Melbourne Park Medical Centre

Updated 12 January 2017

Melbourne Park Medical Centre provides primary medical services to around 7900 patients via a general medical services (GMS) contract. The practice list size is steadily increasing.

The practice is situated in the Aspley area of Nottingham, close to the city centre and is accessible by public transport. The premises are purpose built and were completed in May 2015. A pharmacy is co-located with the practice. Ample car parking is available on site.

The level of deprivation within the practice population is significantly above the local and national average with the practice falling into the most deprived decile. Levels of income deprivation affecting children and older people are slightly above local averages and significantly above national averages.

The clinical team is comprised of five GP partners (one male, four female), three practice nurses and a health care assistant. The clinical team is supported by a practice manager, an assistant practice manager, a trainee practice manager, a reception manager and a team of reception and administrative staff.

The practice is an accredited training practice and had one trainee GP working there at the time of the inspection.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are from 9am to 12pm each morning and from 4pm to 6pm each afternoon. The practice does not provide extended hours appointments.

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 via the 111 service.

Updated 12 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Melbourne Park Medical Centre on 7 October 2016. Overall the practice is rated as good.

Our key findings across the areas we inspected were as follows:

• There was an open approach to safety across the practice. Systems were in place which supported staff to report and record significant events. Significant events were investigated and appropriate action taken as a result.
• Risks to patients were assessed and well managed across the practice.
• Care was delivered to patients in line with current evidence based guidance. Staff had received training which provided them with the skills and knowledge to deliver effective care and treatment.
• Feedback from patients was generally positive about their interaction with practice staff and the standard of care and treatment they received.
• The majority of patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. This was supported by data from the GP patient survey.
• Information about services and how to complain was available in the waiting area and was easy to understand. Improvements were made to the quality of care as a result of complaints and concerns. The practice responded to complaints openly and was keen to meet with complainants to resolve issues as swiftly as possible.
• Patients said they were generally able to access urgent appointments but said it could be difficult to get through to the practice by telephone. In response to issues related to access the practice had improved their telephone system and data from the GP patient survey showed improvements over the last three years.
• The practice had occupied new premises since 2015 which had good facilities and were well equipped to treat patients and meet their needs. The new premises afforded the practice additional space and provided the flexibility for future expansion.
• 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.

We saw one area of outstanding practice:

• In addition to standard health checks, one of the practice nurses provided a home visiting service to elderly patients who were unable to attend the surgery. This was undertaken on a weekly basis. The practice nurse also performed over 85s checks in the community which enabled identification of health and social issues. We saw evidence that the majority of older patients in the practice were receiving regular health reviews. For example, the practice had 495 registered patients over the age of 75, 429 of whom had received a health review in the last 12 months.

The areas where the provider should make improvement are:

• Ensure all staff receive regular appraisals
• Continue to review and improve access to appointments
• Improve the recording of reviews undertaken in relation to significant events
• Improve the identification of carers and the support available to them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 January 2017

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

• Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The practice had higher than average clinical prevalence for the majority of long-term conditions with the exception of asthma.
• Performance for diabetes related indicators was 72.4% which was 6.7% below the CCG average and 16.8% below the national average. The exception reporting rate for diabetes indicators was 4.6% which was significantly below the CCG average of 9.8% and the national average of 10.8%.
• Performance for indicators related to hypertension was 100% which was 1.4% above the CCG average and 2.2% above the national average. The exception reporting rate for hypertension related indicators was 2.9% which was below the CCG average of 3.7% and the national average of 3.8%.
• Effective call and recall systems were operated to ensure patients were reminded to attend the practice for the management and monitoring of their conditions. The practice did not routinely exempt patients as a result of non-attendance and had a low exception reporting rate.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and were offered 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.

Updated 12 January 2017

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 were relatively high for all standard childhood immunisations.
• 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 with afternoon appointments until 6pm to facilitate access for school age children.
• The premises were suitable for children and babies. There was a dedicated child play area in the waiting room.
• We saw positive examples of joint working with community based staff to ensure children were safeguarded from abuse.
• A weekly sexual health clinic was hosted by the practice.

Updated 12 January 2017

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 was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• One of practice nurses provided a home visiting service for elderly housebound patients. In addition to this they undertook health checks for patients over 85 in the community.
• We saw evidence that the majority of older patients in the practice were receiving regular health reviews. For example, the practice had 495 registered patients over the age of 75, 429 of whom had received a health review in the last 12 months.

Updated 12 January 2017

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.
• Although the practice did not provide extended hours services, there were a number of early appointments available at 8.30am and afternoon appointments were available until 6pm.
• Patients could book appointments online and access medical advice via telephone where appropriate.
• 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.

Updated 12 January 2017

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

• Performance for mental health related indicators was 98.5% which was 9.8% above the CCG average and 5.7% above the national average. The exception reporting rate for mental health related indicators was 6.7% which was below the CCG average of 10.5% and below the national average of 11.1%.
• 78.4% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was 6.6% below the CCG average and 5.6% below the national average. This exception reporting rate for this indicator was 1.9% which was significantly below the CCG average of 8.5% and the national average of 8.3%.
• The practice had a practice specific objective regarding self-harm and suicide involving reviews and significant event analyses of a number of cases. The findings were shared with three other local practices.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• Information was available for patients experiencing poor mental health about how to access support groups and organisations.
• The practice was involved with a CCG led project the 'Physform Project’ as part of the pilot with nursing team and GP input. This provided comprehensive assessments of patients with mental health problems.
• 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.

Updated 12 January 2017

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 those with a learning disability. There was a dedicated lead clinician for patients with a learning disability; 75% of patients with a learning disability had received an annual health check in the last 12 months.
• Longer appointments were offered for patients with a learning disability where these were required.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children and 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. Staff had been provided with training in relation to dealing with issues of domestic violence.