Conisbrough Group Practice

Updated 23 December 2016

Conisbrough Group Practice is located in Conisbrough on the outskirts of Doncaster. The practice provide services for 10,412 patients under the terms of the NHS General Medical Services contract. The practice catchment area is classed as within the group of the third more deprived areas in England. The age profile of patients registered at the practice is similar to others in the area.

The practice has six GP partners, one female and five male. They are supported by a first contact nurse practitioner, four practice sisters, two healthcare assistants, a practice manager and a team of reception and administrative staff.

The practice is open between 8am to 7.30pm on Monday and Wednesday and from 8am to 6.30pm Tuesday, Thursday and Friday. Appointments with all staff are available during the practice opening hours. A phlebotomy service with the healthcare assistant was available daily. In addition to pre-bookable appointments that could be booked up to two weeks in advance, urgent appointments were also available for people that needed them.

The practice is located in a purpose built health centre with ample parking to the rear and side of the building. 

When the practice is closed calls were answered by the out-of-hours service which is accessed via the surgery telephone number or by calling the NHS 111 service.

Updated 23 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Conisbrough Group Practice on 10 October 2016. Overall the practice is rated as outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, the practice was accredited by the NHS National Institute for Health Research as a research active practice and a GP had undertaken good clinical practice training. The practice was participating in 12 separate research studies with academic organisations.  
• Feedback from patients about their care was consistently positive.
• The practice worked closely with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, the GPs developed a new person-centred appointment system, implemented in October 2015. The new system offered continuity of care whilst ensuring those who needed an appointment received one. 
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, following feedback from patients an assisted opening mechanism was installed to the door at the back of the practice to promote independence for those using the parking spaces to the rear of the building.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw several areas of outstanding practice including:

• The person centred appointment system worked by asking the patient if their concern was new, did they consider it urgent and who would they usually see. Patients we spoke with and written comments reported a significant improvement in accessing a GP, particularly offering choice and continuity of care. Some reported it was not always necessary to see a GP and their query could be dealt with over the telephone.
• The new model of access was published in the Royal College of General Practitioners Bright Ideas magazine. Staff from other practices in the area and from further a field had visited the practice to see the system in operation with a view to implementing it.
• Two of the partners formed the practice in 2001 by taking over a single handed practice with no regular GP. Over the next 15 years they took on another four single handed GP practices, following a series of GP retirements, to provide services from one purpose built health centre. We were shown the original comprehensive business plan which had been reviewed and developed over the years to support the vision and values. The plan captured the areas originally identified for improvement and outcomes detailed how they were achieved. This demonstrated a long term shared purpose, commitment to support, develop and motivate staff to succeed.
• There was a commitment to developing staff in any area which might have a benefit to patients  This included those working in the practice and for other healthcare providers. For example healthcare assistants were supported to undertake spirometry testing and GPs mentored an orthopaedic practitioner in the primary care environment. The GPs also offered mentorship to practice nurses from other surgeries in the area completing the nurse prescribing course. Administrative apprentices were supported to develop their skills which led to permanent employment at the practice.
• Staff were supported to have roles within the wider community. For example, one of the GPs was a University Lecturer and Clinical Teacher in primary care. Three GPs were GP trainers and another undertaking GP training. Another was involved in scoping the provision of primary care in Doncaster and looking at new ways of working. The practice had also been approached to support other practices in the area.

The areas where the provider should make improvement are:

• Introduce a procedure to track electronic prescriptions through the practice as per NHS Protect Security of prescription guidance 2013.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 23 December 2016

The practice is rated as outstanding for providing responsive and well-led services. The impact of this affected the quality of services provided to all patient groups and this led to an outstanding rating for all population groups.

• The practice had retained a team approach for long term condition management with GPs and nurses undertaking this role and patients at risk of hospital admission were identified as a priority.
• The practice offered echocardiogram (ECG) and spirometry testing to support clinical decision making.
• Nationally reported data from the Quality and Outcomes Framework showed that outcomes for patients were good for patients with long term conditions. For example, performance for diabetes related indicators was comparable to other practices in the area and 6% above the national average.
• Longer and flexible appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual 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 23 December 2016

The practice is rated as outstanding for providing , responsive and well-led services. The impact of this affected the quality of services provided to all patient groups and this led to an outstanding rating for all population groups.

• 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 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.
• GPs visited the local primary school to talk about healthy eating. School children had a competition to devise the patient participation group (PPG) logo which was used by the practice.
• The practice’s uptake for the cervical screening programme was 92%, compared to the local average and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies. GPs would often ask to see young children or those who were at risk of catching infections from others at the end of clinic when the practice was quieter.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 23 December 2016

The practice is rated as outstanding for providing responsive and well-led services. The impact of this affected the quality of services provided to all patient groups and this led to an outstanding rating for all population groups.

• All patients had a named GP.
• The needs of older people with more complex needs were reviewed monthly at a multidisciplinary meeting.
• Patients requiring support from community nurse and physiotherapy could be seen at the practice to ensure they received the individual care they needed.
• Longer appointment times could be arranged for patients with complex care needs and booked in at time to suit the patient.
• Home visits were provided for those unable to attend the surgery.

Updated 23 December 2016

The practice is rated as outstanding for providing responsive and well-led services. The impact of this affected the quality of services provided to all patient groups and this led to an outstanding rating for all population groups.

• 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.
• Patients could request the GP telephone them back at a time they would be available.
• 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 23 December 2016

The practice is rated as outstanding for providing responsive and well-led services. The impact of this affected the quality of services provided to all patient groups and this led to an outstanding rating for all population groups.

• 74% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was lower than the local average of 83% and the national average of 84%.
• The percentage of patients with a serious mental illness who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (2014 to 2015) was 96% compared to a local average of 92% and national average of 90%.
• The practice regularly worked with multidisciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 23 December 2016

The practice is rated as outstanding for providing responsive and well-led services. The impact of this affected the quality of services provided to all patient groups and this led to an outstanding rating for all population groups.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
• The practice offered longer appointments for patients with a learning disability. The practice recognised that trust and rapport for these patients was very important and ensured they saw the same staff member each time they visited. This had resulted in patients being willing to accept the care they needed.
• Teenagers from the local learning disability home assessed the practice for access and feedback their experiences.
• Staff 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. 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.