experience poor mental health such as depression, isolation and stress. As a result they had developed strong links with the mental health support team to offer help advice and early intervention.

Updated 13 August 2015

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

Comments received from patients experiencing poor mental health praised the practice for the level of support and care offered. All of the 37 comment cards were positive about the approach practice staff had towards them. Several comments from patients experiencing mental ill health indicated how supportive the practice staff were.

Staff were aware of the Mental Capacity Act 2005, the Children Acts 1989 and 2004 and their duties in fulfilling it. All the clinical staff we spoke with understood the key parts of the legislation and were able to describe how they implemented it in their practice.

The practice was responsive to the needs of patients experiencing poor mental health. Priority access and longer appointments were available and the needs of students experiencing isolation and depression had been considered.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations including MIND and SANE. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

Updated 13 August 2015

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 those with a learning disability. Practice records showed that 37 patients were registered with a learning disability. Although not all patients were able to attend the practice, 13 had received a health check and a further 12 had received a medication review at the time of our inspection. Additional reviews were planned throughout the year.

The practice was responsive to the needs of vulnerable people. Patients with learning disabilities and those who may be anxious were given priority access to their appointment so they did not have to wait. A quiet room, away from the waiting area was also available for patients who may become anxious.

The practice provided caring and responsive medical care to a respite home for children and young people with physical and learning disabilities. Including GP's working late to ensure the residents had access to care and treatment when needed.

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