Danetre Medical Practice

Updated 17 March 2016

Danetre Medical Practice is located on the local community hospital site and serves approximately 12,600 patients from Daventry town. The practice holds a Primary Medical Services contract and provides GP services commissioned by NHS England. The practice is preparing to move to a General Medical Services contract.

The practice is managed by four GP partners (one male, three female) and there are four salaried GPs who between them provide 57 clinical sessions per week. They are supported by two nurse practitioners, five practice nurses and three healthcare assistants. Nurses have dedicated roles such as diabetes management and immunisations. One GP carries out research and is supported by a research nurse who works two sessions per week. The practice employs a practice manager, a corporate services assistant, an operations manager, a patient services team leader, a care coordinator, a support services team leader and a prescribing technician who received requests and organised repeat prescriptions. They are supported by 18 administration and reception staff who includes team leaders.

The practice is a teaching and training practice, which supports and mentors trainee GPs.

The practice is open from 7.30am until 6.30pm each day. Each GP has varied timings for their clinical sessions so appointment timings will differ depending on which GP a patient is seen by. Appointments commence at 7.30am until 10.30am, 11am until 12.30pm and 1.30pm until 6.30pm each weekday. However, the duty GP will see patients at any times during the opening hours. There are a range of appointment types including’ on the day’ and advance appointments up to four weeks. Urgent appointments are available on the day. Telephone consultations are available for patients who are unsure if they need an appointment and for provision of advice for children.

The practice has opted out of providing GP services to patients out of hours such as nights and weekends. During these times GP services are provided currently by a service commissioned by NHS Nene Clinical Commissioning Group (CCG). When the practice is closed, there is a recorded message giving out of hours’ details.

Updated 17 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Danetre Medical Practice on 2 December 2015. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents had been maximised.

• Risks to patients had been identified and assessed and well managed to minimise those risks.

• The practice was actively involved with local and national initiatives to enhance the care and treatments offered to patients. Practice staff were proactive in piloting new ways of working to improve meeting the needs of patients.

• Patients we spoke with said they were treated with respect and they felt involved with decisions about their care and treatment. They commented about how helpful staff were towards them. Information was available and details of support groups to help them understand about their care needs.

• Practice staff listened and when possible implemented suggestions for improvements and made changes to the way they delivered services. Information about how to make a complaint was available and easy to understand.

• There was a structured programme in place for staff annual appraisals and for planning their training needs. Staff were actively encouraged to enhance their knowledge and skills.

• There was a clear leadership structure and staff told us they felt supported by senior staff and that there was an open culture throughout. There was a clear vision to promote high standards of care. There was a comprehensive governance system in place to monitor the quality of practice wide performance.

We saw areas of outstanding practice including:

• A new post of ‘care co-ordinator’ was established in 2015. The staff member was responsible for the interface and seamless care for patients between primary, secondary (hospital), community care and voluntary organisations. They monitored care of 3% of patients with the most complex needs. The care co-ordinator received and collated information on hospital admissions and discharges including the out of hour’s service. They presented information to the lead GP, multidisciplinary teams and all other services involved, such as; social services. They arranged for tests and referrals to be carried out and made courtesy calls to patients who were on the community matron’s case list and following discharge from hospital. The system provided a comprehensive audit trail of the care provided; identified where more care was required and liaised with the appropriate care provider. It contributed positively to the Northamptonshire ‘frail and elderly’ community programme and served to prevent unnecessary hospital admissions.

• Clinicians carried out regional and national clinical research programmes. The GP researcher was supported by a research nurse in carrying out a wide range of programmes. For example, cardiovascular risk management of patients who experienced mental health illness, bowel/lung cancer and antibiotic prescribing for children who were experiencing flu type symptoms. The results of the research were shared widely and influenced appropriate patient care.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 March 2016

The practice is rated outstanding for the care of people with long term conditions.

Practice staff held information about the prevalence of specific long term conditions within its patient population such as, diabetes and hypertension. Varied appointments were offered to ensure long term conditions were adequately reviewed. Clinical staff kept up to date with specialist areas which helped them ensure best practice guidance was considered. Multidisciplinary and palliative (end of life) meetings were held where patient care was reviewed to ensure they received care that was appropriate for their needs.

A GP and a dedicated research nurse carried out a wide range of clinical research. For example, cardiovascular risk management of patients who experienced mental health illness, bowel/lung cancer and antibiotic prescribing for children who were experiencing flu type symptoms. The results ensured patients received appropriate and treatment to prevent unnecessary deterioration of their conditions.

During 2014-15 93.3% of patients had attended the practice to have their blood pressure checked. To educate and raise patient awareness of the need to attend for this assessment Saturday morning sessions were held by the PRG where patients could drop in to check their blood pressure on the machine that was situated in the waiting area.

The care co-ordinator role ensured that 3% of patients with the most complex needs obtained seamless, timely and appropriate care. The practice manager told us the system worked in reducing the number of hospital admissions.

The nurse practitioners visited patients in their own homes and those who resided in care homes to review their long term conditions and administer flu vaccinations.

Carers were encouraged to identify themselves, new carers were sent an introductory phone text message followed by a letter and a carers pack.

Updated 17 March 2016

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

Staff were responsive to parents’ concerns about their child’s health and prioritised appointments for children presenting with an acute illness. The extended morning hours allowed parents to take their children for appointments outside of school hours. Staff were knowledgeable about child protection. Alerts were put onto the electronic record when safeguarding concerns were raised. There was regular liaison with the health visitor to review those children who were considered to be at risk of harm.   

Updated 17 March 2016

The practice is rated good for the care of older people.

Clinical staff were knowledgeable about the health needs of older patients. They kept up to date registers of patients’ health conditions and information was held to alert staff if a patient had complex needs. Home visits were made to patients who were unable to access the practice. Practice staff worked with other agencies and health providers to provide support and specialist services when they needed it. Clinical staff had identified those patients who were at risk of unplanned hospital admissions and had developed care plans to support them. Part of the role of the two nurse practitioners involved visiting patients who were not able to access the practice. They carried out assessments and provided care and treatment for patients. 

Updated 17 March 2016

The practice is rated good for the care of working-age people (including those recently retired and students).

A full range of health promotion and screening services were provided that reflected the needs of this population group. During 2014 to 2015 there had been an uptake of 100% of available Quality and Outcome Framework (QOF) points for cervical screening. On line appointments, cancelling appointments and repeat prescription requests were available. Appointments were available from 7.30am each day. Telephone consultations were available to those patients who had difficulty in attending or were unsure if they needed to make an appointment. A choose and book referral system was in place to enable patients to choose the provider, date and time that was convenient to them.

Updated 17 March 2016

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

Clinical staff worked with specialist services to review care and to ensure patients received the support they needed. Staff maintained a register of patients who experience poor mental health including dementia. Patients were referred to appropriate services such as psychiatry and counselling services. Clinical staff had received training and were aware of their responsibilities under the Mental Capacity Act 2005 and in respect of gaining consent for patients care and treatment.

Regular reviews were offered towards the end of the day because the practice experienced a high did not attend (DNA) rate when earlier appointments were provided. 

Patients who experienced poor mental health and depression were referred to an in-house a counsellor who visited the practice each week to provide non-medical advice and support to assist patients in coping with their lifestyles and condition.

The local county council held three well-being sessions per week at the practice. Their aim was to provide access to services for people who were experiencing poor mental health. 

Updated 17 March 2016

The practice is rated good for the care of people whose circumstances may make them vulnerable.

The practice held a register of all vulnerable patients including those who had a learning disability. Longer appointments were routinely available for this group of patients and the practice contributed towards their health action plans. There was a clinical lead for dealing with vulnerable adults and children. Staff had been trained in recognising signs of abuse and how to respond to concerns.  We saw evidence that staff had responded appropriately to safeguarding concerns.