Archived: The New Parkfield Surgery

Updated 12 January 2017

The New Parkfields Surgery is located in Alveston, Southern Derbyshire in purpose built premises. It’s population live in an area which is 33% more deprived than the national average, which means that people living there tend to have a greater need for health services.

The practice has a General Medical Services (GMS) contract and currently has 6441 patients registered for their services.

The practice is run by a partnership of two GP’s who are male. There is a vacancy for one further GP.

A number of locum GP’s are regularly used to ensure there are enough GP sessions to meet the population needs.

There is a newly recruited Advanced Nurse practitioner (ANP) two practice nurses and a health care assistant (HCA) who provide treatment room services and chronic disease management. The clinicians are supported by a team of managers, administration team and reception team.

The practice is open between 08.00 am and 6.30 pm Monday to Friday. Appointments are available from 08.30 am to 11.30 am every morning and 2 pm to 6pm daily. Extended hours surgeries were offered at 6 pm to 7.30 pm on Mondays and Tuesdays. In addition to pre-bookable appointments that could be booked up to four weeks in advance, urgent appointments are also available for people who need them on the same day. Telephone consultations with a GP are available by appointment and routine appointments can be booked online.

When the practice is closed patients are directed to Derbyshire Health United (DHU) via the 111 service.

Updated 12 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The New Parkfields Surgery on 15 December 2015. Overall the practice is rated as requires improvement.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, learning from reviews and investigations were not shared widely to ensure improvements were made.
• Risks to patients were generally well managed although some alerts relating to patient safety were not acted upon to keep patients safe
• Data showed patient outcomes were similar to the locality and nationally.
• Although some reviews of processes had been carried out and changes and improvements made, there was some confusion amongst staff about managing incoming mail and test results and issues identified had not been resolved. This could result in care or treatment being delayed for some patients, for example, recommendations made by hospital consultants for a change in prescribed medicines.
• Medicines audits were conducted by the Clinical Commissioning Group (CCG) pharmacy lead, however, a recommendation made by them in relation to some medicines had not been acted upon
• Patients told us they were treated with compassion, dignity and respect.
• Information about services was available in the reception area

• Urgent appointments were usually available on the day they were requested, and there were extended appointment times available on two evenings each week. There were longer appointments for older people and those with complex needs.
• The practice had a number of policies and procedures to govern activity, and many had been recently reviewed but some were overdue. The practice had plans to complete this work in 2016
• The practice had proactively sought feedback from patients and had an active patient participation group.

The areas where the provider must make improvements are:

• Establish and strengthen formal governance arrangements to enable the provider to assess and monitor risks and the quality of the service provision

• Assess risks to patients and take the necessary action to mitigate this.

• Clarify the leadership structure, ensuring there is leadership capacity to deliver all improvements

The areas where the provider should make improvement are:

• Reviewing processes for reporting, acting on and learning from significant events, and ensure that all staff are aware of what constitutes a significant event.

• Carry out fire drills at the required intervals and conduct a fire risk assessment.

• Review disabled access to the premises and the patient toilet facilities

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 February 2016

The practice is rated as requires improvement for being safe, effective and well led. The evidence which led to this rating applies to all population groups including this one.

There was a named GP for patients with long term conditions assisted by the nursing staff, who had roles in chronic disease management, for example in asthma and coronary heart disease, and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed.

All patients with long-term conditions had a structured annual review to check that their health and medicines needs were being met, and individual care plans were developed as appropriate. For those people with the most complex needs, clinicians worked with the community matron and other relevant health and care professionals to deliver a multidisciplinary package of care. For example the community respiratory team and the heart failure team. Joint appointments with the GP and nurse could be offered to patients with diabetes. The practice also had plans in place to increase the service offered by the nursing team in 2016 by attending further training for chronic disease management and amending the model of care provided to enable a more streamlined service.

The practice had improved its achievement for QOF in respect of patients with long term conditions from the previous year and results were comparable to CCG and national average for 2014/15

Updated 11 February 2016

The practice is rated as requires improvement for being safe, effective and well led. The evidence which led to this rating applies to all population groups including this one.

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 were relatively high for all standard childhood immunisations.

The practice worked with an attached midwife who saw patients at the practice and an attached health visitor who provided a clinic at the surgery twice a week. The practice staff told us they they liaised regularly with the midwifery and health visitor team regarding patients and were able to alert them to any concerns regarding a child through the practice’s computer system.

The practice held a register of patients where safeguarding concerns had been identified and meetings took place every four months to discuss patients on the register and included relevant professionals such as the GP lead for safeguarding, care coordinator, practice manager, health visitor and social worker. The GP lead and health visitor met every six weeks to review the register and progress.

New born babies were offered an eight week check at the practice and there was a recall system in place to invite babies and children for immunisations. This was achieved through the use of letters, text messaging and contacting the parent or guardian by telephone to follow up an any missed appointments.

The practice provided contraception advice and the fitting of coils and implants.

Sexual advice was provided where needed, and ensured confidentiality to young people under 16 years in line with Fraser guidance. Fraser guidance is a set of guidelines issued by the Department of Health (DOH) in 2014 that assists GP’s in deciding whether giving sexual advice to a young person in the absence of a parent or guardian (and therefore without parental consent) was in the young person’s best interest

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.

Updated 11 February 2016

The practice is rated as requires improvement for being safe, effective and well led. The evidence which led to this rating applies to all population groups including this one.

It provided proactive, personalised care to meet the needs of the older people in its population, was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

The practice had a population of older people similar to the CCG average. They provided proactive health reviews including a review of prescribed medicines, which was done in conjunction with the CCG pharmacy lead. Each patient over 75 years had a named GP and their personalised care plans.

The practice held regular meetings with the multidisciplinary team and care coordinators to discuss patients with complex needs, which included older people.

The CCG pharmacist lead performed audits on the medicines prescribed by the practice and kept the practice informed of their prescribing data each year. This enabled the practice to review medicines prescribed for their older population.

Home visits were offered to older patients who were unable to attend the surgery for acute medical problems as well as chronic disease management. Influenza vaccinations were provided to patients who could not or would not leave their home.

The practice provided primary medical care services to patients in two residential homes and visited these patients on a fortnightly basis providing annual reviews where required as well as urgent visits when needed

Longer appointments were available for older people who needed them.

Updated 11 February 2016

The practice is rated as requires improvement for being safe, effective and well led. The evidence which led to this rating applies to all population groups including this one.

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, NHS health checks were offered as well as well man checks

The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group. For example, screening for cervical and bowel cancers were provided at the practice and a system was in place to check on the uptake of invitations for these checks.

Annual health reviews were offered to young people if needed, and screening for cervical cancer was provided. The practice had provided screening for 84% of its relevant population which was similar to the CCG average and 2% higher than the national average

The practice provided travel clinics for people who needed health advice and vaccinations prior to travelling abroad

Extended appoitment times were available on a Monday and Tuesday evenings until 7.30pm with a GP and healthcare assistant (HCA) available. Telephone consultations were also available where a patient could book an appointment to speak with a GP over the telephone

The practice promoted a healthy life style, and provided leaflets and information where patients could get further support and in the reception area.

There was also information available to support people with a newly diagnosed condition as well as support for general health concerns.

Patients who were taking regular medications were able to make use of the practices Electronic Prescribing Service where patients prescriptions were sent directly to a pharmacy of their choice.

Updated 11 February 2016

The practice is rated as requires improvement for being safe, effective and well led. The evidence which led to this rating applies to all population groups including this one.

QOF data reported an achievement of 100% for mental health related indicators which was 3% above the CCG average and 7% higher than the average for England. However, their exception reporting rate was 31% which was 10% higher than the nation average for exception reporting. 96% of people on the practice mental health register had received an annual physical health check, and 75% of people with dementia had also received a check within the preeding 12 months. The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia and carried out advance care planning for patients with dementia.

The practice had told patients experiencing poor mental health about how to access various types of support, including counselling services and we saw information about this available in the reception. There was 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.

Most staff had received training on how to care for people with mental health needs, including awareness of dementia. The practice provided a dementia risk assessment as one of its enhanced services and proactively sought to assess patients thought to be at risk of dementia.

The practice worked with the community support team to assess and plan care for patients who needed this and the care coordinator worked with the relevant members of this team to plan care, including mental health team and social care team where required.

Updated 11 February 2016

The practice is rated as requires improvement for being safe, effective and well led. The evidence which led to this rating applies to all population groups including this one.

All patients who had learning disabilities and those who were vulnerable for other reasons were offered an annual review.

Staff were alert to recognising signs of abuse, were all up to date with their safeguarding training and were aware of what to do and who to contact regarding safeguarding concerns

The practice had signed up for the dementia screening enhanced service which encouraged them to identify patients at risk of dementia and offer an assessment opportunistically.

The practice liaised regularly with the community matron and was able to alert her to concerns about patients by telephone, text messaging and through the practice’s computer system. The community matron attended monthly community support team (CST) meetings with a multi-disciplinary team to discuss patients needs in the local area. The team included a GP, care coordinator, mental health team and social care team where required. We were told that these meetings had been running effectively for a long time.

There was a triage system provided for urgent appointments so that patients who were most at risk could be prioritised.

There was a system in place to direct patients with alcohol concerns to an organisation to help them and patients who misused substances were treated at the practice and referred onwards where required. They also treated homeless people from the area, and their open list enabled them to accept asylum seekers.