Chapel Street Medical Centre

Updated 8 February 2017

Dr Young & Partners provides primary medical services to approximately 13000 patients through a general medical services contract (GMS).

The practice covers a three mile area east of Derby comprising the suburbs of Chaddesden and Spondon. The main practice is located in purpose built premises in Spondon, with the branch surgery in Chaddesden. The inspection team did not visit the branch surgery during this inspection.

The level of deprivation within the practice population is in line with the national average with the practice falling into the 5th most deprived decile. The level of deprivation affecting older people is slightly above the national average.

The clinical team is comprised of six GP partners (two female, four male) three female salaried GPs and five practice nurses, including a nurse manager. The clinical team is supported by a practice manager an assistant practice manager, reception and administrative staff. The practice is a teaching practice for medical students.

The main surgery is open from 8am to 6.30pm on Monday to Friday. Consulting times vary but are usually from 8.15am to 12.30am each morning and 3.30pm to 6pm each afternoon. The branch surgery holds clinical sessions at similar times however is closed between 12pm and 3.30pm and on a Wednesday afternoon. Appointments at both sites are available to all patients and can be booked through either reception for convenience.

Appointments are also available on a Saturday mornings to accommodate working age patients and those with caring responsibilities during the week between the hours of 8.15am and 11.30am. These appointments are available with a GP or nurse by prior appointment only at the main practice site.

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

Updated 8 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Young & Partners

on 10 November 2016. 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.
• The additional post of a safety lead had led to quarterly governance meetings and a full review of procedures to reduce risks and instil an ethos of safety and continuous development in this area with staff.
• 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 and dignity, and staff were supportive and respectful in providing care, involving them in 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.
• The practice had been ranked second in Derby city and 16th in the county in feedback from the GP patient survey, results showed that patients rated the practice highly. All questions were rated above the local and national average, For example 92% of patients stated they would recommend this surgery to someone new in the area, against a local average of 80% and a national average of 78%.
• 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 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 areas of outstanding practice:

• Staff had highlighted a potential weakness in the local safeguarding system and had taken it upon themselves to further enhance the safeguarding system to ensure safeguarded patients were proactively managed and potential risk was anticipated and treated appropriately. This was recognised as the responsibility of all staff and we saw several examples where a team approach had been taken to work with community staff to maintain an effective approach to safeguarding. This included having failsafe systems to ensure children and vulnerable adults at risk of harm were not missed.
• Bespoke ‘pop-up’ warnings were set up on the computer system for high risk medicines for example ACE inhibitors and warfarin. These alerted clinicians to the latest guidance and areas to discuss with patients in terms of assessing risk of the medicines side effects versus benefits. This was part of a drive to reduce reliance on clinicians’ memory of updates and ensure patient safety. This had derived from a review of an external significant event and the practice staff had implemented the learning outcomes to reduce the likelihood of prescribing error happening again.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 February 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 recall system had been reviewed and to increase the efficiency was to be linked to the patient’s month of birth.
• Performance for diabetes related indicators was 99.8% which was 7% above the CCG average and 10% above the national average. The exception reporting rate for diabetes indicators was 16.1% which was above the CCG average of 13.4% 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 CCG employed care coordinator.

Updated 8 February 2017

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

• 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 and nurse lead for safeguarding liaised with other health and care professionals to discuss children at risk.
• Immunisation rates were higher than local averaged 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 8 February 2017

The practice is rated as outstanding 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 with the CCG care coordinator to review frail patients and those at risk of hospital admission to plan and deliver care appropriate to their needs.
• Care plans were shared with out of hours services to ensure care was in line with patients wishes and assist in clinical decision when the practice was closed.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs which included nurse appointments and flu vaccinations.
• A designated GP visited a local care 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.
• The practice offered pessary fitting to reduce the need for travel to hospitals.

Updated 8 February 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.
• Appointments could be made and cancelled on line as well as management of repeat prescriptions.
• There was 24 hour blood pressure monitoring available.
• The practice had listened to patient feedback when organising extended hours appointment and as a result offered a Saturday morning clinic for those who were unable to attend in the week.

Updated 8 February 2017

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

• Performance for mental health related indicators was 97.3% which was 1% above the CCG average and 4.5% above the national average. The exception reporting rate for mental health related indicators was 12.2% which was below the CCG average of 17% and in line with the national average of 11%.
• 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 81.3% which was 4% below the local average and 2.5% below the national average. This was achieved with an exception reporting rate of 6.8%, 1.1% lower than the CCG average and the same as the national average.
• 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 and a memory clinic was hosted at the practice.
• Staff had a good understanding of how to support patients with mental health needs and dementia and could organise bespoke appointment reminders depending on the needs of the patient.

Updated 8 February 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 including those with a learning disability.
• The practice offered longer appointments for patients with a learning disability and for those who required it.
• 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.