Littlewick Medical Centre

Updated 12 May 2016

Littlewick Medical Centre provides primary medical services to approximately 15356 patients through a general medical services contract (GMS). This equates to around 15% of the population of the clinical commissioning group (CCG) area. The practice is located in the town of Ilkeston within the borough of Erewash. The town is close to both Nottingham and Derby. The practice has a long history in the area dating back to 1920, and has occupied its current purpose built premises since 2010. The practice has a branch surgery located in West Hallam.

The level of deprivation within the practice population is similar to the national average with income deprivation affecting children and older people marginally below the national average.

The clinical team comprises 11 GPs (nine GP partners and two salaried GPs; seven female and four male), eight practice nurses, three healthcare assistants and a phlebotomist.

The clinical team is supported by a full time practice director, a team manager, a systems manager and reception and administrative staff.

The practice opens from 8am to 6pm Monday to Friday with telephone lines open until 6.30pm. Consulting times are usually from 8.30am to 11.30am and from 2.30pm to 5.30pm. The practice offers some appointments outside of these times in the mornings and evenings to facilitate access for patients who work or find it difficult to access the practice during the day. The branch surgery opens from 8.30am to 12.30pm Monday to Thursday and from 2.30pm to 5.30pm on Fridays. Appointments for the main surgery and the branch surgery are booked via a central booking line.

The practice is an approved teaching and training practice for medical students, nursing students and GP registrars. (A GP registrar is a qualified doctor who is training to become a GP through a period of working and training in a practice)

The practice has opted out of providing out-of-hours services to its own patients. This service is provided by Derbyshire Health United (DHU).

Updated 12 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Littlewick Medical Centre on 17 February 2016. 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. The practice ensured that opportunities for learning were maximised.
• 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. Some clinical staff had undertaken additional training to enhance their skills and had developed areas of special interest to support them in taking lead roles within the practice.
• The practice used proactive methods to improve patient outcomes. For example, the practice ran dedicated child sessions alongside their immunisation clinics which enabled parents to interact whilst children could play and use other services such as infant weighing.
• Feedback from patients about their care, and their interactions with all practice staff, was generally positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and treatment.
• Patients said they generally found it easy to make an appointment with a GP with urgent appointments available the same day.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example the practice was working with the local MP to set up a health and jobs fair for the local community.
• Staff demonstrated a passion to engage with their patients and the wider community to promote health and wellbeing in addition to reducing social isolation. This was achieved by offering a wide range of services such as monthly coffee mornings for carers.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example changes had been made to the appointments system including the introduction of a new telephone system which had increased the call handling capacity of the practice and reduced call waiting times.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.
• The practice had a clear vision which had quality and safety as its top priority.

We saw several areas of outstanding practice including:

• The practice had designed and delivered a wide range of services and groups to promote the health and wellbeing of patients within the wider community to reduce social isolation. These groups included craft, knitting and bingo groups which were all held at the practice on a regular basis. Additionally groups and services were offered by the practice to promote healthier living. These included a falls prevention class and weekly walking groups.
• A system whereby the wounds of patients were attending for dressings were photographed. This enabled the practice to monitor healing and seek expert advice and assistance from the tissue viability team where this was required. Consideration was being given locally as to how this system could be rolled out more widely.
• Strong links had been developed with the local community and the practice involved people in the practice to promote health and wellbeing. For example, the practice was working with their local MP to support a jobs and health fair. In addition the practice had delivered informational talks to local schools. The practice director also sat on the advisory board for the local children’s’ centres.
• The practice had won a national award from the BMJ as Primary Care Team of the Year for work on an outreach project targeted at the vulnerable elderly. This involved work with social care and energy providers and focussed on ensuring that patients were living in healthy environments.

However there were areas of practice where the provider should make improvements:

• Review arrangements in place to ensure patient groups directions are always completed in full to confirm that the practice has adopted the direction.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 May 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was 97.7% which was above the CCG average of 90.2% and the national average of 89.2%. Exception reporting for diabetes related indicators was 10.9% which was similar to the CCG average of 11.8% and the national average of 10.8%.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met.
• 73.4% of patients diagnosed with asthma had an asthma review in the last 12 months which was 1.5% above the CCG average and 3.7% above the national average.
• 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. Feedback from the care coordinator attached to the practice was extremely positive about the level of communication and engagement demonstrated by the practice.
• The practice provided an anticoagulation service to its own patients and to patients across the CCG area who wished to access it. This service was delivered to over 1000 patients and was accessible from two locations or delivered at home as required.

Updated 12 May 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 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 were relatively high for all standard childhood immunisations and attendance was encouraged through child sessions which were run alongside the immunisation clinics. These sessions enabled parents to interact and socialise whilst children played and could be weighed.
• The practice had a dedicated team of staff responsible for safeguarding. The team included a GP, nurse, the practice director and members of administrative staff. They met regularly with attached health and social care professionals to discuss and review children at risk. The practice director liaised externally with the local children’s centres to promote links.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• Appointments were available outside of school hours and the premises were suitable for children and babies. There was a dedicated child room which had been appropriately decorated and had a range of toys and books for children.
• The practice had established links with local schools and had delivered talks to year eight pupils over the last three years to promote the HPV vaccine. Although this vaccine was now being delivered in schools, the practice were seeking to engage with younger people and had plans to introduce a teenage health drop in clinic.

Updated 12 May 2016

The practice is rated as outstanding 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 was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice offered weekly falls prevention classes. These had been attended by 19 patients since they commenced in July 2015. None of these patients had been admitted to hospital as a result of a fall since attending the classes.
• The practice had won national awards for work on an outreach project targeted at the vulnerable elderly. This involved work with social care and energy providers and focussed on ensuring that patients were living in healthy environments. The practice had been working since last year to restart this project and produced an information video for patients to give advice about keeping safe and well at home. Visits were undertaken to see people at home and the video was played using an electronic tablet device.
• The practice undertook daily home visits for patients who needed these.
• GPs, the practice pharmacy technician and the CCG pharmacist met regularly with care home staff to undertaken medication reviews for patients and discuss any changes required.

Updated 12 May 2016

The practice is rated as outstanding 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.
• Patients could access support from doctors and nurses via the telephone and the practice offered some appointments outside of core hours where required to meet the needs of this population group.
• The practice was proactive in offering online services as well as a full range of social and health promotion and screening that reflects the needs for this age group.
• The practice was seeking to increase its use of technology and had installed a touchscreen tablet device in the reception area to enable patients to access health information. In addition the practice had a presence on social media and used this to communicate with patients about service delivery issues.
• The practice website had a comprehensive range of self-help and health promotion information.
• Two GPs within the practice offered a contraceptive implant fitting service.

Updated 12 May 2016

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

• 91.6% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was 6.3% above the CCG average and 7.6% above the national average.

• 96.7% of patients with a mental health condition had a documented care plan in place which was 5.1% above the CCG average and 8.4% the national average.

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

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

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Patients with mental health conditions were invited to attend groups within the practice such as the craft and chatter group to reduce social isolation.

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

Updated 12 May 2016

The practice is rated as outstanding 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, carers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability and for those who required them.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. The community trust employed care coordinator was based in the practice and reflected positively on their relationship with the practice and the benefits this brought to patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations. In addition the practice offered a range of groups and services to support people whose circumstances may make them vulnerable including: Weekly craft and social groups facilitated by the PPG and an occupational therapist for people who may be at risk of isolation; Monthly bingo sessions held at the practice and accessible to patients and members of the community and;Monthly carers coffee mornings held at the practice and were accessible to both patients and members of the wider community.
• 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.