Archived: NEMS Platform One Practice

Updated 24 September 2015

NEMS Platform One Practice provides diverse primary medical services. It is commissioned with the aim of engaging with hard to reach groups, reducing health inequalities and improving the health of local people.

The practice opening in February 2010 with a zero patient list and now has approximately 8,500 patients, of which 84% are under 40 years of age and 25% are from black and minority ethnic population. The practice also has a high transient population and numbers of patients who were vulnerable, homeless, seeking asylum, misused substances or had poor mental health.

The practice is based in Nottingham city centre. The address where the regulated activities take place is: Station Street, Nottingham, NG2 3AJ.

The practice is managed by NEMS Healthcare Limited. The provider also manages a branch GP surgery and a walk in centre at 79A Upper Parliament Street, Nottingham NG1 6LD. In addition, the provider manages the urgent medical care and advice out out-of-hours service for Nottingham City and Nottinghamshire South Clinical Commissioning Groups. This service is registered under a separate registration. This service operates from the same location as NEMS Platform One Practice.

The practice has a large staff team, including administrative staff, a practice manager, assistant practice manager, facilities manager, a deputy and a lead nurse, two specialist mental health nurses (one of which is also a psychotherapist), a consultant nurse practitioner, five practice nurses, four health care assistants, seven salaried and two locum GPs. Various staff work across the two practices.

There are 4.28 whole time equivalent GPs working at the practice, in addition there are 6.9 whole time equivalent nursing staff.

It is a training practice for medical students and nurses.

The practice had one patient list, which means that patients can access the services at the main practice and the branch surgery. The practice opening hours are Monday 8am-7pm, Tuesday 7.30am-6.30pm, Wednesday 8am-7pm, Thursday 8am-6.30pm & Friday 7.30am-6.30pm.

The branch surgery is open from 9am-7pm Monday to Friday. Pre-bookable appointments are also available from 9am-1pm on Saturday and Sunday; in addition, to a small number of urgent appointments. Patients can also access the walk in centre from 9am -7pm every day of the year, which is located at the same site as the branch surgery.

The practice holds an Alternative Personalised Medical Services (APMS) contract to deliver essential and some additional enhanced primary care services. The contract means only salaried GPs are employed and there are no partners.

The practice does not provide out-of-hours services to the patients registered there. These services are provided by NEMS Community Benefit Services Limited. Contact is via the NHS 111 telephone number.

Updated 24 September 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at NEMS Platform One Practice on 30 June 2015. Overall the practice is rated as outstanding.

We found the practice was good for providing safe services and outstanding for providing caring, responsive and effective services and for being well led. It was also outstanding for providing services for the six population groups.

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

• The practice population was very diverse. It included a high transient population and numbers of patients who were vulnerable, homeless, seeking asylum, misused substances or had poor mental health.
• The staff team were highly responsive to meeting patients’ needs and engaging with hard to reach groups, to improve their welfare and reduce health inequalities.

• Feedback from patients was continually positive about the care and treatment they received and the way staff treat them. Staff involved and treated patients with compassion, kindness, dignity and respect.

• Patients were able to access care and treatment when they needed it, and could access appointments and services in a way, and at a time that suited them. The practice provided a transport service to patients who struggled to attend appointments.

• The practice used innovative and effective ways to improve outcomes for patients. High importance was placed on improving patients’ health by offering various screening checks and regular health reviews.

• The services were tailored to meet people’s individual needs and delivered in a way to ensure flexibility, choice and continuity of care. The staff team worked collaboratively with other services to meet patients’ needs, and support vulnerable individuals.

• The practice was safer than other similar practices as people were protected by comprehensive systems to help keep them safe. There was a pro-active approach to anticipating and managing risks, and a focus on openness and learning when things went wrong.

• The practice actively sought the views of patients and staff and implemented improvements to the way it delivered services in response to feedback.

• The practice had a large staff team, which continued to increase in size and skill mix to meet patients’ needs and the expansion of the service.

• The practice had a highly motivated and committed staff team who worked well together. Staff were actively supported to continually develop their knowledge and skills to ensure the delivery of high quality care.

• The practice was exceptionally well-led. The management and governance of the practice assured the delivery of high-quality person-centred care.
• The culture and leadership empowered staff to carry out lead roles and drive continuous improvements. High standards were promoted and owned by all staff.

We saw several areas of outstanding practice including:

• The practice provided a wide range of services to meet patients’ diverse needs. For example, 25% of patients had poor mental health. The practice had developed its own primary mental health services, which included a lead GP and two experienced nurses. One of which was a prescriber and the other was a psychotherapist, which enabled them to offer a broad range of treatments to patients.
• In addition, the two GP leads for substance misuse held weekly shared care clinics, which enabled patients to be treated at the practice. The clinic held at the branch surgery was extended to non-registered patients; seven out of 27 patients attending this were not registered with the practice.
• The practice had high numbers of patients who were asylum seekers. The practice was working with public health and the local charity for refugees and asylum seekers, to develop a multilingual booklet, which would enable families from overseas to understand the National Health Service.
• High importance was placed on educating patients to self-manage their conditions. For example, the practice had implemented a City wide initiative, which demonstrated the use of inhalers by video, and simple physiotherapy exercises for the benefit of patients with asthma and musculoskeletal conditions.

Importantly the provider should:

Develop the clinical audit programme to ensure that all audits are completed to a consistent standard to provide assurances that patients are receiving effective care and treatment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 September 2015

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

Patients had a named GP and nurse to provide continuity of care and ensure their needs were being met. The nurses and GPs had lead roles in the management of long-term conditions, including diabetes, asthma and heart failure having received appropriate training. The practice actively screened patients for various long-term conditions, particularly during a new patient and annual health check. Patients were offered an annual health check; the uptake for various long-term conditions was high. For example, 80% of patients with asthma, 94.5% of patients with chronic obstructive pulmonary disease and 100% of patients with rheumatoid arthritis had received a health review in the last 12 months. The clinical staff worked closely with specialist nursing teams to meet patients’ needs. For example, they held shared care clinics with the specialist community diabetic nurse, to support patients to manage their condition effectively. Data showed that patients with primary long-term conditions such as diabetes, heart failure, stroke and respiratory disorders were engaging with the practice, as the number of emergency admissions was low compared with other local practices.

High importance was placed on educating patients to self-manage their conditions. For example, the practice had implemented a City wide initiative, which demonstrated the use of inhalers by video, and simple physiotherapy exercises for the benefit of patients with asthma and musculoskeletal conditions. The clinical team were also implementing the Diabetes Year of Care approach, which firmly puts the patient at the centre of their care and supports them to self-manage their condition. This initiative was in the early stages of development.

Updated 24 September 2015

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

Priority was given to appointment requests for children and young people. Children and young people were able to attend appointments outside of school and college hours. The health visitor held a weekly baby clinic at the practice. An immunisation clinic was held at the same time as the baby clinic, which enabled the staff to provide immunisations to families attending both clinics. The clinical staff also had several appointments blocked out each day, to enable them to carry out opportunist health screening and immunisations for families and children. Data showed that the immunisation rates for children under two years was 92.42% compared to the local average of 96%, the measles, mumps, and rubella rate was 90.9% compared to the local average of 91% and the pre-school booster rate was 82.9% compared to the local average of 87.52%. The rates were lower than the local average due to the high transient population and cultural issues. However, compared to previous years the immunisation rates were increasing. A robust system was in place for following up patients who did not attend their vaccine.

The practice provided maternity and family planning services, including contraceptive implants. The practice also provided sexual health services, including advice for teenagers. All patients were offered sexual health screening at the new patient check, which includes all sexually transmitted infections. Robust systems were in place to manage risks to children and young people, who were vulnerable or at risk of abuse. The safeguarding leads had jointly developed a child health booklet with the local safeguarding team and a local practice, which had been adopted citywide. This is an educational guide for parents to assist them to seek the most appropriate medical services.

Updated 24 September 2015

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

Patients were supported to remain active and help reduce the risk of falls. The practice kept a register of older people who had complex needs, or were at risk of admission to hospital. As part of the enhanced service all patients over 75 years had a named GP to provide continuity of care and were offered an annual health check. In addition, the practice allocated all patients a named nurse and healthcare assistant (HCA) to oversee their needs. The practice had 33 patients over 75 years; all patients had been offered a health check and 29 had attended this in the last 12 months. Carers were identified and supported to care for older people. Home visits were also carried out for frail and elderly patients who were unable to attend the practice.

The practice had 132 patients aged over 65 years; all patients were offered the influenza immunisation in the 2014/2015 period to reduce the risk of them developing flu, of which 80 patients received this. The practice had introduced a project to further improve the physical and psychological wellbeing of their older population. This involved allocating a named GP, practice nurse and HCA to all patients over 65 years to ensure their needs were being met. They were also offering an annual health assessment. This differed from the above enhanced service, in that the patient inclusion criteria was broader and they were allocated a nurse and a HCA as well as a GP. The practice carried out a search every eight weeks on all patients over 65 years, to establish if they had been seen or had contacted the practice in the last six week. If no contact had been made a HCA would contact them to check all was well.

Updated 24 September 2015

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

Extended opening hours were provided, which include early morning, evening and weekend appointments across two locations. This enabled patients to access appointments at a time that suited them. Patients were also offered telephone consultations and were able to book appointments by telephone or on line. They also had access to ‘choose and book’ for patients referred to secondary services, which provided flexibility over when and where their appointment took place. The practice provided travel immunisation clinics. Sexual health screening including Human Immunodeficiency Virus (HIV) was also offered to all new patients at registration, due to the potential higher incidence in the City and high level of overseas registrants. The practice also worked with local employers to provide flu vaccination programmes for their staff.

NHS health checks were offered to patients aged 40 to 74 years, where patients were screened for various conditions including dementia, diabetes and heart disease, together with lifestyle advice. The uptake on health checks was low due to the practice demographic. For example, between May and June 2015 the practice sent 280 invitations and 20 patients attended. The practice continued to develop ways to encourage patients to attend the health checks. The practice had implemented further training for health care assistants to enable them to carry out robust health checks. Following the success of a national pilot for out of area registration, the practice elected to continue to register patients who live elsewhere and choose to access GP services in Nottingham. The current figure for registrations was 134.

Updated 24 September 2015

The practice is rated as outstanding for the care of people experiencing poor mental health.

Approximately 25% of patients had poor mental health. The practice held a register of patients. All patients had a named GP and nurse to provide continuity of care. The staff team worked collaboratively with other services, to ensure that patients’ needs were regularly reviewed, and that appropriate risk assessments and care plans were in place. Data showed that 95.4% of patients had a comprehensive care plan completed the last 12 months. Patients were supported to access secondary care, where appropriate. Many of the patients had complex mental health needs and required on going support by the practice. The in-house primary mental health team worked closely with the vulnerable adult lead nurse and GP to support patients. Mental health assessments could be booked by any clinician or by the patient themselves. One of the mental health nurses was a prescriber and the other was a psychotherapist, which enabled them to offer a broad range of treatments to patients. The mental health nurse prescriber saw approximately 30 patients a week for assessment, prescribing reviews and short term intervention. The psychotherapist saw approximately 20 patients a week for courses of treatment over 12 to 24 weeks.

The two GP leads for substance misuse held weekly shared care clinics, which enabled patients to be treated at the practice. The clinic held at the branch surgery was extended to non-registered patients; seven out of 27 patients attending this were not registered with the practice. At the main surgery 31 registered patients were receiving support from the clinic.

The practice had a young population; 84% of patients were under 40 years of age. At the time of the inspection, the practice did not have any patients with dementia. However, they screened patients for dementia as part of the new patients check and at the long-term conditions annual reviews to facilitate early referral and diagnosis where dementia was indicated. The unusually low incidence of dementia was due to the practice demographic.

Updated 24 September 2015

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

The practice had high numbers of patients who were vulnerable, homeless, patients seeking asylum, forensic patients or had multiple illnesses and social needs. The practice held a register of all patients whose circumstances may make them vulnerable. Patients had an allocated GP and nurse to ensure continuity of care. Robust systems were in place to manage risks to vulnerable patients and ensure their needs were being met. Patients had a care plan and they were reviewed at the practice’s weekly clinical and monthly multi-disciplinary meetings. Patients were offered same day appointments or telephone consultations. When needed, longer appointments were available. Patients were invited to attend an annual health check. The register included 14 patients with a learning disability. The practice had involved the disability health co-ordinator to ensure they received an annual health checks. Four patients had received a health review in 2015 and the remaining reviews were planned.

There was a GP and nurse lead for safeguarding, both children and vulnerable adults. They were responsible for overseeing and co-ordinating vulnerable patients care at the practice, liaising with other services and attending multi-agency protection meetings. The staff team worked in partnership with the local homeless team and the asylum seekers and refugee forum. For example, homeless people were able to use the practice address to register. An information sharing agreement was in place with the local homeless team for sharing concerns about a patient. The practice also worked closely with the probation services to provide services for patients in three hostels through a shared care agreement.