Archived: The Derby Road Practice

Updated 11 November 2016

The Derby Road Practice and its branch surgery at Pinewood Surgery cover the areas of Ipswich for several miles around the two practice buildings, excluding areas of Ipswich that the practice team cannot safely travel to in a reasonable time. The practice began over 100 years ago with a purpose built surgery at Derby Road, which is still in use following more recent modifications. The branch surgery at Pinewood Surgery was purpose built 20 years ago and extended nine years ago. We attended both practice sites during our inspection.

The practice is run by a partnership of five GP partners (three male and two female). The practice employs four salaried GPs, (three male and one female), two nurse practitioners, a minor ailments nurse, six practice nurses, a health care assistant, two phlebotomists and a senior clinical pharmacist. The clinical team is supported by a practice manager, a deputy practice manager, an administration manager, a clinical administration manager and teams of administrative/reception staff and medical secretaries. The practice has undergone a period of change in the past year with the loss of one GP, and another GP and a practice nurse on maternity leave. They are continuing to attempt to recruit GPs to the area.

The registered practice population of over 17,000 patients across both practice sites are predominantly of white British background. However, the ethnic diversity of the patient population is increasing with migrant communities joining the practice list. The patient population at the Derby Road site has a high number of elderly patients. The practice reports a growing patient list of on average 35 new patients per month, this is mostly at the branch surgery. According to Public Health England information, the practice age profile is in line compared to the practice average across England.

The practice is open between 8am and 6:.30pm Monday to Friday. The practice described an ethos of ‘if patients need to be seen on the day they are’. Following an audit of telephone triage effectiveness the practice Nurse Practitioners provide on the day appointments for patients, allowing on the day or urgent requests for appointments to be booked directly by reception. Each practice site has a daily duty GP who oversees the ‘on the day’ demand. In order to ensure appointments are allocated appropriately there is a protocol staff follow to ensure effective use of clinical time. In addition to pre-bookable appointments that can be booked up to six weeks in advance, urgent appointments are also available for patients that need them.

The practice offers a balance of routine appointments with on the day appointments. In addition there are pre-bookable telephone consultations for appropriate patients and 15 minute face to face appointments. Saturday morning extended hour appointments are available with both GPs and nurses and the practice participates in the Suffolk Federation’s access pilot called ‘GP+’ where patients can make appointments outside core hours, the practice are actively encouraging patients to make use of the underutilised Sunday service this provides.

The practice holds a Personal Medical Services (PMS) contract to provide GP services which is commissioned by NHS England. A PMS contract is a nationally negotiated contract to provide care to patients. The practice offers a range of enhanced services commissioned by their local CCG: including improving patient on-line access, extended hours access and support for people with dementia. Out of hours care is provided via the NHS 111 service.

Updated 11 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Derby Road Practice on 23 August 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.
• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. However, there was scope to improve the practice oversight of staff training.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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.
• Patients said they generally found it easy to make an appointment with a named GP and 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. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Ensure that carers continue to be identified.
• Ensure that there is an effective system in place to oversee the completion and recording of staff training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 November 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 and patients at risk of hospital admission were identified as a priority. Clinical staff oversaw all recalls for patients with long term conditions and liaised with the nursing team to ensure patients were reviewed.
• Performance for diabetes related indicators was better in comparison to the CCG and national averages, with the practice achieving 91% across all indicators. This was 0.5 percentage points above the CCG average and two percentage points above the national average. Exception reporting was in line with CCG and national averages.
• 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. 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, such as the community district matron.
• Repeat prescriptions contained a message to invite patients to make an appointment when their review was due; text reminders and letters were also sent to remind patients to attend for their review.
• Patients with long term conditions such as asthma were sent an appropriate questionnaire to complete prior to their health care and medication review.
• The practice recruited an extra practice nurse during the flu vaccination season to perform all the influenza home visit vaccinations.
• The practice took part in the Norfolk Diabetes Prevention Study, with good uptake (173 patients responded from the 1,800 invited).

Updated 11 November 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.
• Childhood immunisation rates for the vaccinations given were comparable to CCG/national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 95% to 99% which was comparable to the CCG average of 95% to 98% and five year olds from 94% to 99% which was comparable to the CCG average of 94% to 97%.
• 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.
• The practice’s uptake for the cervical screening programme was 80%, which was higher than the CCG average of 76% and the national average of 74%. There was a policy to offer text, telephone and letter reminders for patients who did not attend for their cervical screening test.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• The practice offered weekend appointments and GP+ appointments to enable those patients who worked to bring family members along when convenient.
• The practice opportunistically identified young patients for incomplete vaccination programmes. For example meningitis vaccinations. 

Updated 11 November 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 provided organisational continuity with families, with patients in their 80’s being known by some staff, including GPs, since they were in their 50’s.
• There was a dedicated telephone number for elderly and vulnerable patients to call.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. All home visits were triaged by a clinician to prioritise visits and ensure appropriate clinical intervention. The practice worked closely with the community district matron and nursing teams arranged weekly visits for homes with planning prior to visits in addition to urgent visits when required.
• The practice would contact patients after their discharge from hospital when required, to address any concerns and assess if the patient needed GP involvement at that time.
• The practice offered health checks for patients aged over 75.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure, were above local and national averages

Updated 11 November 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, this included weekend and GP + appointments.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• Appointments were available before and after usual working hours (9am to 5pm) as well as during the day. Telephone appointments were available in addition to on-line appointments and repeat prescription requests, on-line prescription enquiries and emails.
• The practice encouraged its patients to attend national screening programmes for bowel and breast cancer screening. The bowel cancer screening rate for the past 30 months was 64% of the target population, which was above the CCG average of 63% and above the national average of 58%.The breast cancer screening rate for the past 36 months was 82% of the target population, which was above the CCG average of 80% and the national average of 72%. 

Updated 11 November 2016

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

• The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months (01/04/2014 to 31/03/2015) was 89%, this was comparable to the CCG average of 85% and the national average of 84%. At the time of our inspection the practice had invited 163 patients identified as having dementia for a health check, of these 133 had undergone a review since April 2016, others were scheduled with an appointment or had declined. The practice referred patients to various support services as required.

• The percentage of patients experiencing poor mental health who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015) was 96%, this was above the CCG average of 85% and the national average of 88%. Of the 149 patients identified as experiencing poor mental health on the practice register and invited for a health check, 84 had received a health check in the past twelve months with appointments scheduled for the remaining patients
• The practice regularly worked with multi-disciplinary teams in the case management of patients 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.
• 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 11 November 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 homeless people, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability when required. The practice had identified 129 patients with a learning disability on the practice register, 106 of these patients where a health check was appropriate. 82 of these patients had received a health check with invitations sent to the remaining patients.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients. The practice undertook quarterly meetings to discuss vulnerable adults, liaised with the learning difficulty link worker and met monthly with the health visitor to review vulnerable children and families.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations and worked closely with refugee families.
• 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.