St Georges Medical Practice

Updated 20 August 2015

St Georges Medical Practice provides primary medical care services to approximately 9,860 patients. The practice is based in a building in the centre of West Bridge ford which is a suburb of Nottingham. The address where the regulated activities take place is: 93 Musters Road, West Bridgeford, Nottingham, Nottinghamshire NG2 7PG.

Although the practice served a large number of affluent, professional people, within the practice area there were pockets of social deprivation, including a local drop in centre for homeless people or people with drug and alcohol problems.

The practice has a personalised medical services (PMS) contract with NHS England. This is a contract for the practice to deliver enhanced primary care services to the local community or communities over and above the general medical services (GMS) contract. The enhanced services offered included extended hours, minor surgery procedures, alcohol screening and support to older people in care homes

There are six GPs at the practice, three are partners, and three are salaried GPs. There are three male GPs and three female GPs. In addition the nursing team comprises of three nurses and one health care assistant. There are 4.75 whole time equivalent GPs working at the practice.

In addition there are 2.89 whole time equivalent nurses, including health care assistants. The clinical team are supported by the practice manager and an administrative team of ten. Two of the receptionists have a dual role of reception and phlebotomy.

The practice was a teaching practice for first, second and fifth year medical students.

St Georges Medical Practice has opted to take part in the Prime Minister’s challenge fund weekend pilot. This has seen the practice working co-operatively with other GPs in the local area to provide a GP service on both Saturday and Sunday mornings and on Bank holidays.

During the evenings and after 1:00 pm at weekends an out-of-hours service is provided by Nottingham Emergency Medical Services (NEMS) through the 111 telephone number.

Updated 20 August 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St George’s Medical Practice on 10 February 2015. Overall the practice is rated as outstanding.

Specifically, we found the practice to be outstanding for providing responsive and well-led services and was good for providing safe, effective and caring services.

It was rated as outstanding for providing services to people with long-term conditions and working age people (including those recently retired and students). It was good for providing services to older people, 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:

• The practice had a clear vision which had quality and safety as its top priority. High standards were promoted and owned by all practice staff with evidence of team working across all roles.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, the practice hosted a weekly community clinic which provided a triage service for hip and knee conditions.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet people’s needs.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Patients told us they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Patients told us 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.
• Information about safety was recorded, monitored, appropriately reviewed and addressed. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Risks to patients were assessed and well managed.
• Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Information about services and how to complain was available and easy to understand.
• 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 including:

The practice was actively involved in developing and implementing innovative pilot projects with other stakeholders to improve patient outcomes across the wider community. For example:

• the practice had hosted and co-authored a liver screening project along with other health professionals from the Nottingham University hospital and the Rushcliffe clinical commissioning group. This project had improved the diagnostic identification of significant liver disease in patients using a fibroscan and had won an NHS innovations award. This was published in the British Medical Journal after our inspection.

• the practice had hosted a trauma and orthopaedic community clinic since April 2014 as a new model of care. This weekly clinic provided a triage service for a range of hip and knee conditions and was led by a consultant and specialist physiotherapist. An evaluation of the service showed positive outcomes were achieved for patients including timely diagnosis and referrals for further intervention, and efficient use of resources including financial savings in terms of inpatient costs. About 87% of patients who had used the service rated it excellent and 13% rated it good.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 20 August 2015

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

There was a holistic and pro-active approach to meeting patients’ needs, with a focus on the effective management and regular review of long-term conditions. Data showed the practice had consistently achieved high rates since 2006/07 that were above the local and national averages for all long term conditions assessed as part of the Quality Outcomes Framework (QOF).

In some cases their performance was significantly better, for example in respect of hypertension the practice performance was 13.4% above the CCG average and 11.6% above the national average. QOF is a voluntary incentive scheme which financially rewards practices for managing some of the most common long-term conditions and for the implementation of preventative measures.

The practice reviewed all repeat prescriptions each month (about 300) and 80% of the reviews were face to face consultations with the patient to ensure their medicines remained appropriate for their needs.

Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Benchmarking data in respect of secondary care use showed the practice was in line with the CCG average. 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 medication needs were being met. Effective recall systems were in place to ensure patients attended. 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 20 August 2015

The practice is rated as outstanding 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 those 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 and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses.

Updated 20 August 2015

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

Every patient over the age of 75 years had a named GP. Influenza and shingles vaccinations were offered in accordance with national guidance.

Nationally reported data showed good outcomes for conditions commonly found in older people (for example osteoporosis and stroke and transient ischaemic attack) and Quality Outcomes Framework (QOF) data showed the practice had achieved and sustained 100% performance since 2006/7 in respect of these conditions. QOF is a voluntary incentive scheme which financially rewards practices for managing some of the most common long-term conditions and for the implementation of preventative measures.

The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Updated 20 August 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 was involved in a range of innovative research projects to improve the outcomes for patients. For example, the practice was involved in a pilot related to nicotine pre-loading which looked at ways to help people to stop smoking and the practice was proactive in developing services that enabled diagnostic tests that reflected the needs of this age group to be carried out at the practice instead of the local hospitals.

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. Data showed uptake rates for health screening were above the local clinical commission group (CCG) averages.

For example, the practice’s performance for cervical screening uptake was 86.7%, which was better than the CCG average of 83.4% and the national average of 74.3%. Family planning services were provided by the practice for women of working age.

Updated 20 August 2015

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

The clinical staff had comprehensive knowledge and understanding of the Mental Capacity Act and were able to give examples of when they had made referrals to the Independent Mental Capacity Advocate service for patients lacking capacity to make decisions and without friends and relatives to support them.

They had also made referrals to the local authority to request an assessment to determine whether a deprivation of liberty should be authorised for two patient's lacking capacity to consent to such a deprivation.

The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. National data for 2013/14 showed 92.3% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in the record, in the preceding 12 months.

The practice had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Patients experiencing poor mental health were told how to access various support groups and voluntary organisations including MIND and SANE.

The practice carried out advance care planning for patients with dementia and 96 patients had received a dementia diagnosis in 2014/15. Staff had received training on how to care for people with dementia and mental health. The practice offered longer appointments as required and offered home visits for those patients unable to attend the surgery.

Updated 20 August 2015

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

The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. The practice had identified 27 patients with a learning disability. All patients had been offered an annual physical health check and their care plan had been reviewed within the last 12 months.

Much longer appointments (40 minutes) were offered to patients with a learning disability. The practice had access to interpretation services if required.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. The staff had told vulnerable patients about how to access various support groups and voluntary organisations and relevant information as available.

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.