Tudor House Medical Practice

Updated 5 May 2016

Tudor Medical Practice is located in Sherwood in the north of Nottingham. It is approximately 1.5 miles from Nottingham City Centre. There is direct access to the practice by public transport and some limited parking is also available on site.

The practice currently has a patient list size of approximately 6,000 patients.

The practice holds a Personal Medical Services (PMS) contract to deliver care to the public.

The number of patients of working age registered at the practice is higher than national average. A higher number of those of working age registered at the practice are employed compared with the local CCG average.

The practice is managed by two GP partners, (both male) who work on a full time basis. The practice also has a GP associate (female) who works part time. (0.4 Whole Time Equivalent, WTE). They are supported by clinical staff; one full time female senior practice nurse, one part time female practice nurse and two part time female healthcare assistants. The practice also employs a practice manager and a team of reception, clerical and administrative staff.

The practice is a training practice for doctors in their second year of qualification (FY2). Two of these doctors work at the practice on an annual basis.

The practice is open on Mondays 8am to 7.30pm, Tuesdays 8am to 7pm, Wednesdays 8am to 6.30pm, Thursdays 8am to 1pm and Fridays 8am to 6.30pm. Appointments are available Mondays 8am to 7.30pm, Tuesdays, 8am to 6.30pm, Wednesdays 8am to 6.30pm, Thursdays 8am to 1pm and Fridays 8am to 6.30pm. Practice patients are also able to pre book routine appointments on Saturday mornings with another designated practice within the CCG. This is part of a responsiveness contract commissioned by the CCG. The practice advertises this service in its patients waiting area.

The practice has opted out of providing GP services to patients out of hours. During these times GP services are provided by Nottingham Emergency Medical Services.

When the practice is closed, there is a recorded message giving out of hours details

Updated 5 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Tudor House Medical Practice on 1 March 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 and an effective system in place for reporting and recording significant events. Lessons were shared to ensure appropriate action was taken to improve safety in the practice.
• Risks to patients were assessed and well managed. This included health and safety considerations such as ensuring equipment was safe to use, infection control measures and medicines management which kept patients safe.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. A programme of continuous clinical audit was in place which drove quality improvement. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients told us they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Patient feedback which included the National Patient Survey rated the care provided highly.
• The practice had not however considered the needs of all its service users.The practice had a low number of registered carers.
• Information about services and how to complain was available and easy to understand. Reception staff we spoke with knew the procedure in place for addressing complaints.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. Practice management supported staff training and development. The practice sought feedback from staff and patients, which it acted on.

The area where the provider should make improvements are;

The provider must ensure it considers the arrangements in place for identifying carers and deliver care and treatment that reflects the needs of these patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 May 2016

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

• Nursing staff had lead roles in chronic disease management.

• Patients at risk of hospital admission were identified as a priority and appropriate action was taken to reduce the likelihood of attendance.

• National data showed the practice was performing in line with the local CCG average for its achievement within eleven diabetes indicators.The practice achieved 79.7% of the available QOF points compared with the CCG average of 79.1%. Achievement was however below the national average of 89.2%.

• 80.1% of patients diagnosed with asthma, on the register, had an asthma review in the last twelve months. This was above the CCG average of 75.5% and national average of 75.3%.

• Longer appointments and home visits were available when needed.

• The practice had 762 patients with chronic diseases registered. All these patients had a named GP and were offered a structured annual review to check their health and medicines needs were being met.

• Practice supplied data showed that 639 patients (83.86%) had received these checks though this data had not been verified and published. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 5 May 2016

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.

• Immunisation rates for all standard childhood immunisations ranged from 73.5% to 98.6%. This was comparable to CCG averages which ranged from 86.9% to 96.3%.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and our discussions with staff supported this.

• Appointments were available outside of school hours. The practice had an open door policy for children aged under five and children under two were only seen by a partner or senior doctor. The premises were suitable for children.

• We saw that effective collaborative working took place between doctors in the practice, midwives and health visitors.

Updated 5 May 2016

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.

• The practice had recruited an additional nurse whose responsibilities included undertaking health checks for patients aged over 75. These health checks started in March 2016.

• 77% of the practice patients aged over 75 had received their flu vaccination to date.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. The practice provided medical services for 41 older patients living in care facilities.

Updated 5 May 2016

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. The practice offered extended hours appointments with early and late sessions on varying days with all GPs. Pre-booked appointments were available on a Saturday at another local GP practice.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group. Yearly flu clinics were run on a Saturday which would benefit working age patients who preferred weekend attendance.

• 84.1% of women aged over 25 but under 65 had received a cervical screening test in the previous 5 years. The practice was performing above the CCG average of 81.5% and national average of 81.8%.

Updated 5 May 2016

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

• 97.1% of patients with a mental health condition had a documented care plan in place in the previous 12 months. This was above the CCG average of 83.6% and above the national average of 88.3%. Exception reporting was 11.2% below CCG average and 12.6% below national average.

• 77.4% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. This was broadly in line with the CCG average of 83.9% and national average of 84%.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. All patients identified as having dementia had been included in the practice’s avoiding unplanned admissions register.

• 88.9% of patients aged 18 or over with a new diagnosis of depression had been reviewed between 10 to 56 days after their diagnosis. This was above the CCG average of 84% and above the national average of 84.5%.

• We saw limited information displayed in the practice about how patients experiencing poor mental health could access various support groups and voluntary organisations. We noted that signposting information was displayed for those who had been involved in substance misuse. We did not see information available on the practice website.

Updated 5 May 2016

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 those with a learning disability. There were 45 patients on the learning disability register, and 40 (89%) of these had received an annual health check in 2014/15. We were provided with data from the practice which showed the CCG average was 39%.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. Records reviewed showed that patients received ongoing care and support from the appropriate health care service(s).

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations. The practice clinicians had undertaken specialised domestic violence and abuse training (IRIS) and we were provided with examples of how this training had benefitted vulnerable patients.

• Staff we spoke with 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.