Archived: Wellside Medical Centre

Updated 27 November 2017

Wellside Medical Centre provides general medical services to approximately 8,099 patients, and is run by a partnership of three GPs (two male and one female) and a salaried GP who is female.

The main practice is in Derby with a branch surgery located nearby in the area of Mackworth. Patients can attend either the main practice or the branch practice.

We did not visit the branch practice as part of our inspection.

The practice population live in an area of high deprivation, which is the 2nd most deprived on the decile scale. Income deprivation affecting children is 8% higher than the national average and affects older people by around 12% more than the CCG average.

Around 11% of the practice population are unemployed which is double the CCG and national averages, which are both 5%.

The practice demand for people with a chronic illness is significantly higher than CCG and national averages.

The practice team includes a lead nurse four practice nurses, and a health care assistant (HCA). There is a full time practice manager, a reception manager and a number of reception and administrative staff.

The practice is generally open between 8am and 6.30pm Monday to Friday. Appointments are available from 8.30am to 12noon and 3.30pm to 5.30pm Monday to Friday. Extended surgery appointments are available each Saturday from 8am to 11am and are pre-bookable.

The practice does not provide out-of-hours services to the patients registered there. During the evenings and at weekends an out-of-hours service is provided by Derbyshire Health United. Contact is via the NHS 111 telephone number.

Updated 27 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wellside Medical Centre on 9 November 2016. The overall rating for the practice was good but it was rated as ‘requires improvement’ for providing safe services. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Wellside Medical Centre on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 1 November 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection on 9 November 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good

Our key findings were as follows:

• The provider had amended their protocol for chaperoning and only those staff who had received a DBS check were able to provide this service for patients.
• The provider had strengthened their processes for recording actions following safety and MRHA alerts. These were discussed at two-weekly clinical meetings to ensure all relevant staff knew of the actions required to address the alerts and provide an opportunity for learning.
• The provider had implemented weekly meetings for reception and administration staff with the practice manager where actions and outcomes were recorded and accessible to staff. A member of staff from the reception and administration teams were also invited to each clinical meeting.
• The partners had met to explore reasons for high exception reporting in respect of mental health disorders for 2015/16. They had increased the availability of clinical staff and flexibility of appointments offered and improved their recall system. This had resulted in more appointments being offered to patients and a reduction in exception reporting in four out of the six indicators for mental health disorders of between 10% and 17%. This was comparable to CCG and national averages.
• The practice had recruited a new practice manager who was experienced in management within the NHS.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 January 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. The practice had recognised that some patients with multiple conditions found letters for reviews were confusing and sometimes led to non-attendance. It had implemented a process to make the reviews easier for patients, and more efficient by introducing a ‘Chronic Disease Annual Review’ recall system. This enabled many people with multiple conditions to be reviewed at one annual appointment. For those patients requiring more than one review a year, they had an ‘Interim Review’ recall added which was set for the time required, to ensure they were not missed.
• All these patients had a named GP and 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 performance in QOF was comparable with clinical commissioning group (CCG) and national averages in most indicators relating to diabetes. For example 83% of patients with diabetes were reported as having satisfactory blood sugar levels maintained within the preceding 12 months, compared to the CCG average of 80% and the national average of 78%.
• Longer appointments and home visits were available when needed.

Updated 10 January 2017

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

• The practice was aware of the high number of safeguarding concerns because of the area the practice covered, and told us they were vigilant in following up any safeguarding concerns. Staff we spoke with confirmed this and gave appropriate examples of how concerns were managed.
• 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 accident and emergency (A&E) attendances. To ensure concerns were followed up, fortnightly safeguarding meetings were held with social services, health visitors and community teams to discuss families of concern.
• Immunisation rates were slightly lower than CCG average 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.
• Cervical screening rates at 75% were slightly lower than CCG and national averages. (These were 83% and 82% respectively)
• The practice provided routine eight week baby checks, and where an appointment was not available, they opened up embargoed appointments to be as accommodating as possible. This had been a conscious decision to increase patient engagement and enable the health and wellbeing of mother and baby to be reviewed. This meant that any issues or concerns, including signs of post-natal depression, were acted upon earlier.
• Appointments were available outside of school hours and the premises were suitable for children and babies. Where appointment slots were fully booked, the reception staff arranged for the on call GP to call the patient back. When a child was added to the triage list, reception staff alerted the on call GP of this, to ensure they were prioritised.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• The practice provided contraceptive and family planning service for patients.

Updated 10 January 2017

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

• Approximately 12% of the practice’s population were aged over 65, with 5% of these being over the age of 75. The practice had recognised the increasing support and input required to ensure the needs of this population group were met.
• The practice took a multidisciplinary team approach where possible, to manage an increasing older population with more than one illness and increasing social care needs.
• The practice utilised various community specialist teams, such as the adult respiratory team, community heart failure nurses and community allied health professionals in ensuring medical management was maximised. The practice worked closely with the community matron who made home visits.
• The practice utilised a care coordinator to ensure that patients were being supported by NHS, voluntary and private sector organisations where appropriate and held fortnightly clinical meetings at the practice, attended by the GPs, nurses, care co-ordinator, and community matrons. Monthly meetings were also held where a member of the community mental health team and a social worker also attended.
• Quarterly palliative care reviews were held with the district nurses and palliative care teams, so that patients reaching the end of life stage were managed and supported to ensure that dignity and comfort are maintained.

• The practice offered home visits and urgent appointments for those with enhanced needs, and provided flu vaccinations for housebound people in their own homes..

Updated 10 January 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 was proactive in offering online services where medicines could be requested and appointments made.
• The practice offered a range of health promotion and screening that reflected the needs for this age group.
• The practice maintained a Saturday morning appointment session to allow this group to book appointments in advance.

Updated 27 November 2017

The partners had met to explore reasons for high exception reporting in respect of mental health disorders for 2015/16.

They had increased the availability of clinical staff and flexibility of appointments offered and improved their recall system.

This had resulted in more appointments being offered to patients and a reduction in exception reporting in four out of the six indicators for mental health disorders of between 10% and 17%. This was comparable to CCG and national averages for 2016/17.

Updated 10 January 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice supported a women’s refuge and had frequently provided care for women who had suddenly left their own homes/towns due to suffering from domestic abuse. These situations were often chaotic and unpredictable, resulting in a high need for input for both mental and physical health. The practice ensured confidentiality and safety of such patients by placing alerts on the system so that staff were aware not discuss any aspect of the patients details, unless a password was confirmed.

• 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 and annual reviews for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients. Fortnightly meetings were held to discuss patients who were vulnerable and agree plans.
• 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.
• For patients who were reliant on carers or who became anxious when attending the surgery, an additional appointment slot would be opened if none were available on the system so that these patients could be accommodated.