West Hallam Medical Centre

Updated 4 October 2016

West Hallam Medical Centre is located in West Hallam, a large village close to Ilkeston in the County of Derbyshire. There are local bus routes into the village and the surrounding areas. Parking is available on site and free public parking within close walking distance of the practice.

The practice currently has a list size of approximately 4850 patients.

The practice holds a General Medical Services (GMS) contract which is a locally agreed contract between NHS England and a GP to deliver care to the public. The practice provides GP services commissioned by NHS Southern Derbyshire CCG.

The practice is situated in an area with very low levels of deprivation. It has a higher than national average adult population who are of working age and retired. A higher number of those of working age registered at the practice are employed or in full time education compared with the local CCG average. There are less younger people registered at the practice than the national average.

The practice is managed by two partners. One is a GP (male) who works on a full time basis and one is the managing partner (male) who also works on a full time basis. The practice also has three salaried GPs (female) who work part time. They are supported by clinical staff; a trainee advanced nurse practitioner (female), nurse manager who is an independent prescriber (female), practice nurse and two healthcare assistants (females). The practice has a pharmacy on site and employs a dispensary manager and two dispensing assistants. The practice also employ a team of reception, clerical and administrative staff.

The practice is open on Monday, Tuesday, Thursday and Friday from 8am to 6.30pm. On Wednesdays, the practice is open from 8am to 8.30pm. Appointments are available Monday, Tuesday, Thursday and Friday from 8am to 6.30pm. On Wednesdays, appointments are available from 8am to 8.30pm. The practice is closed during weekends.

The practice has opted out of providing GP services to patients out of hours such as nights and weekends. During these times GP services are currently provided by Derbyshire Health United.

Updated 4 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at West Hallam Medical Centre on 28 June 2016. Overall the practice is rated as outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents. All opportunities for learning from 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. Clinical audit drove quality improvement in all areas of activity. Staff had the skills, knowledge and experience to deliver effective care and treatment.

• Resources were deployed to ensure individual patient healthcare needs were optimised. Data showed that the practice was performing highly when compared to practices nationally.

• Patient feedback regarding care and treatment received was consistently positive.

• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. The practice was involved in a new ways of working project, aimed at maximising GP time and efficiency.
• The practice had strong and visible clinical and managerial leadership and governance arrangements. Staff were passionate about their roles and responsibilities, they felt valued within the practice and feedback regarding leadership was consistently positive.

We saw areas of outstanding practice including:

Data which included Quality and Outcomes Framework (QOF) showed the practice consistently achieved high results across the areas of practice. These included those with long term conditions, older people and patients who had a learning disability. The practice did not exception report in some areas of practice or it was low when compared to CCG and national averages.

The practice proactively engaged with their patient population and understood their individual needs and requirements. This was demonstrated in quality monitoring activities such as a mental health audit and the identification of a large number of patients who had carers responsibilities.

The practice had introduced a new model of care in the delivery of its services which represented a move away from traditional GP led care. Staff with specialist skills had been recruited or upskilled within the practice. Patient health care needs were optimised by alignment with staff skill set and expertise. Patients, including those with long term conditions had benefitted from this new model of working and outcomes were evident. These included an increase in reviews being undertaken in 2015/16 for those patients with long term conditions.

Data showed that the practice’s emergency hospital admissions had continually decreased from March 2013 to February 2016. The practice had the lowest number of emergency admissions by locality across 18 practices within the CCG.

The practice worked in collaboration with four local practices on a project to drive improvement in care for older people and reduce emergency admissions from care homes. This had resulted in an 8% reduction in emergency admissions in the preceding 12 months.

However there was an area of practice where the provider should make improvement:

• Consider whether dispensing ‘near misses’ should be recorded and a system put in place to learn lessons from these events.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 October 2016

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

• National data showed the practice was performing in line with the local CCG average for its achievement within eleven diabetes indicators.The practice achieved92% of the available QOF points compared with the CCG average of 93%. Achievement was above the national average of 89%.

• 100% of patients with chronic obstructive pulmonary disease (COPD) had received a confirmed diagnosis. This was above the CCG average of 92% and national average of 90%. None of these patients had been exception reported. The CCG exception reporting average was 11.5% and national average was 9.8%.

• The practice had 2,153 patients with chronic diseases registered. All these patients were offered a structured annual review to check their health and medicines needs were being met.

• The practice had adopted a new recall system and new model of working which aligned individual patient healthcare needs with the most appropriate clinician to meet their needs. Practice supplied data showed that 2,079 patients had received structured reviews within the last year although this data had not been verified and published. For those patients with the most complex needs, wider clinical staff worked together with the care co-ordinator to deliver a multidisciplinary package of care with access to a named GP when required. Recent data showed the practice was the lowest in the locality for emergency admissions into hospital.

• The practice had recently recruited a prescribing pharmacist whose role involved the treatment of patients who had COPD and asthma flare ups.

• The practice offered in house warfarin testing and spirometry for those patients who would benefit.

Updated 4 October 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 disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances.

• Immunisation rates for all standard childhood immunisations ranged from 93% to 98%. This was similar to CCG averages which ranged from 91% to 98%.

• The practice had adopted a policy of following up any childrens missed appointments at the practice or at hospital to identify the reasons for non attendance.

• 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.

• We saw that joint working took place with midwives and health visitors, and any safeguarding concerns were routinely discussed at practice management meetings.

Updated 4 October 2016

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

• The practice had participated in a CCG project aimed at streamlining the medical care offered to patients living in residential care homes. Identified outcomes included improved end of life care for patients and closer and more effective liaison with other health professionals, including care homes staff.

• The practice undertook additional work which included training of care home staff so they felt confident and empowered to care for their patients’ needs with less reliance on the emergency services to assist. The practice also met with relatives of patients to raise awareness of health considerations and other associated issues. Feedback from care home managers was particularly positive. Data also showed an 8% reduction in emergency admissions in the preceding 12 months.

• The practice participated in the ‘Belper 5’ project to enable collaborative working with other local surgeries to improve community care for patient, especially the frail elderly.

• Quality and Outcomes (QOF) data showed the practice had achieved 100% of available points in osteoporosis indicators. Achievement ranged from 5% to 8% above GGC averages and exception reporting was between 10% and 16% lower than CCG averages.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. The practice had utilised the skills of a trainee advanced care practitioner to undertake these visits under supervision from the GP partner.

• Data supplied by the practice showed that flu vaccination rates in 2015/16 for the over 65s were 82% (CCG average 73%) The practice ran flu clinics at a local community facility to encourage uptake and offer flexibility to patients.

Updated 4 October 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 booked from 8am to 6.30pm weekdays with an extended hours surgery on Wednesdays until 8.30pm.

• As a result of the practice’s new model of working, GP appointment availability had increased, waiting times for urgent appointments decreased and the practice had noted a 50% reduction in those requesting a telephone consultation.

• 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.

• 88% of women aged over 25 but under 65 had received a cervical screening test in the previous 5 years. The practice was performing above the CCG average of 84% and national average of 82%.

Updated 4 October 2016

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

• 91% of patients with a mental health condition had a documented care plan in place in the previous 12 months. This was similar to the CCG average of 92% and above the national average of 88%. None of these patients had been exception reported. CCG average for exception reporting was 20.9% and national average was 12.6%.

• The practice had undertaken an audit to identify any patients with serious mental health problems who were not already included on the mental health register. Patients who were recorded on the register were highlighted for additional advice and treatment including various annual screenings. The audit identified 7 patients who were not included on the register and these patients were therefore included. A further 7 patients were highlighted for additional reviews.

• 91% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was above the CCG average of 85% and national average of 84%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. This included patients with dementia residing in care homes and the CCG project that the practice participated in also directly benefitted these patients.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. A variety of information was provided to patients at the practice.

Updated 4 October 2016

The practice is rated as outstanding 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 were 30 patients on the learning disability register, and all of these had received an annual health check in the last twelve months.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with other health care professionals including the care co-ordinator in the case management of vulnerable patients.

• The practice had identified a high number of patients with carers responsibilities, 25% of the practice list size. The practice had engaged with a local carers organisation and provided a monthly clinic in the practice to offer help and support to carers.

• 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.