Derwent Valley Medical Practice

Updated 29 December 2016

Derwent Valley Medical Practice is located in Chaddesden, a large residential suburb in the city of Derby. It is approximately two miles east of the city centre. There is direct access to the practice by public transport from surrounding areas. There are parking facilities on site.

The practice currently has a list size of approximately 10,906 patients. The practice also has a branch surgery in Spondon which is located 3 miles from Chaddesden. We did not inspect the branch site during our inspection.

The practice holds a General Medical Services (GMS) contract with NHS England. The GMS contract is held between general practices and NHS England for the delivery of primary care services to the local communities. The practice provides GP services commissioned by NHS Southern Derbyshire Clinical Commissioning Group (CCG). A CCG is an organisation that brings together local GPs and experienced health professionals to take on commissioning responsibilities for local health services.

The practice is situated in an area with higher levels of deprivation. The practice has a higher than national average number of adults who have reached retirement age.

A lower number of patients registered at the practice are in paid work or full time education (55%) compared with the local CCG and national averages (60%).

The practice has undergone a number of partnership changes and practice management told us this had significantly impacted upon pressure and resource. Since January 2016, three partners had resigned to work abroad. The management advised us that they were now developing stability and had a vision for the future with their current partners. At the time of our inspection, there were four partners (3 male, 1 female). The current partnership is supported by one salaried male GP, one male advanced nurse practitioner, four female practice nurses and two female healthcare assistants. The practice also directly employs a pharmacist. The practice has a practice manager, assistant practice manager, office manager and a team of reception, clerical and administrative staff.

The practice is open on Mondays, Wednesdays, Thursdays and Fridays from 8am to 6.30pm and on Tuesdays from 8am to 8pm. The branch site at Spondon is open on Mondays, Tuesdays, Wednesdays and Fridays from 8am to 6.30pm and on Thursdays from 8am to 8pm. Appointments are available Mondays to Fridays from 8am to 12pm and from 3.30pm to 6pm on weekdays with evening appointments available on Tuesdays at Chaddesden and on Thursdays at Spondon. In addition, the practice also opened on some Saturday mornings to accommodate patient needs.

Outside of this cover, out of hours service is provided by Derbyshire Health United. Patients can contact NHS 111.

The practice is a Learning Centre for the University of Nottingham and teaches a large number of medical students across all year groups. In addition, the practice has welcomed requests from students wishing to obtain work experience prior to submitting an application for medical school.

Two of the GP partners also work at the University of Nottingham, one as a Director of Clinical skills and one as a GP Teaching Fellow.

Updated 29 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Derwent Valley Medical Practice on 6 September 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 and an effective system in place for reporting and recording significant events. Learning outcomes were shared with staff.
• Risks to patients were assessed and generally well managed. Health and safety precautions had been taken which included checking that equipment was fully working and safe to use and infection prevention and control measures were in place.
• 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.
• Comment cards we received from patients showed that they felt they were treated with compassion, dignity and respect.
• Patient feedback from surveys undertaken was mixed. Patients had confidence and trust in the last GP they saw but satisfaction rates for patients getting to see their preferred GP were low. The practice was taking positive action to address all patient feedback received.
• 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.
• 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.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• The practice should continue in its efforts to improve the patient care experience in relation to access arrangements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 December 2016

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. Care plans were in place for all of these patients.

• National data showed the practice was performing above the local CCG and national averages for its achievement within eleven diabetes indicators.The practice achieved 98% of the available QOF points compared with the CCG average of 93%. Achievement was also above the national average of 89%.

• Data showed that 97% of patients with chronic obstructive pulmonary disease (COPD) had received a confirmed diagnosis. This was above the CCG average of 92% and national average of 90%. Exception reporting was 9.9% which was better than the CCG average of 11.5% but similar to the national average of 9.8%.

• Longer appointments and home visits were available when needed.

• In-house services were provided for patients with long term conditions. These included ECG testing (test that checks for problems with electrical activity of the heart) ambulatory BP (ongoing blood pressure monitoring) and spirometry (test used to assess breathing and to assist in diagnoses).

Updated 29 December 2016

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.

• The practice had trained all its staff in safeguarding and had undertaken an audit to test staff knowledge of safeguarding matters.

• We saw that effective collaborative working took place between doctors in the practice and those attached staff involved in child welfare.

• Immunisation rates for all standard childhood immunisations ranged from 88% to 100%. This was comparable to CCG averages which ranged from 91% to 98%.

• We reviewed information which showed that children and young people were treated in an age-appropriate way and were recognised as individuals.

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

Updated 29 December 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. All older patients had a named GP. Frequent visits were made by the practice GPs and the nurse practitioner to their care home patients in and outside of working hours. A care home manager we spoke with praised the practice for their responsiveness and hands on approach.

• The practice utilised the skills of a CCG funded care co-ordinator who held regular multidisciplinary meetings where all patients who were vulnerable and requiring intervention were discussed with input from other care teams into their holistic care.

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

• The practice had received 100% of total available QOF points in osteoporosis indicators. This was above CCG average of 93% and national average of 81%. The practice had not exception reported any patients within the indicators.

Updated 29 December 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. Extended hours appointments were available for patients up until 8pm two evenings of the week and telephone consultations were available.

• 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.

• A total of 83% of women aged over 25 but under 65 had received a cervical screening test in the previous 5 years. The practice was performing similar to the CCG average of 84% and national average of 82%.

• The practice offered NHS Health checks to its working age patients and those who had reached retirement age.

Updated 29 December 2016

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

• A total of 78% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was below the CCG average of 85% and below the national average of 84%.

• A total of 100% of patients with a mental health condition had a documented care plan in place in the previous 12 months. This was above the CCG average of 92% and above the national average of 88%. Exception reporting was 22% which was similar to the CCG average of 20.9% but above the national average of 12.6%.

• 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. The practice had access to an in-house counsellor and referred patients into this service.

• The practice had commenced an antipsychotic prescribing audit to establish current standards of monitoring. Antipsychotics are medicines usually prescribed for patients with mental health disorders.

Updated 29 December 2016

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 those with a learning disability. There were 98 patients on the learning disability register. All of these patients had been invited to attend for a review in 2015/16 and 66 of these patients had received a review during this time.

• 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. Documentation supported that patients received ongoing care and support from the appropriate health care service(s).

• The practice had implemented a policy where it would follow up those vulnerable patients who had missed appointments at a hospital or clinic to understand reasons for non attendance. They then encouraged patients to attend a further appointment.

• 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.