Nutwood Medical Practice

Updated 14 January 2016

Nutwood Medical Practice is a busy town practice providing care and treatment to 4700 patients of all ages, based on a General Medical Services (GMS) contract. The practice is part of NHS Cumbria Clinical Commissioning Group (CCG) and provides care and treatment to patients living in Grange over Sands and the surrounding areas. The district within which the practice is located has the second highest life expectancy in Cumbria with the average person expected to live to 81.1 years of age, with 73.4% of them being in good health. The practice serves an area where deprivation is lower than the England average, and 38% (1807) of patients are aged 65 years or over. Of this group of 1807 patients, 108 were aged over 90 years. The practice had a very low proportion of patients who were from ethnic minorities.

The practice is based in Grange over Sands and we visited the following location as part of inspection:

Grange Health Centre, Kents Bank Road, Grange over Sands, Cumbria, LA11 7DJ.

The Nutwood Medical Practice is located in a purpose built health centre and provides patients with fully accessible treatment and consultation rooms. The practice shares the building with another GP practice and community social and health based services. Staff are also responsible for managing the building on behalf of the other occupants. The practice provides a range of services and clinics including, for example, services for patients with asthma, diabetes and coronary heart disease. It consists of four GP partners (two male and two female), a practice manager, a deputy practice manager, two practice nurses and three healthcare assistants, a reception and medicines manager and a small team of administrative and reception staff. The partners also employ a salaried GP. When the practice is closed patients can access out-of-hours care via the Cumbria Health On-Call service, and the NHS 111 service.

The practice was open Monday to Friday between 8am and 6:30pm. Two GPs provided:

• Face-to-face consultations: 8:30am to 11:30am and between 3pm and 5pm;

• Telephone consultations: 11:30am to 12:30pm and between 5pm and 6pm.

Updated 14 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Nutwood Medical Practice on 11 August 2015. Overall, the practice is rated as outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses.

• Feedback from patients was continually positive about the way that staff treated people. Patients said they were treated with compassion, dignity and respect. Arrangements had been made which promoted and supported patients to become active partners in their care.

• Outcomes for patients who use services were consistently very good. Nationally reported Quality and Outcomes Framework (QOF) data, for 2013/14, showed the practice had performed very well in obtaining 98.3% of the total points available to them for providing recommended care and treatment to patients.

• Risks to patients and staff were assessed and well managed.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and responsibilities.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• All staff were actively engaged in activities to monitor and improve quality and outcomes;

• Staff were consistent in supporting patients to live healthier lives through a targeted and proactive approach to health promotion.

• Information about how to complain was available and easy to understand.

• Information was provided to patients to help them understand the care available to them.

• The practice had made changes to the way it delivered services as a consequence of feedback received from patients. This included demonstrating good responsiveness to patient feedback about telephone access to the practice.

• There was a clear leadership structure and staff felt supported by the management team. Good governance arrangements were in place.

• Staff had a clear vision for the development of the practice and were committed to providing their patients with good quality care.

  We also saw areas of outstanding practice:

• The practice nurse had completed an audit to enable them to evaluate patients’ satisfaction with, and understanding of, the Year of Care model staff used to provide their annual diabetes consultations and reviews. Patient responses showed a high level of satisfaction, with 100% (23) indicating that they were ‘very confident’ or ‘sometimes confident’ about managing their own health.

• Staff demonstrated a strong commitment to developing innovative ways of delivering care, treatment and support to older patients and those with long-term conditions. For example, they had supported AGE UK to obtain the funding the charity needed to develop a new ‘Care Navigator’ role. Staff also helped to pilot a new ‘Case Manager’ role before it was rolled out to other local practices. Staff had organised for a local Age UK Village Agent and a local solicitor to run free advice and support sessions in the health centre.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 14 January 2016

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

Nationally reported Quality and Outcomes Framework (QOF) data, for 2013/14, showed the practice had performed very well in relation to providing care and treatment for the clinical conditions commonly associated with this population group.

Staff had been proactive in identifying those patients who had long- term conditions. A consequence of this was that there were high prevalence rates for most long-term conditions which reflected the profile of the patient population. For example, over the last four years the practice’s prevalence of Atrial Fibrillation (irregular heart beat) had gone up from 3.4% (156 patients) to 3.9% (179 patients) and, in the past 12 months, 85% of those assessed as needing anticoagulation treatment were receiving it. In-house clinics were provided which meant that patients receiving anticoagulation therapy were able to have their blood levels monitored close to home. Information supplied by the practice demonstrated the significant progress staff had made in providing recommended care and treatment to diabetic patients. Staff had reviewed all new cancer diagnoses using the Royal College of General Practitioners cancer audit tool, to help improve the early diagnosis of cancer and patient outcomes. A key outcome of this audit had been to introduce a system, which involved staff checking that all fast-track cancer referrals had actually been received by the hospital to which the referral had been made. Staff demonstrated a strong commitment to providing good end of life care by, for example, participating in Gold Standard Framework Meetings every six weeks.

Staff offered proactive, personalised care to meet the needs of patients with long-term conditions. In addition to their work with AGE UK, and the piloting of the new ‘Case Manager’ role referred to above, nursing staff had adopted the ‘Year of Care’ approach, as their model for providing personalised care to patients with diabetes and chronic obstructive pulmonary disease (COPD). (This model focusses on promoting self-management and educating the patient about any long-term conditions they have.) Patients with other long-term conditions also received access to appropriate care and treatment which met their needs.

Updated 14 January 2016

The practice is rated as outstanding 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, the practice maintained a register of vulnerable children and contacted families where a child had failed to attend a planned appointment. Appointments were available outside of school hours and the practice premises were suitable for children and babies. The practice offered contraceptive and sexual health advice. There was a weekly midwife clinic, and a recall system in place to ensure that new mothers attended for postnatal and six-weekly checks. The practice offered a full range of immunisations for children at a weekly immunisation clinic. The practice had performed very well in delivering childhood immunisations. For example, the nationally reported data that was available showed that the immunisation rates for 15 of the 20 childhood immunisations were above 90% and over, and five of the immunisations rates were 100%.

Updated 14 January 2016

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

Nationally reported Quality and Outcomes Framework (QOF) data, for 2013/14, showed the practice had performed very well in relation to providing care and treatment for the clinical conditions commonly associated with this population group. Staff had been proactive in identifying older patients at risk of developing long-term conditions so they could benefit from receiving recommended care and treatment.

Older patients made up 38.44% of the practice’s overall patient population. Staff were highly committee to providing proactive, personalised care to meet the needs of these patients. For example, they had supported AGE UK to obtain the funding the charity needed to develop a new ‘Care Navigator’ role. (This is a new role where the post holder provides support to patients at risk of an unplanned hospital admission and losing their independence.) Staff also helped to pilot a new ‘Case Manager’ role before it was rolled out to other local practices. (This is also a new role where the post holder helps patients to access the help and support they require.) Staff had organised for a local Age UK Village Agent and a local solicitor to run free advice and support sessions in the health centre. The GP team carried out weekly visits to patients living in a local care home so they could receive proactive, planned care. The practice offered home visits and longer appointment times where this was needed by their older patients. Staff had completed care plans for the 2% of patients who had been assessed as being at-risk. These covered, where appropriate, patients’ end of life needs.

Updated 14 January 2016

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

The practice was proactive in offering online services, such as for booking appointments and ordering repeat prescriptions. Over 1700 patients had registered for on-line access following proactive steps taken by staff to promote this. Early and late appointments were offered on request to make it easier for families and working-age patients to obtain convenient appointments. Staff provided a full range of health promotion and screening that reflected the needs of this age group. Following a fall in the practice’s cervical cytology rates (a method of preventing cancer by detecting abnormalities) in 2012/13 and 2013/14, the practice had been proactive in taking steps to address this. They provided evidence that their achievement rate had moved back above the local CCG average, from 81.1% in 2013/14 to 83.8% in 2014/15. Staff had been proactive in identifying those patients at risk of developing long-term conditions so they could benefit from receiving recommended care and treatment.

Updated 14 January 2016

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

The practice had very high numbers of patients with dementia. Nationally reported data showed the practice had performed very well in obtaining 100% of the total points available to them for providing recommended care and treatment to patients with dementia. This achievement was 4.4% above the local CCG average and 6.6 points above the England average. Screening and assessment was offered to patients at risk of dementia, and patients were able to benefit from being referred to, where appropriate, the ‘Case Manager’ and ‘Care Navigator’ staff based at the health centre.

The practice had relatively small numbers of patients with mental health needs. The QOF data showed that the practice had performed well in obtaining 100% of the total points available to them for providing recommended care and treatment to patients with other mental health needs. This achievement was 8.8% above the local CCG average and 9.6% above the England average. Patients experiencing poor mental health were provided with advice about how to access various support groups and voluntary organisations, and were able to access ‘talking therapies’ which provide help with a range of common mental health problems.

Updated 14 January 2016

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

Nationally reported data showed the practice had performed well in obtaining 100% of the points available to them for providing recommended care and treatment to patients with learning disabilities. This achievement was 14.3% above the local CCG average and 15.9% and above the England average. The practice maintained a register of patients with learning disabilities and offered extended reviews (30 minutes) with a named GP. Where appropriate, clinical staff referred vulnerable patients so they could benefit from the support offered by the local Care Navigator. Systems were in place to protect vulnerable children. For example, the practice had a child and vulnerable adults lead who regularly met with health visiting staff to discuss clinical and safeguarding issues. Staff ‘flagged’ the records of all at-risk children to identify when the practice had been contacted about these patients. Staff knew how to recognise signs of abuse in vulnerable adults and children and were aware of their responsibilities regarding information sharing and the documentation of safeguarding concerns. They knew how to contact relevant agencies in normal working hours and out-of-hours.