Rosebery Medical Centre

Updated 28 April 2017

Rosebery Medical Centre is run by a partnership of nine GPs and a business partner, which is known as Charnwood Community Medical Group. The main practice is Rosebery Medical Centre, which is located in Roseberry Street, Loughborough in Leicestershire. There are two branch surgeries located approximately two miles from the main practice; Outwoods Medical Centre in Beaumont Road, Loughborough and Forest Edge Medical Centre in Old Ashby Road, Loughborough. We did not inspect the branch surgeries as part of this inspection.

At the time of our inspection the practice had approximately 12,200 patients. The main practice is located in adapted premises; all three surgeries have car parking and disabled access and are accessible by public transport.

Rosebery Medical Centre is part of NHS West Leicestershire Clinical Commissioning Group (CCG). The practice has a General Medical Services (GMS) contract with NHS England. This is a contract for the practice to deliver general medical services to the local community or communities. The practice is located in the town of Loughborough, which is largely an area of lower deprivation with some pockets of higher deprivation, compared with the national and local Clinical Commissioning Group (CCG) area.

The staff team includes nine GP partners (five female, four male) along with a salaried GP (female). Three of the GP partners work full time; the remaining GP's work part time. The team also includes a business partner who works fulltime, an accounts manager, administrative manager, two practice nurses (female), five Healthcare Assistants (female), five cleaners and reception and administration staff.

The practice is a teaching practice for medical students and a training for GP trainees and foundation year 2 doctors.

Rosebery Medical Centre is open from 7.30am to 6.30pm Monday to Friday, Outwoods Medical Centre is open from 8.am to 5.30pm on Monday, Wednesday and Thursday and from 7.30am to 5.30pm on Tuesday and Friday and Forest Edge Medical Centre is open from 8am to 5pm Monday to Friday.

Appointments are available throughout the day at Rosebery Medical Centre from Monday to Friday, at Outwoods Medical Centre every day apart from Friday afternoon, and at Forest Edge Medical Centre every day apart from Tuesday afternoon.

The practice offers extended early morning surgeries on Tuesdays, Thursdays and Fridays. Evening telephone calls are available every day.

The practice has opted out of providing out-of-hours services to its patients. The out-of-hours service is provided by Derbyshire Health United.  Contact is via the NHS 111 service.

Updated 28 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rosebery Medical Centre on 9 November 2016. 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.  Risks to patients were assessed and well managed.
• An effective system in place for reporting and recording significant events.
• Comments from patients were generally very positive with regards the care and services they received. Patients said they were treated with compassion, dignity and respect, and were involved in decisions about their care and treatment.
• Most patients told us they were usually able to access appointments or telephone consultations when they needed them.
• The involvement of other organisations and the local community was integral to how services were planned to ensure that services meet people’s needs.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• There was evidence of quality improvement including clinical audits.
• There was a focus on continuous learning and improvement at all levels within the practice. The practice team was forward thinking and part of local pilot schemes to improve outcomes for patients.
• There was a clear leadership structure and staff felt well supported by management.
• The provider was aware of the requirements of the duty of candour.
• Information about services and how to complain was accessible. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice actively sought feedback from patients in a variety of ways, which was acted on to improve the services.

We saw the following area of outstanding practice:

There were high levels of engagement with the patient participation group (PPG) to improve the services. The PPG was actively involved in the planning and delivery of services, and shared an open and innovative partnership with the practice. The practice and the PPG had undertaken various joint research projects to look at the needs of patients. For example, the PPG achieved a national award for outstanding examples of leadership in health research and primary care, for their joint involvement in a two year study of patients’ management of long term conditions, which had led to improvements to patients care. The PPG and practice also held joint health awareness events for its patients including a diabetes education evening and a kidney health awareness event, which involved external organisations.

The area where the provider should make improvements are:

• Further identify patients who are carers to ensure they receive appropriate support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 April 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• The practice maintained registers of patients with long term conditions.

• Longer appointments and home visits were available where needed.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• The practice participated in a number of schemes to improve outcomes for patients with long-term conditions. For example, the practice was part of a pilot to invite patients with three or more chronic diseases to attend structured education sessions to help them stay healthy.

• The number of patients who had received a health review in the last 12 months was high. For example, 60 or 100% of patients on the mental health register and 138 or 95.1% of patients with chronic obstructive pulmonary disease (COPD) were reviewed during the year.

Updated 28 April 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 who were at risk, for example families with children in need or on children protection plans.

  Children were seen the same day if unwell. Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

• The Practice maintained a childhood immunisation tracker to monitor rates and identify support required. Immunisation rates were above the target of 90% for all standard childhood immunisations.

• Data from the Quality and Outcomes Framework (QOF) for 2014/2015 showed that 82.4% of women aged 25-64 had received a cervical screening test in the preceding five years. This was comparable with the national average of 81.4%.
• The practice offered family planning and contraception services including implant/coil insertion.

Updated 28 April 2017

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population, including their registered patients in care homes.

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

• All patients with palliative care needs and over the age of 75 years had a named GP to oversee their care.

• The frailest two per cent of the practice patients had a hospital admission avoidance care plan in place, which highlighted their needs and wishes and was reviewed regularly. The practice worked closely with other services, and held monthly multidisciplinary meetings to discuss and review patients’ needs.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• The practice was part of local schemes to support older patients’ health and social needs. For example, the practice had worked with Age UK to set up a weekly support group at the surgery for older patients including those with dementia. Transport to the service was available via Age UK.

Updated 28 April 2017

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

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. For example, the practice was open from 7.30am Monday to Friday and offered extended early morning surgeries on Tuesdays, Thursdays and Fridays. Evening telephone calls were also available every day for families and working age people, who could not access the service during normal opening hours.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• Patients were able to book appointments around their working day by telephone or on line. Repeat prescription requests were also available on line.

Updated 28 April 2017

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

• Patients were offered same day or longer appointments where needed.

• The practice held a register of patients experiencing poor mental health, including people with dementia.

• The practice had 119 patients on the mental health register. 60 had a care plan in place and all of those had received an annual review.

• Patients at risk of dementia were identified and offered an assessment.

• The practice carried out advance care planning for patients living with dementia.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

Updated 28 April 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 including homeless people and those with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

• The practice held a register of patients with a learning disability and had developed individual care plans for each patient, carried out annual health checks and offered longer appointments to this group of patients.

• The practice had 40 patients on the learning disability register and 36 had received an annual health check.

• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• The staff knew how to recognise signs of abuse in vulnerable adults and children. The staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies.