The Alice Medical Centre

Updated 11 July 2016

The Alice Medical Centre is a single handed GP practice which provides primary medical services to 3211 patients through a general medical services contract (GMS). The practice is located in the Bestwood Park area near to Nottingham city centre.

The level of deprivation within the practice population is above the national average. The practice is in the second most deprived decile meaning that it has a higher proportion of people living there who are classed as deprived than most areas.

The clinical team comprises one full-time GP (female) and a locum GP (male) currently working one day a week, a practice nurse and a health care assistant. The clinical team is supported by a full time practice manager, a secretary and a team of reception and administrative staff.

The practice is open from 8am to 8pm on Monday and 8am to 6.30pm Tuesday to Friday with the exception of Thursdays when the practice closes at 12.30pm. Telephones are covered by the out of hours provider between 8am and 8.30am, although a clinician is available during this time in case of an emergency.

Appointments are available from: 9am to 12pm and 4pm to 6pm on Mondays; 9am to 12pm and 3.10pm to 6pm on Tuesday, Wednesday and Friday; and 8.30am to 12pm on Thursday.

The practice is an approved teaching practice for medical students.

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

Updated 11 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Alice Medical Centre on 24 May 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 was in place for reporting, investigating and recording significant events.

• Risks to patients were assessed and well managed overall. This included appropriate recruitment checks, medicines management and emergency procedures.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

• Clinical audits were driving improvements to patient outcomes.

• Feedback from patients about their care, and their interactions with all practice staff, was consistently and strongly positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.

• 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.

• The practice had a clear vision which had quality and safety as its top priority. The strategy and business plan to deliver this vision was reviewed and discussed with staff.

• The practice had suitable arrangements in place for clinical and managerial leadership.

• There was a clear leadership structure in place and staff felt respected, valued and supported.

• The Patient Participation Group (PPG) had started to be active from April 2016.

The areas where the provider should make improvement are:

• Consider how to use the carers register more proactively to improve support for carers.

• Strengthen oversight of responses to complainants’ to make sure these address all concerns raised by them.

• Continue to proactively recruit PPG members to ensure they provide a voice for patients, and are influential in shaping service provision.

• Review the systems for recalling patients with learning disabilities to attend for their annual health checks and / or receive regular monitoring.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 July 2016

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

• The practice nurse had a lead role in chronic disease management and patients at risk of hospital admission were identified as a priority.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. 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. For example, specialist community teams including the integrated respiratory team, heart failure nurses, palliative care and district nurses.

• Performance data showed the practice performed well in the management of patients with long terms conditions. However, performance for diabetes related indicators was below the local and national averages. The practice had implemented strategies to address this including adopting the “year of care” model for diabetes management.

• The practice nurse held a joint clinic with a local diabetes specialist nurse each month to review patients with complex needs.

• Longer appointments and home visits were available when needed. For example, patients with long term conditions and other needs were reviewed at a single appointment where possible, rather than having to attend multiple health reviews.

Updated 11 July 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 at risk of abuse. For example, children and young people who had a high number of accident and emergency (A&E) attendances and safeguarding meetings were held quarterly with the health visitor.

• Immunisation rates were relatively high for all standard childhood immunisations. For example, vaccination rates for children under two years old ranged from 85.4% to 100% compared to the CCG average of 91.1% to 96.3%. Staff monitored the uptake of childhood vaccinations to enable those who did not attend to be followed up.

• All children under the age of 15 were offered a same day appointment and patients we spoke with confirmed this happened; and that children and young people were treated in an age-appropriate way.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice worked closely with other health professionals in the case management of these patients, and this included the health visitor, child and adolescent mental health services and the community paediatrics.

• The whopping cough vaccination was also offered to all pregnant mothers and postnatally.

• Weekly baby clinics were previously held at the practice until April 2016. Due to shortages in health visitors within the local area this clinic is now offered at another practice and is due to be reviewed in September 2016.

Updated 11 July 2016

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

• Patients aged 75 years and over had a named GP to provide continuity of care and were offered an annual “wellbeing” health check to ensure their health needs were being met.

• Influenza, pneumococcal and shingles vaccinations were offered in accordance with national guidance.

• A total of 211 patients aged 65 years and over, had received a flu vaccination in 2015/2016, and 80% of these patients had attended the Saturday flu clinics.

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

• The practice had close links with its two local care homes and the named GP undertook regular visits to review the ongoing needs of the residents. Care home staff told us the practice provided a highly responsive service to patients and this included visiting on the same day when this was required.

• Older patients at risk of admission to hospital, living with dementia and / or frail were discussed at multidisciplinary meetings hosted by the practice. Care plans were in place for older patients with complex needs.

• Nationally reported data showed most outcomes for conditions commonly found in older people, were in line with local and national averages.

Updated 11 July 2016

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

• Extended hours appointments were available from 6.30pm to 8pm on a Monday evening and telephone consultations were available each day for those patients who had difficulty attending the practice due to work or school commitments.

• The practice offered online services for booking GP appointments and requesting repeat prescription requests. Patients could sign up to electronic prescribing so that prescriptions could be sent directly to the pharmacy of the patient’s choice.

• The practice offered access to routine appointments on a Saturday under a local agreement with another GP practice (Hucknall road Medical Centre), and these appointments were bookable until 1pm on the Friday.

• A full range of health promotion and screening that reflects the needs for this age group was offered. This included NHS health checks for patients aged 40 to 74 years and smoking cessation advice.

• The 2014/15 Public Health England data showed the practice’s cancer screening rates were marginally below the CCG and national averages. The practice was aware of areas for improvement and had implemented strategies to address this.

• Family planning services were provided to registered and unregistered patients including the fitting and removal of contraceptive implants and intra uterine devices such as coils.

• Diagnostic tests and treatment room services that reflected the needs of this age group were carried out at the practice. This included blood pressure monitoring, phlebotomy, ear irrigation and minor surgery.

Updated 11 July 2016

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

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. For example staff had access to a psycho geriatrician and liaised with the mental health intensive recovery team to facilitate home visits and same day support if patients were not coping well with dementia.

• All patients identified as having dementia were included in the practice’s avoiding unplanned admissions register to ensure they benefitted from the additional scope of this service.

• 96% of patients with a mental health condition had a documented care plan in the last 12 months which was above the CCG average of 83% and the national average of 88%.

• 93% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months which was above the CCG and national averages of 84%.

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

• Staff told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

• The practice undertook reflective learning with two other GP practices following significant events relating to patients who had attempted suicide, self-harmed and overdosed on medicines.

Updated 11 July 2016

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

• The practice held a register of 18 patients with a learning disability. Thirteen patients had been offered an annual health check and three had attended.

• Staff received biennial learning disability awareness training and had a good understanding of how to support patients with learning disability.

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

• Patients receiving end of life care had a named GP and a planned visiting programme was put in place in consultation with family. The patients care needs were reviewed at a multi-disciplinary team meeting at which the end of life care facilitator attended.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• 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.