Sherrington Park Medical Practice

Updated 20 April 2016

Sherrington Park Medical Practice is situated in a large residential area close to the city centre of Nottingham

The practice is run by a partnership between two GPs (one male and one female) in adapted residential premises and has been operational for just over 20 years. The practice employs a full time nurse practice nurse and a health care assistant. The clinical team is supported by a full-time practice manager and a team of eight part-time administrative, secretarial and reception staff.

The registered list size of 4,193 are predominantly of white British background, although there is some diversity within the registered practice population. The practice are ranked in the fifth more deprived decile, and is in line with the national average. The practice age profile has higher percentages of patients aged 25-55 years old. It has lower percentages of patients aged under 25, although it has slightly higher percentages for 0-4 year olds. There are lower percentages of patients aged over 60 registered with the practice.

The practice opens from 8.30am until 6.30pm Monday to Friday, apart from one Tuesday afternoon each month when the practice is closed for training purposes. The practice also closes each Tuesday lunchtime for approximately one hour for a staff meeting. GP morning appointments times are available from 8.45am to between 11.30am or 1pm, and afternoon surgeries run from 3.50pm to 6pm. Extended hours GP and nurse surgeries are provided from 7.30am to 8.00am every Tuesday morning.

The practice has opted out of providing out-of-hours services to its own patients. When the practice is closed, patients are directed to NEMS (the contracted out-of-hours provider) via the 111 service.

The practice holds a General Medical Services (GMS) contract to provide GP services which is commissioned by NHS England. The practice also offers a range of enhanced services which are commissioned by NHS Nottingham City CCG.

Updated 20 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sherrington Park Medical Practice on 7 March 2016. The overall rating for this practice is outstanding.

Our key findings were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events, and we saw evidence that learning was applied from events.
• 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.
• Feedback from patients about their care, and their interactions with all practice staff, was consistently and strongly positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Patients said they found it easy to book an appointment with a GP, and routine appointments could also be booked up to six months in advance. Urgent appointments were available the same day.
• The two GPs held their own patient lists to ensure continuity of care and establish strong relationships with patients and their families.

• The practice used clinical audits to review patient care and we observed how outcomes had been used to improve services as a result.

• The practice worked effectively with the wider multi-disciplinary team to plan and deliver effective and responsive care to keep vulnerable patients safe. This approach had impacted on unplanned hospital admissions and attendance at Accident and Emergency.
• There was a strong and proactive leadership structure within the practice, and staff felt well-supported by management.
• The practice had good facilities and was well-equipped to treat patients and meet their needs.
• The practice reviewed the way it delivered services as a consequence of feedback from patients.

We saw several areas of outstanding practice including:

• The practice provided excellent access to GP appointments. This was reinforced by the national GP survey results. For example, 89% of patients described their experience of making an appointment as good compared to the CCG average of 74% and national average of 73%. Patients we spoke to on the day of the inspection also highlighted the ease of making an appointment to see a doctor. The practice had low attendance rates at Accident & Emergency (220 per thousand population compared against the local average of just above 300), and a lower number of unplanned hospital admissions in comparison to other local GP practices (53 patients per thousand population versus the local figure of 90), demonstrating that good access achieved positive outcomes for patients.

• The practice worked in collaboration with other practices. For example, reviewing and learning from incidents; peer review meetings; and arranging and hosting monthly presentations from locally based professionals – for example, a consultant in chest related diseases had recently spoken to the group.

• In response to a lower rate of diagnosis, the practice had introduced a more comprehensive assessment tool to identify patients with dementia, and implemented an alert for patients at risk of developing dementia on the clinicians’ computers. This had helped identify more patients with dementia to enable them to receive treatment and support at the earliest opportunity. The diagnosis rate had increased from 35.2% to 48.5% to bring this in line with the local average of 55%. The use of the new screening tool had identified three new patients with dementia in the first two months of its implementation, who would not have been identified using the standard assessment tool.

In addition the provider should:

• Strengthen the infection control lead role by defining key responsibilities, and ensuring additional training is undertaken to support this role.
• Review the relationship with the Patient Participation Group (PPG) to ensure they provide a voice for patients, and are influential in shaping service provision.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 April 2016

• The practice achieved 431 out of 435 points (99.1%) for clinical indicators within QOF. This was 7.9% higher than the local CCG average and 4.6% above the national average.

• Performance for diabetes related indicators at 95.8% was above the CCG average of 79.1% and the national average of 89.2%. The level of exception reporting for diabetes patients was also noted to be lower than local and national averages.

• QOF indicators for asthma were broadly in line with CCG and national averages. For example, 71.4% of patients with asthma received a review in the preceding 12 months, compared to the CCG and national averages of 75.5% and 75.3% respectively. The partners were taking actions to increase performance in this area. This included recruiting for additional nursing hours, and ensuring all new patients with an asthma diagnosis were flagged to receive a review once the medical records were received by the practice.

• All patients with a long-term condition received a structured annual review to check their health and medicines needs were being appropriately met.

• For those patients with the most complex needs and associated risk of hospital admission, the practice team worked closely with the local community health providers including the community matron and respiratory team to deliver a multidisciplinary package of care.

• The diabetes nurse specialist attended the practice each month to provide a joint clinic with the practice nurse to review patients with diabetes.

• The clinical team reviewed the computer templates each year to ensure key clinical information was recorded during consultations. Designated staff roles for data inputting and notes summarisation helped to maintain accurate disease registers.

• Patients could book a double or triple appointment if they wished to be seen for more than one issue, or had a particularly complex issue to discuss.

Updated 20 April 2016

• A flexible appointment system ensured that children could be seen on the same day when this was indicated. Appointments were available outside of school hours. Telephone triage was utilised to ensure those with urgent requirements were dealt with promptly.

• The premises were suitable for children and babies. Toys were provided for children attending the surgery. Baby changing facilities were available and the practice accommodated young mothers who wished to breastfeed.

• Personal GP patient lists enabled the doctor to build excellent family relationships, and promote continuity for patients.

• The practice held quarterly meetings with the health visitor, and also reviewed any children on a child protection plan at their own monthly clinical meeting.

• The practice provided neonatal checks, six week post-natal checks for new mothers and eight week baby checks.

• Immunisation rates were high for all standard childhood immunisations, and in line with local averages. For example, vaccination rates for children under two years old ranged from 93.7% to 100% compared against a CCG average ranging from 91.1% to 96.3%.The practice team monitored uptake of childhood vaccinations to enable those who did not attend to be followed up.

• Patients we spoke with on the day, and feedback received from our comment cards, stated young people were treated in an age-appropriate way and were recognised as individuals.

Updated 20 April 2016

• The practice offered proactive and personalised care to meet the needs of older people. The practice used a regular monitoring process to identify frail and vulnerable patients, and those at high risk of hospital admission, to plan and develop individual care packages.

• Care plans were in place for older patients with complex needs. Monthly multi-disciplinary meetings were held to review frail patients and those at risk of hospital admission to plan and deliver care appropriate to their needs.

• The practice nurse and healthcare assistant monitored hospital admissions and discharges, and telephoned high-risk patients within 48 hours of discharge to review if any additional help may be required.

• It was responsive to the needs of older people, and offered home visits and urgent appointments for those who needed them. Longer appointments could be booked if these were required. The practice were flexible with older patients if for example, they attended on the wrong day or time.

• The practice followed up any patient aged 90 and above who had not attended for a review to see if they were well, and to arrange to go and see them at home if required.

• The practice offered all patients aged 75 and over an annual health check. In the year to date, 58% of patients who have been invited for the health check had attended. Over 75s were provided with an information pack about services available to them.

• Flu vaccination rates for the over 65s were 77.6% which was higher than the local average of 72.9% and the national figure of 73.2%.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure were in line with or above local and national averages

Updated 20 April 2016

• The registered patients were predominantly within this population group including a high percentage of working professionals, and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• There was excellent access to GP consultations and we observed that appointment systems worked efficiently on the day of our inspection. Feedback from patients was consistently positive about their experience in obtaining an appointment quickly and a time that was convenient to them. For example, the 2016 national GP survey indicated that 95% of patients were able to get an appointment to see or speak to someone the last time they tried compared to a CCG average of 83% and a national average of 85%.

• An early morning extended hours’ surgery was provided each week by both GPs, the nurse, and the health care assistant. This had been a preferred option expressed by patients, rather than access to a late evening service.

• Telephone consultations were available each day for those patients who had difficulty attending the practice due, for example, to work commitments.

• The practice was proactive in offering online services to book GP appointments and repeat prescriptions. The practice also undertook electronic prescribing so that prescriptions could be sent directly to the pharmacy of the patient’s choice.

• A text reminder service was used to help reduce non-attendance for appointments.

• Both GPs had additional qualifications in occupational health which was beneficial in terms of supporting people to remain at work, or to facilitate an earlier return. The GPs also referred, or encouraged patients to self-refer, to a local service that assisted people to return to work. This service also helped unemployed patients with a disability to secure employment.

• Health promotion and screening was provided that reflected the needs for this age group.

• The practice provided travel clinic services and was a registered yellow fever centre.

• The practice’s uptake for the cervical screening programme was 89.8% which was above the CCG average of 81.5% and the national average of 81.8%. This was the second highest rate of 57 practices in the CCG.

Updated 20 April 2016

• 94.1% of people diagnosed with dementia received a face to face review of their condition during 2014-15.This was 10% higher than the CCG and national averages, although the exception reporting rate was slightly higher by 2%.

• The practice achieved 99% for mental health related indicators in QOF, which was 10.3% above the CCG and 6.2% above the national averages. The practice had slightly higher exception reporting rates for six of the seven mental health related indicators.

• 94% of patients on the practice’s mental health register had received an annual health check during 2014-15. This was 10.5% above the CCG average and 5.8% above the England average, with exception reporting rates approximately the same.

• The practice provided care for vulnerable patients with mental health and learning disabilities in two local residential units.We spoke to staff at the homes who commented that the practice provided good standards of care and support for their residents. At one of these units, the healthcare assistant had commenced quarterly site visits to develop relationships with clients in response to their apprehensions about going to the practice. This had produced positive outcomes including all residents receiving the flu vaccination in the last year, when previously uptake had been low.

• In response to a perceived lower detection of dementia, the practice had implemented the Montreal Cognitive Assessment to compliment the more commonly used Six-item Cognitive Impairment Test (6CIT). This had helped identify more patients with signs of dementia to enable them to receive treatment and support at the earliest opportunity.

• The practice worked with multi-disciplinary teams in the management of people experiencing poor mental health, including those with dementia. This included the mental health crisis team to ensure those patients experiencing acute difficulties received urgent assistance to manage their condition.

• The practice told patients experiencing poor mental health and patients with dementia about how to access services including talking therapies and various support groups and voluntary organisations. Information was available for patients in the waiting area.

• The practice undertook reflective learning following significant events when patients had ended their own lives.

Updated 20 April 2016

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability. Homeless people could register with the practice.

• The practice worked with multi-disciplinary teams in the case management of vulnerable people and informed patients how to access various support groups and voluntary organisations.

• 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.

• The practice provided good care and support for end of life patients and had signed up to a national programme to deliver high quality palliative care. Patients were kept under close review by the practice in conjunction with the wider multi-disciplinary team.

• The practice had carried out annual health checks for people with a learning disability, and 68% of patients had received an annual review in the last 12 months. It offered longer appointments for people with a learning disability.

• Of 19 patients on the practice register of learning disability patients, three patients had a care plan in place.