Rivergreen Medical Centre

Updated 7 December 2016

Rivergreen Medical Centre provides primary medical services to approximately 8700 patients through a general medical services contract (GMS). This is a locally agreed contract with NHS England.

The practice was formed over 50 years ago and it is located in purpose built premises in the Clifton area of Nottingham, a large post war housing estate about four miles from the city centre. All facilities are on the ground floor including consulting and treatment rooms.

The level of deprivation within the practice population is above the national average with the practice falling into the second most deprived decile. The level of deprivation affecting older people is above the national average. The practice has higher than average numbers of patients over 65 years old. Numbers of young people is in line with local and national averages.

The clinical team includes four GP partners, a salaried GP (two female, three male), four practice nurses, and a healthcare assistant. The clinical team is supported by a practice business manager (managing partner), an assistant practice manager, reception and administrative staff. At the time of the inspection a pharmacist had just joined the practice team. The practice is a teaching practice for first year medical students.

The surgery is open from 8am to 6.30pm on Monday to Friday. There are morning and afternoon consulting clinics, with appointments starting at 8.20am up to 5.50pm each day.

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) and is accessed via 111.

Updated 7 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rivergreen Medical Centre on 28 September 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. Effective systems were in place to report, record and learn from significant events. Learning was shared with staff and external stakeholders where appropriate.

• Risks to patients were assessed and well managed. Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• GPs worked collaboratively with neighbouring practices in the area in forming a research hub and sharing a clinical pharmacist resource.

• The practice demonstrated a caring approach by holding a joint carers event with neighbouring practices to support the health and wellbeing of patients identified as carers in their community.

• Training was provided for staff which equipped them with the skills, knowledge and experience to deliver effective care and treatment.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Patients told us they were able to get an appointment with a GP when they needed one, with urgent appointments available on the same day.

• 100% of patients stated they had confidence in the last GP they saw or spoke to.

• The practice was awarded the ‘You’re Welcome’ status for meeting the criteria for young people friendly health services.

• 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 and learning from complaints was shared with staff and stakeholders.

• The practice had good facilities and was well equipped to treat patients and meet their needs. Services were designed to meet the needs of patients.

• 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. The partners held an annual business review meeting where all staff were involved, with a half yearly review.

We saw an outstanding feature:

• The practice was forward thinking in anticipating future models of care by taking the lead on local projects regarding new models of care and developing unique roles in the practice. They had employed a GP Support Officer to provide administration support and enable GPs to allocate more time to appointments.

However, there was an area where the provider should consider improvements:

• Review the system for monitoring emergency medicines kept in doctor’s bags to ensure the GPs carry in date medicines when they undertake home visits.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 December 2016

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

• Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance for chronic obstructive pulmonary disease related indicators was 97% which was 2% above the CCG average and 1% above the national average.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and were offered a structured annual review to check their health and medicines needs were being met.

• For patients with the most complex needs, practice staff worked with relevant health and care professionals to deliver a multidisciplinary package of care. Regular multidisciplinary meetings were hosted by the practice. The practice worked closely with the community trust employed care coordinator.

• Patients identified as having pre-diabetes were offered structured education courses as part of a diabetes prevention programme to improve outcomes for the patients.

• Telehealth services were offered, allowing patients to monitor their blood pressure readings at home and feedback their results to a clinician at their review appointments.

Updated 7 December 2016

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

• Systems were in place to identify children at risk. The practice had a child safeguarding lead and staff were aware of who they were.

• 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. The GP lead for safeguarding liaised with other health and care professionals to discuss children at risk.

• Immunisation rates were relatively high for all standard childhood immunisations and the practice worked with health visitors to follow up children who did not attend for immunisations.

• Relevant patients had access to a mother and baby group held locally on Thursday afternoons to help new mothers to exercise and socialise at the same time.

• The practice offered a range of contraception services including implants, with referrals to other providers offered for coil fittings.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals. The practice was awarded the ‘You’re Welcome’ status for meeting the criteria for young people friendly health services.
• The practice regularly engaged local students for work experience placements. There was a member of staff who joined the practice permanently after training with them as an apprentice.
• Urgent appointments were available on a daily basis to accommodate children who were unwell.

Updated 7 December 2016

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

• The practice had a significantly high elderly population with approximately 18% aged over 65 years, compared to the CCG average of 11%. They offered proactive, personalised care to meet the needs of the older people in their population. Regular multidisciplinary meetings were held to review frail patients and those at risk of hospital admission to plan and deliver care appropriate to their needs.

• The practice was responsive to the needs of older people, and offered GP and nurse home visits and urgent appointments for those with enhanced needs.

• Data from 2015/16 showed 72% of eligible patients aged over 65 years were given flu vaccinations. Pneumonia and shingles vaccinations were offered to eligible patients.

• All patients aged over 75 years old had a named GP for continuity of care.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure were in line with or above local and national averages.

Updated 7 December 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.

• Appointments could be made and cancelled online as well as management of repeat prescriptions. Patients were able to access their medical records and make administration enquiries online. Practice supplied data showed an average of 120 appointments per month were booked online.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• Uptake rates for screening were similar or better than the national average. For example, the uptake rate for cervical cancer screening in 2014/15 was 80%, which was in line with the CCG average of 77% and above the national average of 76%.

Updated 7 December 2016

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

• Data from 2015/16 showed the number of people with a complex mental health condition that had received a comprehensive care plan in the preceding 12 months was 86%, compared to the CCG average of 87% and the national average of 89%. This was with an exception rate of 14%, which was 3% above the local average and in line with the national average of 12%.

• The practice kept a record of all patients who had not attended an annual review and recorded the reasons why they did not attend or had not been invited.

• The number of patients with a diagnosis of dementia who had their care reviewed in a face-to-face review in the last 12 months was 73% which was 13% below the local average and 11% below the national average. This was achieved with an exception reporting rate of 4% in line with local and national rates.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• GPs told us they developed an integrated template for mental health reviews which incorporated physical checks, as part of a pilot scheme, to provide a holistic approach to patient care.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

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

Updated 7 December 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.

• There was a ‘special patient list’ held at reception for patients who were considered frail or unwell but not on the vulnerable patients register. Staff ensured they were offered appointments if they felt they needed to be seen by a clinician.

• There were 13 patients identified on the learning disabilities register in 2015/16, and 12 had attended a face to face review appointment.

• There were longer appointments for patients with a learning disability and for those who required it.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. Regular multidisciplinary meetings were hosted by the practice. In addition the practice held regular meetings to discuss patients on their palliative care register. There were 26 patients on the palliative care register.

• 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. In addition, all staff had undertaken training in domestic violence.