The Calverton Practice

Updated 22 October 2015

The Calverton Practice provides primary medical care services to approximately 9,250 patients. The practice is based in the centre of the village of Calverton.

The practice offers a dispensary service, and the pharmacy is between 8.30am and 6.30pm

The practice has a Primary Medical Services (PMS) contract with NHS England. This is a contract for the practice to deliver primary care services to the local community or communities.

In addition the practice offers a number of enhanced services to its patients. These are services over and above the usual GP contract. The Calverton Practice offers: an alcohol-related risk reduction scheme, avoiding unplanned admissions to hospital or long-term care particularly for older patients, facilitating timely diagnosis and support for people with dementia, a learning disabilities health check scheme and a dementia identification scheme.

There are five GP partners at the practice and the practice provides current placements for doctors in training. The practice has male and female GPs and patients can choose the gender of the GP they see. In addition the nursing team comprises of five practice nurses and two healthcare assistants. The clinical team are supported by the practice manager and an administrative team.

The Calverton Practice has opted out of providing out-of-hours services to its own patients. Out-of-hours services are provided by Nottingham Emergency Medical Services – NEMS. Patients can also attend one of two walk in centres situated within Nottingham which deal with minor illness and injury.

Updated 22 October 2015

We carried out an announced comprehensive inspection at The Calverton Practice on 7 January 2015. Overall the practice is rated as outstanding.

Specifically, we found the practice to be outstanding for providing effective and responsive services. It was also outstanding for providing services for people with long-term conditions and working age people (including those recently retired and students).

It was good for providing safe, caring and well-led services. It was also good for providing services for older people, people with long-term conditions, families, children and young people, people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia)

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• 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.

We saw several areas of outstanding practice;

• The practice ran a tier 4 anticoagulant service overseen by the practice pharmacist which included providing services to all housebound patients by appropriately trained Heath Care assistants. This service was not routinely available in other practices within the CCG area.

• The practice employed a practice pharmacist who was also trained as an independent prescriber. The pharmacist offered clinics which were tailored to meet the needs of patients with complex conditions. This service was available to all registered patients. The practice was able to demonstrate very effective prescribing rates in terms of hypnotic usage, anti-inflammatory medication and antibiotic prescribing compared to the national average as a result of continuous quality improvement.

• The practice ran a morning walk in service for minor illness led by appropriately trained practice nurses. The practice was able to demonstrate lower accident and emergency (A&E) attendance rates than the average for the locality.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 22 October 2015

The practice is rated as outstanding 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. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met.

There was a system in place for reviewing repeat medicines for patients with several long-term conditions or those receiving multiple medicines to ensure prescribing was minimised and that the medicines prescribed were suitable and appropriate to maintain the health and wellbeing of patients.

The practice employed a pharmacist with prescribing rights. They were able to demonstrate better than national average prescribing rates for antibiotics, anti-inflammatories as well as hypnotics. The tier 4 anticoagulant service provided a service to housebound patients. The practice tailored its medication reviews to coincide with a patient’s birthday by sending a hand written birthday card and invitation to attend for appointment.

For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 22 October 2015

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 accident and emergency (A&E) attendances. Immunisation rates were high for all standard childhood immunisations.

Regular multi-disciplinary meetings were held with school nurses, district nurses and health visitors to discuss children and families who may be at risk of harm or abuse. Staff we spoke with told us they followed up any children who persistently failed to attend appointments.

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 and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses.

Updated 22 October 2015

The practice is rated as good for the care of older people.

Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services. Every patient aged 75 and over received a hand written birthday card from their named GP with an invitation to attend for an annual review.

It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. We spoke to the managers of three care homes and all three were very happy with the service they received from the practice. All three spoke positively about the GPs bedside manner, and said that the practice was very good at ringing back if the care home had a query or a concern.

Updated 22 October 2015

The practice is rated as outstanding 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 had a nurse led walk in treatment room session, where patients with minor ailments could be seen on the day, without having to make an appointment to see a GP. This was for non-emergencies, and patients said they had found it very useful. This service was available from 8:30 am to 11:00 am

Results from the 2014 national patient survey identified that 78% of patients found it easy to get through on the telephone, and 91% said they found the reception staff helpful. In addition 94% said the last appointment they got was convenient. These demonstrated high patient satisfaction in respect of access, a factor which is important for patients of working age.

The practice was able to demonstrate that by providing a daily walk in service for minor illness that they had one of the lowest uses of local emergency services within the locality. It also offered a consultant led muscular skeletal service. The practice had the services of a physiotherapist available to support and treat patients. The physiotherapist worked in the practice seeing patients on a part-time basis, with the practice having bought in the physiotherapist’s services to supplement their work. Two patients spoke very positively about the services provided by the physiotherapist and the positive effect this had and how it had reduced the travel time and increased convenience for them.

The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 22 October 2015

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

The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia. There was a system to highlight vulnerable patients on the practice’s electronic records. This included information to make staff aware of any relevant issues when patients attended appointments. For example if a patient had been diagnosed with dementia and this had made them vulnerable in ways they had not been before.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations including MIND and SANE. These are two organisations that offer support and advice to people experiencing poor mental health and their families. It had a system in place to follow up patients who had attended A&E where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

Updated 22 October 2015

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. It had carried out annual health checks for people with a learning disability and these patients had received a follow-up. It offered longer appointments for people with a learning disability.

Reception staff said they were aware of patients whose circumstances may make them vulnerable. A smaller waiting room was available if required for patients who found the main waiting room intimidating or threatening. It was clear that patients from vulnerable groups such as those with learning disabilities or experiencing poor mental health could access the practice without fear of stigma or prejudice. We observed staff treated patients in a sensitive and sympathetic manner.