Archived: The Dale Surgery

Updated 25 November 2016

The Dale Surgery provides primary medical services to approximately 4050 patients through a primary medical services contract (PMS). The patient list size is stable.

The practice has been providing services for over 25 years and is situated in Sneinton a district of Nottingham city. It occupies premises which were initially two terraced houses and have been linked by a bridge and extended several times over the last twenty years. The practice is accessible by public transport. In 2015 the partners from Greenwood and Sneinton Family Medical Centre, a neighbouring practice, combined with the Partners of the Dale Surgery and the beginnings of a full merger were begun. The management and administration was moved to the main site in 2015 and all other clinical services were moved in April 2016.

At the time of the inspection The Dale surgery was in operation, effectively as a branch surgery, providing additional rooms for GP consultations, with all other clinical services being available at the main site 550 meters along the road, a two minute bus ride or seven minute walk.

The long term plan is for an extension of the main site and the closure of the Dale Surgery when the merger is completed.

The level of deprivation within the practice population is below the national average with the practice population falling into the ninth most deprived decile. Income deprivation affecting children and older people is significantly below the national average. The practice has above average numbers of working age patients and below average numbers of elderly patients.

The clinical team comprises five GP partners (three male, two female), one prescribing nurse, five practice nurses and two healthcare assistants. The clinical team is supported by a practice manager two deputy managers and a team of reception and administrative staff. The Practice is a teaching and training practice, taking registrars, medical students as well as nursing students and currently has four GP trainees and two foundation doctors between the two practices.

The practice opens from 8am to 6.30pm Monday to Friday. Consulting times are generally from 9am to 11.30am each morning and from 2pm to 4.30pm each afternoon. An additional early session runs on Thursday morning from 7am to 8am and appointments are available with a GP or HCA, and a late session runs on a Tuesday evening from 6.30pm to 8.30pm with two GPs.

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 25 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Dale Surgery on 11 October 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 enable staff to report and record significant events. Learning from events was shared with relevant staff.
• Risks to patients were assessed and well managed. A range of risk assessments were in place within the practice to support the ongoing review and management of risk.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Feedback from patients about their care, and their interactions with all practice staff, was positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Most patients said they found it easy to make an appointment with a GP. Urgent appointments were available on the day for patients who needed them. Advanced bookings could be made with no restriction on timescales.

• The practice used clinical audits to review patient care and outcomes had been used to improve services as a result.

• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice worked effectively with the wider multi-disciplinary team to plan and deliver effective and responsive care to keep vulnerable patients safe.
• There was a clear leadership structure within the practice, and staff felt well-supported by management.
• Significant emphasis was put on encouraging training clinicians into General Practice and placements were supported at all stages of training.
• The practice reviewed the way it delivered services as a consequence of feedback from patients and from staff. For example the practice had recruited an additional nurse to support the nursing team following feedback.
• The provider was aware of and complied with the requirements of the duty of candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 November 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 diabetes related indicators was 36% which was 43% below the CCG average and 53% below the national average. The exception reporting rate for diabetes indicators was 8.1% which was in line with the CCG average of 9.8% and the national average of 10.8%.

• Performance for indicators related to hypertension was 77% which was 21% below the CCG average and 21% below the national average. The exception reporting rate for hypertension related indicators was 8.4% which was above the CCG average of 3.7% and the national average of 3.8%.

• 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 those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 25 November 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 been on the safeguarding register or the practice had concerns about were monitored through a register to ensure they remained a priority for care when required.

• The premises were suitable for children with a room for baby changing facilities and breast feeding available if required.

• Appointments were available outside of school hours with the GP and nurses.

• We saw positive examples of joint working with midwives, health visitors and school nurses. There was a weekly midwife clinic held at the practice.

• All children under five were offered same day appointments.

Updated 25 November 2016

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

• 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.

• There was a lead GP responsible for co-ordinating the care of elderly patients who were at risk of admission to secondary care.

• The practice had won a contract to supply intermediate care to a rehabilitation care home for those that are ‘stepping down’ from hospital to being discharged to their homes. In partnership with other community teams there has been a proven reduction in readmission to hospital for patients discharged through this process.

• Care plans were in place for older patients with more complex needs. Monthly multi-disciplinary meetings were held to review frail patients and those at risk of hospital admission to plan and deliver care appropriate to their needs.

• Longer appointments were also provided for older people on request.

• A phlebotomy service was offered in the practice to reduce the need for patients to travel.

Updated 25 November 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. For example, extended hours appointments were offered one morning and one evening per week. The practice continued to offer bookable appointments as well as run a ‘sit and wait’ clinic Monday to Thursday.

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.

Updated 25 November 2016

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

• Performance for mental health related indicators was 85% which was 4% below the CCG average and 8% below the national average. The exception reporting rate for mental health related indicators was 5% which was significantly below the CCG average of 10.5% and below the national average of 11%.

• 80% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was 4% below the CCG average and 4% below the national average. This exception reporting rate for this indicator was 9% which was slightly above the CCG average of 8.5% and the national average of 8.3%.

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

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

• There was a GP with a special interest in mental health conditions and they worked closely with secondary care partners in the care of patients with mental health conditions including dementia.

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

Updated 25 November 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. Homeless people could register with the practice.

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

• The practice regularly worked with other health care professionals in the case management of vulnerable patients and informed patients how to access various support groups and voluntary organisations.

• Drop in clinics had proved popular with patients with chaotic lifestyles who often missed pre-booked appointments.

• The practice hosted several clinics to allow local access to services such as exercise therapy and smoking cessation.

• 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.