Chatsworth Road Medical Centre

Updated 26 October 2016

Chatsworth Road Medical Practice provides medical services to approximately 9,150 patients through a primary medical services contract. Services are provided from a purpose built building situated on the corner of Storrs Road in Brampton, Chesterfield.

The buidling has two floors, with patient services being delivered from the ground floor and second floor for patients who can manage stairs. A small annexe is adjacent to the main surgery building and this is where GPs facilitate the community dermatology clinic and community nurses operate some of their clinics.

The practice demographics shows that: deprivation levels are below national average, patients are predominately white British, higher numbers of older people aged 75 and over, and lower than average numbers of children and young people

The clinical team comprises of four GP partners (two female and two male) of whom one GP is currently on maternity leave, two female salaried GPs, a regular female GP locum and three practice nurses (female) and a health care assistant. The clinicians are supported by an administration team comprising, a full time practice manager, two team leaders, receptionists, medical secretaries and summarisers.

Community based professionals working with the practice team include the community matron, specialist community nurses, a practice support pharmacist and a pharmacy technician.

The practice opens from 8am to 6.30pm Monday to Friday. Generally appointments are from 9am to 11.30am each morning and from 3.30pm to 6.30pm each afternoon. Extended hours appointments are offered on various Monday and Tuesday evenings from 6.30pm to 8pm and on a Saturday morning between 8am to 11am. A small number of on the day appointments are released at 8am each morning for patients needing to be seen the same day.

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

Updated 26 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Chatsworth Road Medical Centre on 21 June 2016. Overall the practice is rated as outstanding.

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

• There was a genuinely open culture in which all safety concerns were highly valued and seen as integral to learning and improvement. Opportunities for learning from internal and external incidents were communicated widely with multi-disciplinary colleagues and external agencies.

• Robust systems were in place to ensure risks to patients were assessed and well managed. This included medicines management, recruitment and planning for emergencies.

• Staff took a holistic approach to assessing, planning and delivering care and treatment to patients in line with current evidence based guidance.

• All staff were actively engaged in clinical and internal audits to monitor and improve the care for patients.

• Published data showed patient outcomes were at or above average compared to the local and national averages.

• Regular multi-disciplinary team meetings took place to ensure patients with complex health needs were supported to receive coordinated care.

• All sources of information we reviewed including feedback from patients, carers and stakeholders was continually positive about the caring nature of staff. Positive examples were given by patients to demonstrate that staff had gone the extra mile to support them when needed and the care they had received exceeded their expectations.

• The practice provided excellent access (telephone and appointments) for patients to receive medical care and this was strongly reflected in patient feedback and survey results. In addition, usage of secondary services was below the local averages.

• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice actively reviewed complaints and made improvements as a result.

• The practice had a clear vision which had quality and safety as its top priority. The action plan to deliver this vision was reviewed and discussed with staff.

• The practice had strong and visible clinical and managerial leadership and governance arrangements.

• There was a strong focus on continuous learning and improvement at all levels. This included patient education facilitated by the patient participation group.

We saw several areas of outstanding practice including the following:

• A team approach had been adopted to create an open and transparent environment for staff to raise significant events, however minor or significant, with the resulting impact of significant events increasingly being reported. Staff referred to significant events as learning opportunities to share (LOTS) which reflected the shared ethos within the practice. LOTS were also discussed during fortnightly multi-disciplinary team meetings and outcomes were shared with external agencies if needed, to ensure shared learning and improvement.

• Patient feedback was overwhelmingly positive about the way staff treated people and patients confirmed they had consistently received an excellent and compassionate service. This was corroborated by stakeholder feedback, friends and family test results and a wide range of internal and external survey results.

• The community dermatology clinic was accessed by patients registered with other GP practices within North Derbyshire. The service had been in operation for 18 months and was led by two GPs with special interest in dermatology; in collaboration with three other GPs and consultant. Diagnostic and treatment services were offered over two sessions a week and 484 patients had accessed the service as at 31 May 2016. Records reviewed showed this had promoted positive outcomes for patients and staff. For example:

• The operation of the service had reduced the treatment waiting times at the local hospital by 50%.

• 50% of patients who had received treatment were discharged after their initial appointment and the onward referral rate to secondary care was 12%.

• An overall recovery rate of 95% was achieved.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 October 2016

The practice is rated as outstanding for the care of people with long-term conditions. The impact of this affected the quality of services provided to all patient groups and this led to an outstanding rating for all population groups.

• The practice has consistently achieved above average points for most clinical performance indicators for long term conditions.

• Nursing staff had lead roles in chronic disease management and care planning took place for patients with conditions such as asthma and diabetes.

• Patients with the most complex needs including patients at risk of hospital admission were identified as a priority. A named GP worked with other health and social care professionals to deliver a multi-disciplinary package of care. This included collaborative working with specialist nurses for heart failure and respiratory conditions.

• Medicines including prescribing was effectively managed to ensure patients received safe care. In addition, structured annual reviews were undertaken to check patients’ health and medicines needs were being met.

• Patients had excellent access to appointments and home visits; and this aligned with the lower than local average emergency admission rates for ambulatory care sensitive conditions. These are chronic conditions for which it is possible to prevent acute exacerbations and reduce the need for hospital admission through active management.

• Practice survey results showed high patient satisfaction for anticoagulation monitoring for patients seen at the practice and at home.

Updated 26 October 2016

The practice is rated as outstanding for the care of families, children and young people. The impact of this affected the quality of services provided to all patient groups and this led to an outstanding rating for all population groups.

• The practice had achieved an uptake rate of 100% for all vaccinations given to children under two years and an average rate of 99% for all vaccinations given to five year olds. This was above the local averages.

• Children had excellent access to clinicians when needed and this included same day appointments for urgent medical needs and appointments outside of school hours.

• Benchmarking data showed the practice had achieved low paediatric referral rates and low emergency admission rates; which were below the local average.

• The safeguarding of children, young people and pregnant women was a priority within the practice.

• 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 they were provided with good care.

• The practice website contained useful information and videos on pregnancy care planning, antenatal and post-natal care; as well as general information on maternity leave and employment rights. This empowered mothers to make informed decisions about their care and baby.

• A full range of family planning services was provided including emergency contraception, intra-uterine device insertion and implant fitting.

Updated 26 October 2016

The practice is rated as outstanding for the care of older people. The impact of this affected the quality of services provided to all patient groups and this led to an outstanding rating for all population groups.

• All patients aged 75 years and over had a named accountable GP.

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

• Data reviewed showed:

• Clinical outcomes for conditions commonly found in older people, for example osteoporosis and rheumatoid arthritis, were above local and national averages.

• The emergency admission rates for people aged 75 and over were below the local average.

• Patients at risk of hospital admission were discussed at fortnightly multi-disciplinary meetings and the practice team regularly

• Medicine reviews for patients aged over 80 on multiple medicines were regularly carried out.

• The practice staff ensured best interest decisions were made for patients lacking the mental capacity to make specific decisions about their care. This was in liaison with the patient’s next of kin and the wider multi-disciplinary teams.

• The practice provided care to residents living in a local care home for older people. A nominated GP visited the care home each week and care planning was undertaken with relatives. Feedback received from staff and residents was extremely positive with comments highlighting good continuity of care and a high quality service was provided.

Updated 26 October 2016

The practice is rated as outstanding for the care of working-age people (including those recently retired and students). The impact of this affected the quality of services provided to all patient groups and this led to an outstanding rating for all population groups.

• Patients could access the Citizens Advice Bureau (CAB) service within the practice. The CAB service was hosted every fortnight and offered patients free, confidential and independent advice on debt, benefits, housing and employment for example.

• The uptake rates for cervical, bowel and breast cancer screening were above local and national averages. For example, 82% of females aged between 50 and 70 years had been screened for breast cancer in the last three years compared to a local average of 77% and national average of 72%.

• The practice was proactive in offering a full range of health promotion that reflected the needs for this age group. For example, travel and flu vaccinations, and advice on diet, smoking and alcohol cessation.

• Late evening doctors’ appointments were offered on various Mondays and Tuesdays between 6.30pm and 8pm. Pre-bookable appointments were available every Saturday morning; and NHS health checks for patients aged 40-74 were also undertaken on a Saturday.

• The practice had adjusted the services it offered to ensure they were accessible, flexible and offered continuity of care.  This included telephone consultations, text messages, and online access to book appointments, request prescriptions and view medical records (subject to registration for the services).

Updated 26 October 2016

The practice is rated as outstanding for the care of people experiencing poor mental health (including people with dementia). The impact of this affected the quality of services provided to all patient groups and this led to an outstanding rating for all population groups.

• Patient feedback was positive about the support given by staff in times of crisis and being signposted or referred to various support groups and community mental health services.

• Staff had a good understanding of how to support patients with mental health needs and dementia. For example, all staff were trained as “dementia friends” and a lead member of staff was a dementia champion.

• Carers of patients with dementia were identified and staff took account of their needs, for example, appointment flexibility and respite needs.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health and those with dementia. For example, annual meetings were held with a consultant psychiatrist and the community mental health teams to discuss referral pathways and joint care arrangements.

• Annual physical health checks were carried out for patients, including medicine reviews, regular blood monitoring where needed, and health promotion advice was offered. The outcomes of the health reviews were shared with the mental health team to inform the care programme approach (CPA) review. The CPA provides a framework for effective mental health care for people with severe mental health needs.

• Systems were in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Care plans were also shared with the out of hours provider for patients at risk of hospital admission and / or relapse. This ensured co-ordination of care when the surgery was closed.

The published data for 2014/15 showed:

• 84% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, and this was in line with the local and national averages. This was achieved with an exception reporting rate of about 7% compared to a local average of 9% and national average of 8%.

• 98% of patients diagnosed with a mental health need had a comprehensive care plan in the last 12 months. This was above the local average of 93% and the national average of 88%. This was achieved with an exception reporting rate of about 10% compared to the local average of 15% and national average of 11%.

Updated 26 October 2016

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable. The impact of this affected the quality of services provided to all patient groups and this led to an outstanding rating for all population groups.

• Patient satisfaction surveys had been undertaken specifically for people with learning disabilities and their carers, as well as patients who were housebound and received home visits. Patients were extremely satisfied with the overall care received and areas of improvement were considered by the practice and patient participation group.

• Annual health checks including a review of care plans was facilitated for patients with learning disabilities. At the time of our inspection, 15 out of 29 annual health checks had been completed since 1 April 2016.

• Longer appointments and home visits were offered for annual health and medicine reviews.

• The practice regularly worked with other health and social care professionals in the case management of vulnerable patients including those receiving end of life care. For example, regular meetings were held with the local care home staff to review the services offered and to discuss the care needs of the residents.

• Temporary residents including those living in care homes could register at the practice and access services.

• Staff had received training in safeguarding vulnerable adults and children. There were fully aware of their responsibilities to act upon concerns and ensure the safety of patients.

• The practice was considered a safe haven should vulnerable adults need to seek support whilst in the community.

• Reasonable adjustments were made to the service and premises to accommodate the needs of patients with disabilities and impairments. For example, a low counter on reception for wheelchair users and a hearing loop to support the needs of patients with hearing impairment.