Groby Road Medical Centre

Updated 4 May 2017

Groby Road Medical Centre provides primary medical services to approximately 9,043 patients residing within Leicester City. The practice also provides services to patients residing in two residential care and nursing homes in the surrounding area. 65% of the patient population have a long standing health condition compared to the local average of 50% and the national average of 53%.

It is located within the area covered by NHS Leicester City Clinical Commissioning Group (LCCCG). It is registered with the Care Quality Commission to provide the regulated activities of; the treatment of disease, disorder and injury; diagnostic and screening procedures; family planning; maternity and midwifery services and surgical procedures.

At the time of our inspection the practice employed five GP partners, one GP associate who is also the practice manager and provides GP sessions two days per week, two salaried GPs, one practice nurse who was also a nurse manager, three health care assistants (HCA), one phlebotomist and a team of seven receptionists. They are supported by an assistant practice manager and a reception manager. The surgery is open from 7.45am until 6.30pm Monday to Friday. The practice offers extended hours appointments on a Wednesday and Thursday morning from 7am until 8am and on a Tuesday and Thursday evening from 6.30pm until 7.30pm.

The practice is part of a pilot scheme within Leicester City which offers patients an evening and weekend appointment with either a GP or advanced nurse practitioner at one of four healthcare hub centres. Appointments are available from 6.30pm until 10pm Monday to Friday and from 9am until 10pm on weekends and bank holidays. Appointments are available by walk in, telephone booking or direct referral from NHS 111.

The practice provides on-line services for patients such as to book routine appointments, order repeat prescriptions and view patient summary care records.

The practice has a General Medical Services (GMS) contract. The GMS contract is the contract between general practices and NHS England for delivering care services to local communities.

The practice had previously received funding to extend the premises to increase the number of consulting rooms and improved disability access which included automated door openers and a passenger lift to give access to the first floor consulting rooms. The building works took place over a period of approximately six months and the work was completed at the beginning of April 2016, prior to our first inspection in May 2016.

The practice does not offer car parking facilities for patients however, on street car parking is available directly outside the practice. The practice has limited staff car parking available and there is a disabled car parking space in the staff car park which is available upon request.

The practice has an active patient participation group (PPG) who meet every three months.

The practice has opted out of providing the out-of-hours service. This service is provided by the out-of-hours service accessed via the NHS 111 service. Advice on how to access the out-of-hours service is clearly displayed on the practice website and over the telephone when the surgery is closed.

A previous inspection was carried out in May 2016 and enforcement actions were taken in relation to breaches of regulation 12 safe care and treatment and regulation 17 good governance.  Warning notices were issued and the practice was placed into special measures for a period of six months.

Updated 4 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Groby Road Medical Centre on 27 January 2017. Overall the practice is rated as good.

This inspection was carried out to follow-up our previous comprehensive inspection which took place on 24 May 2016 when we rated the practice as inadequate overall. In particular, the practice was rated as inadequate for providing safe, effective and well-led services, requires improvement for being caring and good for being responsive. The practice was placed in special measures for a period of six months.

Following the inspection in May 2016, the practice submitted an action plan to the Care Quality Commission outlining how they would make the necessary improvements to comply with the regulations. The practice also invested in a practice resilience support programme provided by the Royal College of General Practitioners (RCGP) to provide diagnostic assessment and tailored intervention throughout the period of special measures. In January 2017, we found the practice had responded to the concerns raised at the previous inspection and significant improvements had been made.

The practice is rated as good for the provision of safe, caring and effective services and for being well-led and requires improvement for being responsive. Our improved rating of good reflects the positive development of leadership and management systems to deliver significant progress in improving services.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Significant improvements to risk management had been made and risks to patients were now being assessed and managed. The practice had implemented a risk register and employed the services of external specialists to carry out specific risk assessments such as for fire and legionella.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• The practice had implemented a system of appraisals, mentorship and supervision, all members of staff had received an appraisal.
• The practice had implemented a meeting structure and a 12 month programme of meetings. Evidence showed that staff were working with multi-disciplinary teams to understand and meet the range and complexity of patients’ needs.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had implemented a new management structure. There was a clear leadership structure in place and staff told us they felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The practice had a clear vision that had improvement of service quality and safety as its top priority. The practice fully embraced the need to change, high standards were promoted and there was good evidence of team working.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Address the issues highlighted in the national GP survey in order to improve patient satisfaction, including access to appointments and ease of getting through to the practice by telephone.
• Review systems in place to manage and monitor processes to improve outcomes for patients in order to improve exception reporting rates which are higher than local and national averages.

This service was placed in special measures in August 2016. Improvements have been made and Groby Road Medical Centre is now rated as good. I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 May 2017

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

• Nursing 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 94% which was higher than the CCG average of 86% and the national average of 89%. (Exception reporting was 20% which was higher than the CCG average of 8% and the national average of 12%).

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and 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.

• The practice provided influenza clinics with pre-booked appointment slots on an evening and weekend during influenza season.

Updated 4 May 2017

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 were relatively high for all standard childhood immunisations.

• 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.

• The practice’s uptake for the cervical screening programme was 67%, which was comparable to the CCG average of 67% and the national average of 74%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• Childhood immunisation rates for the vaccinations given were comparable to CCG/national averages. For example, childhood immunisation rates for the vaccinations given to five year olds ranged from 90% to 96%.

• There was a clinical immunisation lead who engaged with families and local health visiting teams to increase uptake rates for childhood immunisations.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 4 May 2017

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

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

• Age Concern provided regular advice sessions in the patient waiting area.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• Where older patients had complex needs, the practice shared summary care records with local care services.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 4 May 2017

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.

• The practice offered extended hours appointments on a Wednesday and Thursday morning from 7am until 8am and on a Tuesday and Thursday evening from 6.30pm until 7.30pm.

• 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.

• An automated arrival machine was available to give patients the opportunity to arrive themselves for their appointment rather than speak to a receptionist.

• A range of health promotion and screening was available including smoking cessation, travel advice and vaccinations.

• The practice provided on-line services for patients such as to book routine appointments, order repeat prescriptions and view patient summary care records.

Updated 4 May 2017

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 77% which was lower than the CCG average of 93% and national average of 93%. (Exception reporting rate was 14% which was higher than the CCG average of 11% and the national average of 11%).
• 85% of patients with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the CCG average of 85% and the national average of 84%.

• Performance for dementia related indicators was 100% which was the maximum amount of points available compared to the CCG average of 95% and national average of 97%. (Exception reporting rate was 9% which was lower than the CCG average of 14% and the national average of 13%).

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

• The practice carried out advance care planning for patients with dementia.

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

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

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

Updated 4 May 2017

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 homeless people, travellers and those with a learning disability.

• 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.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• 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.