Quorn Medical Centre

Updated 9 March 2017

Quorn Medical Centre provides primary medical services to approximately 8700 patients through a general medical services contract (GMS). This is a locally agreed contract with NHS England.

The practice has been located in purpose built premises since 1986 in the Quorn village in Leicestershire. Facilities are on two floors and these include consulting and treatment rooms.

The level of deprivation within the practice population is below the national average with the practice falling into the least deprived decile. The level of deprivation affecting children and older people is significantly below the national average. The practice has a slightly higher than average numbers of patients over 65 years old. The number of people aged 20 to 40 years old is significantly lower than national averages.

The clinical team includes two GP partners (male), four salaried GPs (female), three practice nurses and one healthcare assistant and one phlebotomist. They are supported by a practice manager and 11 reception and administrative staff. It is a teaching practice offering placements for university medical students in their third and fourth year.

The surgery is open from 8.30am to 6pm on Monday to Friday. Extended opening hours are provided from 6.45am to 8am on Thursday and Friday mornings. There are morning and afternoon consulting clinics, with appointments starting at 8.45am up to 5.30pm every day.

The practice has opted out of providing out-of-hours services to its own patients. This service is provided by Derbyshire Health United (DHU) and is accessed via 111.

Updated 9 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Quorn Medical Centre on 10 January 2017. Overall the practice is rated as outstanding.

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 people who use the service were consistently better than expected when compared to other practices.

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

• Patients were valued as individuals and empowered as partners in their care. They told us they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• National patient survey results showed 98% of patients said they were able to get an appointment to see or speak to someone the last time they tried. This was much better than others locally.

• 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 leadership, governance and culture were used to drive and improve the delivery of high quality person centred care. 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.

We saw some areas of outstanding practice, including:

• GPs had led and delivered improved outcomes and care for patients including across the local Clinical Commissioning Group (CCG) and over wide range of clinical areas including diabetes. The practice actively sought to prevent diabetes through the identification and follow up of patients with pre-diabetes or statistically at risk of diabetes.

• Services were tailored to meet the needs of individual people and delivered in a way to ensure flexibility, choice and continuity of care, as demonstrated by below average for their use of accident and emergency (A&E), emergency admissions and outpatient referrals in 2015/16.

• There was evidence of a highly engaged and proactive patient participation group (PPG) who participated in a number of initiatives to enrich the lives of patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 March 2017

The practice is rated as outstanding 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.

• The practice operated a recall process for patients with long term conditions and provided home visits to housebound for routine checks required. Longer appointments were available when needed.

• The outcomes for patients with long term conditions were above national averages. For example, the overall performance on asthma related indicators was 100%, compared to the CCG average of 99% and the national average of 97%. The exception reporting rate asthma indicators was 0.7%, below the CCG average of 9% and the national average of 7%.

• For patients with the most complex needs, practice staff worked with relevant health and care professionals to deliver a multidisciplinary package of care. People with long term conditions were encouraged to attend structured education courses, for example, diabetes and pulmonary rehabilitation courses, to improve their outcomes.

• The practice actively sought to prevent diabetes through the identification and follow up of patients with pre-diabetes or statistically at risk of diabetes. There were 798 patients identified who were given lifestyle advice and reviewed annually to delay the onset of diabetes, resulting in better outcomes. GPs told us they had observed positive outcomes through a lower than expected diabetes prevalence.

• Performance for diabetes related indicators was 100%, compared to the CCG average of 93% and the national average of 90%. The exception reporting rate was 6%, compared to the CCG average of 11% and the national average of 12%.

• Additionally, diabetic retinopathy clinics were provided from the practice premises, reducing the need for patients to travel long distances to access them.

Updated 9 March 2017

The practice is rated as outstanding 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 a child safeguarding lead GP and staff were aware of who they were. Meetings were held regularly with the health visitor, midwife and district nursing team to review children at risk, with liaison with the school nurse as required.

• Antenatal and baby clinics were provided regularly from the practice premises.

• Immunisation rates were high for all standard childhood immunisations. For example, immunisation rates for children under two years old averaged at 98% above the national standard of 90%.

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

• Urgent appointments were available on a daily basis to accommodate children who were unwell.
• The practice provided general medical services to approximately 300 students at a local school, including sexual health services. The practice encouraged all patients aged 15 to 24 years old to have chlamydia screening, with referrals offered for complex cases to specialist services.

Updated 9 March 2017

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

• They offered proactive, personalised care to meet the needs of the older people in their population. Monthly multidisciplinary meetings were held to review frail patients and those at risk of hospital admission to plan and deliver care appropriate to their needs. These included patients living in care homes.

• Home visits were available for older patients and patients who had clinical needs which resulted in difficulty attending the practice. Requests were assigned to a home visiting service operated in the local area, ensuring patients were seen promptly.
• Elderly people who may be isolated were signposted to a local befriending scheme where they could be matched to a volunteer who visited them regularly to offer friendship and support.

• Feedback from a care home whose residents were registered with the practice was positive about the care and treatment provided, including support with end of life care needs. Staff from the care home told us all practice staff were highly responsive to their needs and GPs visited promptly when needed.

• Data from 2015/16 showed 75% of eligible patients aged over 65 years were given flu vaccinations, compared to the CCG average of 71.5%. Pneumonia and shingles vaccinations were offered to eligible patients.

• All patients aged over 75 years old had a named GP for continuity of care.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including atrial fibrillation, osteoporosis, rheumatoid arthritis and heart failure were above local and national averages. For example, the practice achieved 100% for outcomes relating to heart failure. This was achieved with an exception reporting rate of 12%, compared to the CCG average of 9% and the national average of 9%.

• There were provisions for older patients with mobility difficulties to access full medical services on the ground floor.

Updated 9 March 2017

The practice is rated as outstanding 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 opening hours were provided from 6.45am to 8am on Thursday and Friday mornings, with GP and nurse appointments. Additionally, the practice self-funded the provision of appointments with the healthcare assistant during the extended opening hours as this was not covered in their agreement with NHS England.

• The practice was proactive in offering online services via its website. Appointments could be made and cancelled online as well as management of repeat prescriptions. Patients were able to access their medical records online.

• Uptake rates for screening were similar or better than the national average. For example, the uptake rate for cervical cancer screening in 2015/16 was 87%, above the CCG average of 83% and above the national average of 81%.

• Patients who had been absent from work because of illness were supported with their return to work through the use of fit notes and the local fit to work scheme.

Updated 9 March 2017

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

• There were 56 patients on the mental health register. Published data showed 95% of patients on the mental health register with complex mental health conditions had a comprehensive care plan in the preceding 12 months, compared to the CCG average of 94% and the national average of 89%. This was achieved with an exception rate of 32%, compared to the CCG average of 30% and the national average of 13%. GPs told us they worked with a mental health facilitator who held clinics every two weeks at the practice to encourage patients who had declined invitations for review to attend. In addition, they told us there had been computer coding problems discovered in 2015/16 which affected their performance, and the problems had been resolved.

• The practice monitored their performance by keeping a record of all patients who had not attended an annual review and recorded the reasons why they did not attend or had not been invited.

• There were 71 patients on the dementia register. Nationally reported data showed 78% of patients diagnosed with dementia had a care plan reviewed in a face to face appointment, compared to the CCG average of 87% and the national average of 84%. The exception reporting rate was 9%, compared to the CCG average of 12% and the national average of 7%.

• Patients could access a practice therapist who provided weekly counselling clinics through referrals from a GP or via self-referral forms which were available in the waiting area.

• Patients experiencing poor mental health were told 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 9 March 2017

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. The electronic patient record system flagged patients who were known to be vulnerable or at-risk to staff, including those with a learning disability and children on the safeguarding register.

• Patients at risk of admission, receiving end of life care and those with life limiting conditions were given open access, ensuring that they could see a clinician when they felt they needed one.

• There were 33 patients on the learning disabilities register and 30 had had attended a face to face review appointment in 2016. Two patients had declined the appointments and one patient was not deemed appropriate. The practice liaised with the community learning disabilities specialist nurse to ensure patients who did not attend appointments received appropriate care at home.

• The practice provided medical services to three care homes for people with learning disabilities. Feedback from one of the homes where 13 patients were resident was highly positive about the caring and attentive manner of the GPs and access to the surgery when required. Staff from the home told us their residents received personalised care with annual health checks carried out and care plans updated regularly.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients, including patients on the palliative care register. There were 47 patients on the 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.

• The practice had identified 160 patients as carers which was equivalent to 1.8% of the practice list. Carers were offered annual health checks.

• Information was on display that advised patients printed material and practice documents were available in large print, easy-read format. Language interpreters were also available for patients who needed them.

• A hearing loop was available in the practice.