Welbeck Surgery

Updated 11 November 2016

Welbeck Surgery provides primary medical services to approximately 3885 patients through a general medical services contract (GMS).

The practice is located in purpose built premises in Sherwood, Nottingham. All facilities are on the ground floor including consulting and treatment rooms. The practice has car parking including parking for patients with a disability.

The level of deprivation within the practice population is below the national average with the practice falling into the 5th most deprived decile. The level of deprivation affecting older people is below the national average. The practice has higher than average numbers of working age patients. Numbers of older people are below average.

The clinical team is comprised of three GP partners (two female, one male), one practice nurse, and a healthcare assistant. The clinical team is supported by a practice manager, reception and administrative staff. The practice is a teaching practice for medical students.

The surgery is open from 8.30am to 6.30pm on Monday to Friday. Consulting times vary but are usually from 8.50am to 11.30am each morning and 3.30pm to 5.50pm each afternoon.

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 11 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Welbeck Surgery on 30 August 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 report, record and learn from significant events. Learning was shared with staff and external stakeholders where appropriate.

• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• Outcomes for patients were generally above or in line with local and national averages.

• Training was provided for staff which equipped them with the skills, knowledge and experience to deliver effective care and treatment.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Patients told us they were able to get an appointment with a GP when they needed one, with urgent appointments available on the same day.

• Feedback from the GP patient survey showed that patients rated the practice highly. For example 100% of patients stated they had confidence in the last GP they saw or spoke to.

• 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 and learning from complaints was shared with staff and stakeholders.

• The practice sought feedback from specific groups including vulnerable groups, such as under 25 year olds or patients with a diagnosis of autism, whose views were often overlooked in general surveys to ensure the service provided was responsive to all patients.

• In the previous year the practice had one of the lowest A and E attendance rates in the local area.

• The practice had good facilities and was well equipped to treat patients and meet their needs. Services were designed to meet the needs of patients.

• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

We saw an area of outstanding practice:

• The practice led in several areas which benefited vulnerable patients to ensure proactive care was available to those who might otherwise not engage in GP led care.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 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 96.7% which was 17% above the CCG average and 7% above the national average. The exception reporting rate for diabetes indicators was 15% which was above the CCG average of 10% and the national average of 11%.

• 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 patients with the most complex needs, practice staff worked with relevant health and care professionals to deliver a multidisciplinary package of care. Regular multidisciplinary meetings were hosted by the practice. The practice worked closely with the community trust employed care coordinator.

Updated 11 November 2016

The practice is rated as good for the care of families, children and young people.

• The practice had sought feedback from people under 25 through ‘future pulse’, a local initiative between Bright Ideas Nottingham and The Carers Federation, to find ways in which access to health care in Nottingham could be improved.

• Systems were in place to identify children at risk. The practice had a child safeguarding lead and staff were aware of who they were.

• 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. The GP lead for safeguarding liaised with other health and care professionals to discuss children at risk.

• Immunisation rates were relatively high for all standard childhood immunisations and the practice worked with health visitors to follow up children who did not attend for immunisations.

• The practice offered a full range of contraception services including coil fitting and implants.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

• Urgent appointments were available on a daily basis to accommodate children who were unwell.

Updated 11 November 2016

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. Regular multidisciplinary meetings were held to review frail patients and those at risk of hospital admission to plan and deliver care appropriate to their needs.

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

• A designated GP visited local care homes and residential homes to allow for regular monitoring of patients.

Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure were in line with or above local and national averages.

Updated 11 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.

• Appointments could be made and cancelled on line as well as management of repeat prescriptions.

• 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. Uptake rates for screening were similar to the national average. For example, the uptake rate for cervical cancer screening was 81% compared with the national average of 82%.

Updated 11 November 2016

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

• The number of people with a mental health condition that had received a comprehensive care plan in the last 12 months was 95%, which was 11% above the local average and 7% above the national average. This was with an exception rate of 2%, which was 9% below the local average and in line with the national average of 10%

• The number of patients with a diagnosis of dementia who had their care reviewed in a face-to-face review in the last 12 months was 91% which was 7% above the local average and 7% above the national average. This was achieved with an exception reporting rate of 10% in line with local and national rates.

• 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.

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

Updated 11 November 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.

• The practice had sought feedback from patients with a diagnosis of autism to find areas they could improve within the practice, in accordance to the Royal College of General Practice guidelines.

• The practice worked closely with a Nottingham refugee forum and often registered temporary patients with the charities address to ensure they had access to healthcare when needed.

• The practice offered longer appointments for patients with a learning disability and for those who required it. Annual reviews were undertaken by the healthcare assistant and the nurse practitioner.

• The practice held an open access session once a week for patients with a history of alcohol and substance misuse in partnership with the Nottingham Council Drug and Alcohol Partnership.

• The practice worked closely with the local food bank both as a collection point and the GPs were signatories to allow food vouchers to be allocated when the need was identified.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. Regular multidisciplinary meetings were hosted by the practice. In addition the practice held regular meetings to discuss patients on their palliative care register.

• 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.