Archived: St Lawrence Road Surgery

Updated 4 August 2016

St Lawrence Road Surgery is run by a partnership of two GPs, and provides primary medical services to 4,475 patients living in North Wingfield and the surrounding area.There are several small villages in the catchment area, which are isolated. One of the key challenges is access to the practice from public transport and services. 

The area has a high rate of respiratory disease largely  relating to the past coal mining industry .

The clinical team includes two GP partners, a salaried GP (two female, one male). There is also an advanced nurse practitioner, two practice nurses, a healthcare assistant and two phlebotomists to collect blood samples. 

The team are supported by reception, administrative and secretarial staff, and includes a practice manager, an office supervisor, an accounts manager and an operations manager who is also the care co-ordinator and secretary. 

The practice is a teaching practice for third year and fifth year medical students. These are students undergoing a programme of medical education to become doctors.

The practice hold a General Medical Service (GMS) contract with NHS England to deliver primary medical services. The practice is open Monday to Friday from 8am to 6.30pm.

The practice has opted out of providing out-of-hours cover to its patients. If patients require a GP outside of normal working hours they are advised to contact the GP out of hours service provided by Derbyshire Health United.

Updated 4 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of St Lawrence Road Surgery on 2 September 2015. A breach of legal requirements was found, in that a risk assessment had yet to be completed to determine the risks of exposure to legionella. Overall the practice was rated as good with requires improvement for the safe domain.

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

We undertook a desk based review on 20 July 2016 to check that the provider had completed the required actions, and now met the legal requirement. We did not visit the practice as part of this inspection. This report only covers our findings in relation to those requirements.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lawrence Road Surgery  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.

Overall the practice is rated good including the safe domain.

An assessment had been completed to determine the risks of exposure to legionella, and an action plan and control measures were in place to eliminate and manage the risks identified in the report to ensure the services were safe.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 January 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. Patients were also referred to the community support scheme in order to assist in preventing unplanned admission to hospital. Patients with multiple long-term conditions were offered a longer appointment to save them from multiple attendances. Patients with diabetes were empowered to self-manage their condition by being taught how to test their own blood sugar, interpret the results and adjust their own insulin which a medicine used to stabilise blood sugars in diabetes. This personalised care can result in better control of blood sugars and therefore less risk of developing secondary complications of diabetes including heart disease. For those patients with the most complex needs, the named GP worked with relevant health and care professionals including a community matron to deliver a multidisciplinary package of care.

Updated 28 January 2016

The practice is rated as good for the care of families, children and young people. Children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk of or were known to have safeguarding concerns. Immunisation rates were high for all standard childhood immunisations. Appointments were available outside of school hours and the premises were suitable for children. Vaccinations were also offered opportunistically for those families which were ‘hard to reach’. We saw good examples of joint working with midwives, health visitors and school nurses.

Updated 28 January 2016

The practice is rated as good for the care of older people. The practice offered proactive, personalised care to meet the needs of older patients and had a range of enhanced services. For example, the practice had a community support scheme whereby they employed a care co-ordinator to follow up patients after hospital discharge, out of hours contacts or A&E attendance. Once the patients had been identified, the practice multidisciplinary team (MDT) which included; district nurses, psychiatric nurse and social care workers met to discuss each patient in order to formulate a personalised care plan. Personalised care plans enhance standards of care that patients receive and can assist in prevention of readmission to hospital.

The practice also carried out over 75 annual health checks, assessing both physical and mental health needs, either at the practice or in their own homes. As a result of these health checks patients were then given a personalised care plan. Patients were also encouraged to bring their carer/family with them to the health checks.  We saw that carers were also identified during these appointments and then signposted to the appropriate services according to their needs.

Updated 28 January 2016

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice offered early morning and late appointments and lunch time blood tests to accommodate personalised working needs. All patients we spoke with praised the appointment system confirming how flexible this was. Patients were able to book appointments online although the uptake for this service was low. We saw that patients were asked about how they would manage their forthcoming retirement. For example issues such as finance and how to manage time when not working were discussed at health checks and annual reviews. The practice had also subscribed to electronic prescribing which enabled flexibility for collecting medicines.

All patients could have a referral to the local food bank if this was required. The Citizens Advice Bureau also held a weekly clinic which gave individuals in the practice the chance to address any financial worries or concerns.

Updated 28 January 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Forty-five per cent of patients experiencing poor mental health had received an annual physical health check. This was lower than the national average and was considered to be an outlier with regards to the Quality and Outcomes Framework (QOF). The practice had identified this as a coding issue that had been corrected. Patients who had not attended for a health review were telephoned and offered a personal invitation to ensure patient safety and possible reasons for non-attendance. We were also assured that patients who had not received their annual health review at the practice had been reviewed in secondary care.

All staff including the reception team had received training in dementia care. The practice had invited a member of the team from the Alzheimer’s Society to assess their waiting room and discuss with staff ways of making improvements to enhance the patient experience.

The practice regularly worked closely with the Community Mental Health Team in the case management of patients experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia.

We saw evidence that where patients were assessed as having a low mood during a consultation this led to depression screening. If the depression screen was positive patients were then provided with some health promotion material on how to manage depression and were also signposted where to find further support.

The practice allowed a community psychiatric nurses to book clinical rooms for clinics on an as required basis.

Updated 28 January 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. All staff we spoke with knew how to recognise signs of abuse in vulnerable adults and children .All staff including receptionists 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 held a register of patients living in vulnerable circumstances including travellers and those with a learning disability. We saw evidence that the practice adapted their invitation letters for annual health reviews, For example there were visual invites consisting of more pictures for those individuals with learning disabilities.

The practice worked regularly with multi-disciplinary teams in the case management of vulnerable patients. It had told vulnerable patients about how to access various support groups and voluntary organisations tailored to suit individual needs. For example, we saw that there was a file which provided details of opticians and dentists who specialised in patients who may have a learning disability.

We also saw that health questionnaires were sent to a patient with learning disabilities prior to their appointment to identify new concerns. This plan was then discussed at the health check and signposted referrals to new services including physiotherapy and occupational therapy.

Appointments for travelling families were often provided at short notice where possible and this appointment could be used as an opportunity to provide any opportunistic immunisations if required.