Newbold Surgery

Updated 21 September 2016

Dr M A Bradley (also known as Newbold Surgery) provides care to approximately 11,308 patients in the village of Newbold, to the north of Chesterfield. The practice provides primary care medical services via a Personal Medical Services (PMS) contract commissioned by NHS England and North Derbyshire Clinical Commissioning Group (CCG). The site operates from a purpose built two-storey detached building constructed in 1987, and all patient services are provided on the ground floor.

The practice is run by a partnership of five GPs (four male and one female) and the partners employ four female salaried GPs. Newbold Surgery is an established training practice with two GP registrars in place at the time of our inspection.

The nursing team is led by a senior practice nurse acting as the nurse manager with a team of four more practice nurses and four health care assistants. The clinical team is supported by a practice manager and a patient services manager, with a team of 16 administrative and reception staff. The practice also employs three cleaning staff.

The registered patient population are predominantly of white British background with higher percentages of patients aged over 50. The practice is ranked in the fifth more deprived decile with a deprivation score (2015) of 24.4 compared against a CCG average of 18. Although the practice serves a predominantly urban area, the practice boundary extends to some rural villages on the edge of the Peak District.

The practice opens daily from 8am until 6.30pm. Extended hours opening operates every Tuesday and Wednesday evening when the practice opens until 8pm. The practice closes one Wednesday afternoon each month for staff training.

Scheduled GP morning appointments times are usually available from approximately 8.40am until 10.50am. Afternoon GP surgeries run approximately from 2.30pm to 5pm. Extended hours appointments on Tuesday and Wednesday evenings are available between 6.30pm and 7.20pm

The practice has opted out of providing out-of-hours services to its own patients. When the practice is closed, patients with urgent needs are directed via the 111 service to an out-of-hours service operated by Derbyshire Health United (DHU).

Updated 21 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr M A Bradley (Newbold Surgery) on 12 August 2016. Overall the practice is rated as good.

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

• There was an effective system in place for the reporting and recording of significant events. Learning was applied from events to enhance the delivery of safe care to patients.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• A programme of clinical audit reviewed care and ensured actions were implemented to enhance outcomes for patients.
• The practice worked with members of the wider health and social care team to keep vulnerable patients safe. However, they did not participate in regular multi-disciplinary team meetings to plan and co-ordinate patient care collaboratively.
• The practice had an effective appraisal system in place and was committed to staff training and development. The practice team had the skills, knowledge and experience to deliver high quality care and treatment.
• Patients told us they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Patients provided positive views on their experience in making an appointment to see a GP or nurse. The practice offered a range of appointment options including pre-bookable routine, urgent, and telephone consultations each day. Longer appointments were available for those patients with more complex needs.
• The practice had good facilities and was well-equipped to treat patients and meet their needs. Some adjustments had been made within the premises to ensure these were easily accessed by patients with a disability.
• There was a clear leadership structure in place and the practice had a governance framework which supported the delivery of good quality care. Regular practice meetings occurred, and staff said that GPs and managers were approachable and always had time to talk with them.
• The partnership had a clear vision for the future of the service, and were proactively engaged with their CCG in order to progress this.
• The practice had an open and transparent approach when dealing with complaints. Information about how to complain was available, and improvements were made to the quality of care as a result of any complaints received.
• The practice analysed and acted on feedback received from patients in conjunction with their patient participation group (PPG). There was clear evidence that the practice aimed to address patient feedback and continually improve their service provision.

The areas where the provider should make improvement are:

• Review the monitoring arrangements for the distribution of blank prescriptions within the practice.
• Review practice staff attendance at the fortnightly multi-disciplinary team meetings with community health and social care staff.
• Review the availability of clinical meeting minutes for all clinicians within the practice.
• Continue to increase the uptake of annual health reviews for patients with a learning disability, and strengthen the use of coding in this group to ensure the register is correct. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 September 2016

• The practice undertook annual reviews for patients on their long-term conditions registers. The recall system was co-ordinated by a dedicated member of staff. Housebound patients would be visited by the health care assistant to undertake screening tests which would then be reviewed by a GP.
• Patients with multiple conditions were usually reviewed in one appointment to avoid them having to make several visits to the practice.
• There was a lead designated GP and/or nurse for all the clinical domains within QOF.

• The practice had upskilled their nursing team to deliver effective care for patients with long-term conditions. For example, three nurses were independent prescribers and had completed additional training in specific disease management areas. This included a nurse who was being supported to do accredited training in spirometry.
• A specialist diabetes nurse attended the practice to undertake a joint monthly clinic with the practice nurse to manage more complex patients with diabetes. This included those with a learning disability or poor mental health. The specialist nurse had provided insulin initiation training to develop the expertise of the practice nurse in the management of diabetes.
• There was an emphasis towards self-management, and care plans were developed with patients to set their own goals.
• Patients with a long-term condition received a written invitation to attend the surgery for a pre-booked appointment to receive their annual flu vaccination.

Updated 21 September 2016

• The GPs saw new mothers for a post-natal review and baby check. This was used an opportunity to book the infant’s vaccination appointments.
• Childhood immunisation rates were in line with local averages. Rates for the vaccinations given to children up to five years of age ranged from 92.9% to 100% (local averages 95.2% to 99.1%).
• The health visitor and midwife attended a meeting with the lead GP for child safeguarding once a month to discuss any concerns. Child protection alerts were used on the clinical system to ensure clinicians were able to actively monitor any concerns.
• Appointments for children were available outside of school hours.
• Family planning services were provided to fit and remove intrauterine devices (coils) and implants, and advice and support was available for all aspects of contraception. This included the c-card scheme (a free condom distribution and advisory service for 13-19 year olds). Chlamydia screening kits were available in patient toilets.
• The practice worked within their local community to promote health – for example, a GP had attended three local schools to educate children about attending the doctor’s surgery without apprehension. As part of this, the practice ran a new practice logo design competition, and displayed this at the practice entrance, and on leaflets and letterheads.
• The practice had baby changing facilities, and welcomed mothers who wished to breastfeed on site. Toys and books were available for small children.

Updated 21 September 2016

• Although the practice worked collaboratively with the wider health and social community to plan and co-ordinate care to meet their patients’ needs, they did not participate in regular meetings on site attended by the wider multi-disciplinary team. However, there was good liaison in place between the care co-ordinator and practice clinicians to ensure effective and co-ordinated patient care.
• Longer appointment times could be arranged for those patients with complex care needs, and home visits were available for those unable to attend the surgery.

• The practice provided care for residents at two local care homes, and fortnightly visits were undertaken to each home by a GP. The same GP usually visited each home to ensure continuity of care, and build good relationships with the care home team. Care plans were in place to support the ongoing needs of these patients.

• The practice worked with an independent pharmacist and the CCG medicines management technician to review the long-term use of multiple prescribed medicines, including those patients that were housebound.
• Uptake of the flu vaccination for patients aged over 65 was 78%, which was higher than local (73.9%) and national (70.5%) averages. An annual flu clinic had developed into a local social community event with representatives from organisations including the fire brigade, the Alzheimers Society, and carer support charities. The Patient Participation Group (PPG) helped to organise and co-ordinate the event which took place in the local village hall.  

Updated 21 September 2016

• The practice offered on-line booking for appointments and requests for repeat prescriptions. The practice provided electronic prescribing so that patients on repeat medicines could collect them directly from their preferred pharmacy.
• Extended hours’ GP and nurse consultations were available on two evenings each week.
• Telephone consultations were available each day, meaning that patients did not have to travel to the practice unnecessarily.
• The practice promoted health screening programmes to keep patients safe. NHS health checks were available towards the end of the day to enable working people to attend more easily.
• Pre-bookable evening appointments were provided for flu vaccinations for patients aged 18-65.

Updated 21 September 2016

• The practice achieved 100% for mental health related indicators in QOF, which was 1.9% above the CCG and 7.2% above the national averages. Exception reporting rates for mental health were higher at 20.3% (local 14.5%; national 11.1%).
• 96.9% of patients with poor mental health had a documented care plan during 2014-15. This was slightly above the CCG average of 93.2% and higher than the national average of 88.5%.
• Key information from annual reviews was shared with secondary care to ensure that physical health was maintained for these patients.
• In-house access to counselling and associated talking therapies was available by GP or self-referral.
• The practice had established good working relationships with local community mental health care teams and the community psychiatric nurse (CPN).
• 80.6% of people diagnosed with dementia had had their care reviewed in a face-to-face meeting in the last 12 months. This was slightly below local and national averages by approximately 3.5%. Exception reporting rates were higher at 14.3%, compared to the local and national average of 8.3%.
• The practice staff had received training to become ‘Dementia Friends’ and were working to achieve full dementia friendly practice status. The PPG had been involved in this process and had reviewed internal signage to meet the needs of patients with dementia. This included using numbers on consulting room doors and the use of black signs on a yellow background as these are easier for older people to see, especially those with dementia.

Updated 21 September 2016

• The practice was working hard to increase the uptake of annual health checks of patients with a learning disability, and had introduced easy-read letters with picture prompts, and liaised with carers to co-ordinate attendance. However, not not all patients were correctly coded on the practice’s IT system. Information received following the inspection confirmed that 71% of eligible patients had received a health check in the last 12 months. The coding of patients had also been updated to ensure the register was correct. 
• A GP worked with the local substance misuse service to provide a shared care drug clinic on site. This service had recently been extended to other patients registered with a different practice but residing locally.
• There was a designated lead GP for palliative care. Patients with end-of-life care needs were reviewed at designated monthly palliative care meetings. However, the minutes of these meetings were not readily available to other practice clinicians. All patients nearing their end of life had appropriate care plans in place to meet their needs.
• The practice supported homeless patients to register at the practice.
• Staff had received adult safeguarding training and were aware how to report any concerns relating to vulnerable patients. There was a designated lead GP for adult safeguarding, who had delivered some safeguarding training to support staff at a local care home.
• The practice worked with patients to promote mutually respectful relationships with clear boundaries. This helped to provide help and support to some patients, enabling them to stay registered with the practice, rather than removing them from their list and passing difficulties onto another practice.
• The practice was a recognised safe haven for people with a learning disability. This Derbyshire partnership scheme aimed to protect people with learning disabilities from potential bullying or abuse, and helped them feel safe and confident within the community by having access to a place where they could be supported if required.
• Longer appointments and home visits were available for vulnerable patients.