Hugglescote Surgery

Updated 29 March 2017

Hugglescote Surgery provides primary medical services to approximately 7350 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 2009 in Hugglescote near to the former mining town of Coalville 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 fourth least deprived decile. The levels of deprivation affecting children and older people are in line with local averages but below the national averages. The practice has a slightly higher than average numbers of patients under 18 years old.

The clinical team includes three GP partners (male), two salaried GPs (female), one advanced nurse practitioner/nurse manager, three practice nurses and two healthcare assistants. They are supported by a practice manager and 14 reception, administrative and cleaning staff. The practice manager is supported by another manager who offers management services on a self-employed basis. It is a teaching and training practice offering placements for university medical students and GP registrars (qualified doctors training to become GPs). At the time of our inspection there were three GP registrars.

The surgery is open from 8am to 6.30pm on Monday to Friday. It does not provide the extended opening hours service. There are morning and afternoon consulting clinics, with appointments starting at 8.30am up to 5.50pm for GPs and 8am to 6.10pm for nurses.

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 29 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hugglescote Surgery on 17 January 2017. 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 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.

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

• 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. They engaged with the practice to host a number of health promotion initiatives which included evening talks for patients with long term conditions.

• 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.

• The practice demonstrated a responsive approach by taking account of the needs of their local population, and not just their registered patients. This enabled services to be delivered closer to patient’s homes.

• National patient survey results showed 93% of patients said the last appointment they got was convenient.

• 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 provider was aware of and complied with the requirements of the duty of candour.

We saw some outstanding features:

• The practice was responsive to the needs of vulnerable people, and delivered interventions or redesigned operating procedures to actively meet these needs. This included the provision of a community transport service at a reduced cost compared to local taxi rates. Practice supplied data showed 44 patients had used the service between April 2015 and December 2016.

• The practice took a flexible approach in accommodating traveller families, resulting in overall increased uptake of childhood immunisations. For example, overall immunisation rates for two year olds increased from 90% in December 2010 to 100% achievement in the same quarter in 2016.

We found an area where the practice should make improvements:

• Continue to take steps to improve annual reviews of patients with learning disabilities.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 March 2017

The practice is rated as good 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 monthly recall process for patients with long term conditions in the month of their birthday and provided home visits by the nursing team to housebound patients for routine checks required. Longer appointments were available when needed.

• For patients with the most complex needs, practice staff worked with relevant health and care professionals to deliver a multidisciplinary package of care. There were regular clinics provided from the practice premises by specialist nurses in diabetes, respiratory and heart failure.

• The practice participated in evening learning events organised by their local GP federation in January, February and June 2016 conducted by pulmonary rehabilitation specialists for patients with asthma and COPD. A total of 560 patients from the federation practices attended the events. Of the 100 people who provided feedback at the event in June, 95 said they found the information helpful in managing COPD.

• Other events organised by the practice were a diabetes awareness event in 2015 for their own patients and another in January 2017 for patients from the whole federation.

• Nationally reported data showed 77% of patients on the diabetes register had their blood glucose in well controlled range, compared to the CCG average of 83% and the national average of 78%. The exception reporting rate was 10%, same as the CCG average of 10% and below the national average of 13%.

• The outcomes for patients with long term conditions were mostly in line with national averages. For example, Performance for indicators related to asthma was 100%, which was 0.4% above the CCG average and 2.6% above the national average. The exception reporting rate was 15%, compared to the CCG average of 9% and the national average of 7%.

Updated 29 March 2017

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 a child safeguarding lead GP and staff were aware of who they were.

• Formal meetings were held bi-monthly with the health visitor to review children at risk. Feedback from the health visitor was positive about the effective working relationship with the practice and midwife.

• Antenatal and baby clinics were provided regularly from the practice premises by a health visitor and midwife.

• The practice took a flexible approach with regards to appointments for children living in the travelling community to enable the practice to administer childhood immunisations opportunistically.

• The practice nursing team held immunisation clinics before and after school for the convenience of school age children. Immunisation rates were high for all standard childhood immunisations. For example, immunisation rates for children under two years old averaged at 94%, above the national standard of 90%.

• The practice provided a wide range of sexual health services. Patients who requested for coil fittings and implants were referred to local family planning services and other providers in the locality.

• Urgent appointments were available on a daily basis to accommodate children who were unwell.

Updated 29 March 2017

The practice is rated as good 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.

• The practice established links with a local community transport service provider who carried patients aged over 60 years from their homes to the practice at a reduced cost compared to local taxi rates. Practice supplied data showed 44 patients had used the service between April 2015 and December 2016, with some patients using it multiple times for visits to the surgery. Information about the service was available in the practice waiting areas and on the website.
• Home visits were available for older patients and patients who had clinical needs which resulted in difficulty attending the practice. Requests received in the morning were assigned to a home visiting service commissioned by the CCG operated in the local area, ensuring patients were seen promptly.

• The practice provided enhanced medical care to patients resident in a local nursing home, with twice weekly visits by a GP. Staff took an integrated care approach involving local dieticians, physiotherapists and old age psychiatry teams where appropriate. Staff from the care home told us all practice staff were highly responsive to their needs and GPs visited promptly when needed.

• Feedback from the care home was positive about the care and treatment provided, including support with end of life care needs. There were 46 patients on the palliative care register and 128 patients on the unplanned admissions register. The practice reviewed all deaths of patients on the palliative care register. Data provided by the practice showed that in 2016, 77% of patients on the register had died in their preferred place of death.

• 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 7%, compared to the CCG and national averages of 9%.

• Information on local wellbeing groups to support older people to socialise and maintain their independence was available in the practice waiting room.

Updated 29 March 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.

• Early morning and late appointments were offered to enable working patients to be seen. Urgent and routine telephone appointments were available daily if needed. National patient survey results were positive about access to the service.

• Flu, pneumonia and shingles vaccinations were offered on a Saturday for the convenience of working patients and those unable to attend appointments during weekdays.

• 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. Additionally, patients were able to collect their prescriptions from a pharmacy of their choice through the electronic prescription service.

• Uptake rates for screening were better than the national average. For example, the uptake rate for cervical cancer screening in 2015/16 was 86%, above the CCG average of 83% and above the national average of 81%.

Updated 29 March 2017

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

• There were 39 patients on the mental health register. Published data showed 94% 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 51%, compared to the CCG average of 30% and the national average of 13%.

• GPs told us they worked with a mental health facilitator attached to the practice who held regular clinics to encourage patients who had declined invitations for review to attend. The practice monitored their performance and was able to demonstrate how the low patient numbers affected their performance rates, and patients had been appropriately excluded.

• Patients were recalled at least three times for their reviews using a variety of contact methods including letters, telephone calls, messages on prescriptions and text messages. The variety of contact methods reduced the risk of patients not receiving a reminder.

• Patients were given pre-arranged regular appointments with the same GP.

• There were 45 patients on the dementia register. Nationally reported data showed 76% 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 5%, compared to the CCG average of 12% and the national average of 7%.

• Patients experiencing poor mental health were told how to access various support groups and voluntary organisations. Feedback sent to the practice by a patient was positive about the aftercare advice provided by a GP at the practice, and the caring approach of the practice.

• Staff had a good understanding of how to support patients with mental health needs and dementia. All staff had undertaken dementia awareness training.

Updated 29 March 2017

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. 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.

• The surgery provided medical services to 143 people from the travelling community through a locally agreed enhanced service. Patients were fully registered with the surgery, and they could use the practice address for their medical correspondence. Staff would telephone them if any mail arrived for them.

• A flexible approach was taken when patients requested appointments to ensure their health needs were assessed conveniently. Practice supplied data showed 50% of appointments booked by them were offered on the same day. Staff told us their flexible approach enabled them to achieve high immunisation rates for children from travelling families.

• Staff had received training delivered by a travelling family service health visitor and a patient living in the travelling community to raise awareness of how they could tailor services to suit the needs and lifestyle of travelling communities.

• The practice provided general medical services to patients living in a women’s refuge in the local area. Staff were aware of confidentiality and sensitivities required when interacting with the patients.

• Information on local temporary accommodation for people who may be homeless was displayed in the waiting area.

• There were 34 patients on the learning disabilities register in 2015/16. However, only seven of them (21%) had attended a face to face review appointment. Staff told us dedicated clinics for reviews were offered in addition to the choice of routine appointments at times convenient for patients. Staff told us there were plans to carry out reviews in residential homes with minimal disruption to the patients’ routines, and improve uptake of reviews. Additionally, the practice liaised with the community learning disabilities specialist nurse to ensure patients who did not attend appointments received appropriate care at home.

• GPs demonstrated a caring approach by seeing a patient with learning disabilities in their car to assess their health because they were not comfortable to enter the surgery.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. Patients receiving palliative care were given their GP’s mobile numbers for contact out of hours to enable them to have continuity of care. Feedback from the care home was positive about the care and treatment provided, including support with end of life care needs.

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