Torkard Hill Medical Centre

Updated 20 September 2016

Torkard Hill Medical Centre is located in Hucknall, a town in the north of Nottingham. The practice is run by a partnership of six GP partners, (four male, two female), and provides primary medical services to approximately 14,500 patients. This number is increasing due to local housing expansion.

The practice has a slightly higher than national average number of patients who are of working age, including those approaching retirement. It also has a slightly higher proportion of carers and nursing home patients than the national average.

The practice holds the Personal Medical Services (PMS) contract to deliver primary medical services.

The clinical team includes six GP partners, two salaried GPs, trainee GPs, f ive practice nurses and two healthcare assistants. The clinical team is supported by a practice manager, head of business development and a team of reception and administrative staff. The practice also employs two cleaners .

The practice is open from 8.30am to 6.30pm Monday to Friday. Patients can phone the practice from  8am to request an urgent appointment.  Routine appointments can be pre-booked four weeks in advance in person, by telephone or online. 

The practice has opted out of providing GP services to patients out of hours such as nights and weekends. During these times GP services are provided by NHS 111.

The practice is a training practice for GP registrars (qualified doctors who are doing extra training to become GPs) and is involved in the teaching of medical students from a local university.

Updated 20 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Torkard Hill Medical Centre on 2 December 2015. A breach of legal requirements was found in that administrative staff who may undertake chaperone duties had not received a disclosure and barring service (DBS) check, and a risk assessment had not been completed  to determine whether a DBS  check was required.

Overall the practice was rated as good. In view of the above the practice was rated as requires improvement for providing safe services.

After the comprehensive inspection, the practice wrote to us to say what action they had taken to meet the legal requirement in relation to the breach.

We undertook this desk based review on 30 August 2016 to check that the provider had completed the required actions, and now met the legal requirements. We did not visit the practice as part of this inspection. This report only covers our findings in relation to the above requirement.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Torkard Hill Medical Centre  on our website at www.cqc.org.uk.

Our finding across the area we inspected was as follows:The practice had taken appropriate action to meet the legal requirement.

• The practice is rated as good for providing safe services.​
• The recruitment and chaperone policies had been reviewed to ensure the practice obtained appropriate Disclosure and Barring Service (DBS) checks for all staff.
• Records showed that a DBS check was obtained for all appropriate staff immediately after the comprehensive inspection.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 March 2016

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

• Clinicians had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority and appropriate action taken to reduce the likelihood of attendance. GPs and nursing staff took an active role in the regular review of unplanned admissions patients.

• National data showed the practice was performing in line with the local and national averages for eleven diabetes indicators. The practice received total points of 88.4% compared with the CCG average of 87.3% and national average of 89.2% .

• Longer appointments and home visits were available when needed.

• The practice had 3763 patients with long term conditions on its register. All these patients had a named GP and were offered a structured annual review to check their health and medicines needs were being met. The practice had developed effective systems for review and monitoring of these patients. 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.

Updated 24 March 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. Immunisation rates for all standard childhood immunisations ranged from 92% to 99%.This was in line with CCG averages which ranged from 88% to 98% .

• 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 included information for young people regarding consent and confidentiality on its website.

• The practice, in partnership with the patient participation group (PPG), had visited a local school to obtain young people’s feedback about what they expected from their NHS. The practice also used the opportunity to deliver health promotion and advice.

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

• We saw positive examples of joint working with midwives and health visitors. Documented records we reviewed supported effective, collaborative working.

Updated 24 March 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. All older patients had a named GP and all care and residential homes were assigned a named GP. Frequent visits were made by the practice GPs to their care home patients in and outside of working hours. Care home managers we spoke with praised GPs for their hands on approach.

• Care plans were implemented for those patients identified as close to the end of life. The practice held regular multidisciplinary meetings where all patients on the palliative care register were discussed. The practice was also part of the Gold Standards for end of life care.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. This included offering vaccinations for those who could not attend the practice.

Updated 24 March 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. The practice offered extended hours appointments with early and late sessions on varying days with all GPs.

• The practice offered GP led telephone triage which negated the need for some patient attendance at the practice.

• 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. Yearly flu clinics were run on a Saturday for working age patients who preferred weekend attendance.

• National data showed the practice was performing above local and national averages for those female patients whose notes recorded that a cervical screening test had been performed in the preceeding 5 years. The practice received total points of 88.5% compared with the CCG average of 86.2% and national average of 81.8%.

• Working age patients were invited to attend the patient participation group (PPG) which was run as a virtual group to encourage working age people to join.

Updated 24 March 2016

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

• National data showed the practice was performing above the local and national averages for the number of its patients who had been 89.5

• National data also showed the practice was performing above the local and national averages for seven mental health related indicators. The practice received total points of 100% compared with the CCG average of 93.8% and national average of 92.8%. The practice’s overall exception rate reporting was 1.2% below CCG average and 1.3% below national average.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Information was displayed within the practice and on the practice website where mental health services were listed as having a support clinic.

• 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. We saw an example where an unknown patient with mental health needs was identified for GP follow up and secondary referral as a result of attendance at accident and emergency.

• Staff had a good understanding of how to support patients with mental health needs and dementia. The practice had participated in a dementia research study to explore the effectiveness of early intervention support strategies. The practice undertook screening for dementia during routine patient reviews.

• An ongoing proactive review into dementia screening of care home patients had identified 55 who were suitable for screening. Of these, 62% were found to have a diagnosis of dementia. Those identified had their prescription reviewed to ensure optimisation and compatibility with the patients’ condition, care plans developed and referral where required to the dementia outreach team.

Updated 24 March 2016

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

• The practice identified patients living in vulnerable circumstances including those with a learning disability. 27 patients with a learning disability were held on a register and all had been offered an annual health check.

• The practice offered longer appointments for patients with a learning disability. Markers were placed on patient records so reception staff knew to allocate a longer appointment time when required.

• GPs within the practice had recently updated their knowledge with learning disability training and we were passed evidence of this training.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. Documentation supported that patients received ongoing care and support from the appropriate health care service(s).

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations. This included information within the practice waiting area and on their website. The practice had worked in collaboration with the patient participation group (PPG) to identify carers, signpost them to various support networks and ensure their views were represented.

• 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. GPs undertook health and well being checks for patients with chronic mental health problems residing at a local care home.