Archived: Acorn Medical Practice

Updated 25 July 2016

Acorn Medical Practice is a single handed GP practice and provides primary medical services to approximately 2,814 patients through a general medical services contract (GMS). The current GP took sole responsibility for the practice as from 31 October 2015.

The practice is located in purpose built premises near to Mansfield city centre. There are car parking facilities and the practice is accessible by public transport. The level of deprivation within the practice population is above the national average. The practice is in the third most deprived decile meaning that it has a higher proportion of people living there who are classed as deprived than most areas.

The clinical team comprises one male GP, an advanced nurse practitioner (works only on Fridays), a practice nurse and a healthcare assistant. The clinical team is supported by a full time practice manager, a business supervisor, a team of four reception and administrative staff and a cleaner.

The practice opens from 8am to 6.30pm Monday to Friday; with the exception of Wednesday when the practice closes at 5pm or 12pm due to staff protected learning time. GP appointments including telephone consultations were typically available from 9am to 1pm and 3pm to 5.30pm. Extended hours were offered from 7.30am on a Thursday morning.

The practice has opted out of providing out-of-hours services to its own patients. This service is provided by Derby Health United.

Updated 25 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Acorn Medical Practice on 17 May 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 within the practice. A system was in place for acting on patient safety alerts and we found significant events were reported, recorded and investigated.

• Most risks to patients were assessed and well managed. Immediate action was taken to mitigate risks related to the management of medicines.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had received relevant training to provide them with the skills, knowledge and experience to deliver effective care and treatment.

• Most patients expressed a high level of satisfaction about the care and services they received. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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.
• There was a clear leadership structure and staff were engaged in developing the practice ethos and how it was run. Staff felt supported by management.
• The practice had a patient participation group which was actively involved in patient education, fundraising activities and improvement work in liaison with practice staff.

The areas where the provider should make improvement are:

• Ensure carers continue to be proactively identified and supported by way of information and regular health reviews.

• Ensure the systems in place for recalling and reviewing patients continue to be strengthened to improve patient outcomes. This also includes performance indicators for mental health, depression, dementia and some long term conditions.

• Ensure the management of medicines is regularly reviewed and robust.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 July 2016

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

• Performance data showed clinical outcomes for patients was in line or marginally lower for most long term conditions when compared with local and national averages. The practice had identified areas for improvement and this included monitoring and management of patients with diabetes.

• The practice maintained registers of patients with a range of long term conditions. These patients were offered a structured six monthly or annual review to check that their health and medicines needs were being met. Recall systems had been strengthened to ensure patients attended.

• For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multi-disciplinary package of care. This included working closely with community based specialist nurses in diabetes, respiratory conditions and heart failure.

• Staff had the knowledge, skills and competencies to respond to the needs of patients.

• The practice was engaged with the avoiding unplanned admissions enhanced service and patients at risk of hospital admission were identified as a priority.

• Patients could access home visits, longer or same day urgent appointments when needed.

Updated 25 July 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 need and at risk of abuse. This included regular safeguarding meetings held with the health visitor, GP, practice nurse and practice manager.

• Immunisation rates were relatively high for all standard childhood immunisations.

• 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.

• Same day urgent appointments were available for children who were unwell. Appointments were available outside of school hours and the premises were suitable for children and babies.

• There was a good working relationship with the health visitor and midwife attached to the practice. Mothers had access to ante-natal and post-natal care.

Updated 25 July 2016

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

• All patients over the age of 75 years had a named GP.

• Influenza, pneumococcal and shingles vaccinations were offered (where necessary) in accordance with national guidance.

• Home visits to patients in their own homes or care homes were carried out when requested.

• Monthly multi-disciplinary care meetings were held to avoid hospital admission and ensure integrated care for older people with complex health care needs.

• Nationally reported data showed most patient outcomes for conditions commonly found in older people, including rheumatoid arthritis and heart failure were above local and national averages. Lower outcomes were achieved for osteoporosis with a value of 66.7% compared to a CCG average of 74.6% and national average of 81.4%.

Updated 25 July 2016

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

• The practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. For example, extended hours were offered on a Thursday morning from 7.30am with the GP, practice nurse and health care assistant.

• Patients could access telephone consultations and online services to book appointments, request prescriptions and view some personal information.

• A full range of health promotion and screening that reflects the needs for this age group was offered. Measures were in place to increase the uptake of NHS health checks for patients aged 40 to 74 and patients eligible for the bowel and breast cancer screening.

• Family planning services were provided for women of working age.

• Minor surgery, phlebotomy services and diagnostic tests that reflected the needs of this age group were carried out at the practice.

Updated 25 July 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 of patients experiencing poor mental health, including those with dementia. For example, the mental health crisis team and the child and adolescent mental health services.

• Practice supplied data for 2015/16 showed the overall achievement for clinical indicators related to dementia, depression and mental health were lower than the 2014/15 published data for the practice; as well the local and national averages.

• Patients experiencing poor mental health could access a range of information on 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.

• Practice staff were scheduled to attend dementia friend training in May 2016 to ensure they had a good understanding of how to support these patients.

Updated 25 July 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 those with a learning disability.

• Annual health check-ups and longer appointments were offered for patients with a learning disability and for those who required it.

• The practice worked closely with other health care professionals in the case management of vulnerable patients and patients receiving end of life care. Monthly multi-disciplinary and gold standards framework meetings were hosted by the practice.

• 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.