Dr Hale and Partners Also known as Lister House Surgery

Updated 12 March 2018

Dr Hale and Partners is registered with the Care Quality Commission to carry out regulated activities from the following two locations:

• Dr Hale and Partners also known as Lister House Surgery - 207 St Thomas Road, Derby, Derbyshire, DE23 8RJ. The branch site is Oakwood Medical Centre which is located at Danebridge Crescent, Derby, DE21 2HT.

• Lister House at Chellaston (formally known as Meadowfields Practice) - Fellow Lands Way, Chellaston, Derby, Derbyshire, DE73 6SW. The branch site is Lister House at Coleman Street, Coleman Street, Allenton, Derby, DE24 8NH.

The provider has a combined patient list of about 34620 with most of the 103 practice staff working across the four GP surgeries. The clinical team comprises of:

• Six GP partners (two female and four male), nine salaried GPs (eight female and one male) and a pharmacist.

• Two advanced nurse practitioners including the nursing lead, 10 practice nurses and three healthcare assistants. All of these staff are female.

• A mental health nurse/psychiatric lead (male) and a community support worker (female).

The provider is an established training and teaching practice and accommodates GP trainees (a qualified doctor who is completing training to become a GP) and medical and nursing students. At the time of our inspection there were two GP trainees in post.

The clinical team is supported by:

• A management team comprising of the business practice manager, assistant practice manager, informatics manager, quality manager, reception manager and an assistant reception manager.

• An administrative team comprising of senior receptionists, receptionists, medical secretaries and administrators.

• The accounts, premises and payroll team include a senior administrator, maintenance lead and housekeepers.

The attached community staff are located onsite and this includes district nursing teams, community matrons, midwives and a care co-ordinator. A pharmacist employed by the clinical commissioning group also provides regular support to the practice.

Dr Hale and Partners (“the location”) also known as Lister House Surgery

Dr Hale and partners provides primary care medical services patients via a General Medical Services (GMS) contract commissioned by NHS England and NHS Southern Derbyshire Clinical Commissioning Group. Patients registered at Lister House Surgeryor Oakwood Medical Centreare able to access services from either of the two sites. The combined patient list for the two surgeries was 24, 050 at the time of inspection.

Our inspection visit took place at Lister House Surgery, which is located in the inner city of Derby.

Services are provided from a purpose-built premise and this includes consulting and treatment rooms located over two floors. The practice age profile comprises higher numbers of patients aged 0 to 54 years and lower numbers of people aged 55 years and over when compared to the local and national averages.

The registered patient population is predominantly of white British background particularly at Oakwood medical centre. Lister House surgery includes a high number of people from minority ethnic groups and a transient population. Interpreting facilities are available to cater for the multiple languages spoken including a Slovak Romani interpreter based at Lister House Surgery five days a week. The practice also provides regular support to residents living in nine care homes. The level of deprivation within the practice population is above the national average with the practice rated in the second most deprived decile.

Lister House Surgery is open between 7am and 7pm Monday to Friday. Oakwood Medical Centre is open from: 7am to 6.30pm on Monday and Friday; 8am to 6.30pm on Tuesday and Thursday and 7am to 12pm on Wednesday. The consulting times for clinicians varies but is usually from either 7.20am or 8am to 6.30pm; with urgent appointments available from 8am to 12pm and 1pm to 6.30pm.

The practice has opted out of providing out-of-hours services to its own patients. This service is provided by Derbyshire Health United and is accessed via 111.

Updated 12 March 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Hale and Partners (formerly Dr Moss and Partners) on 13 and 18 October 2016. The overall rating for the practice was good. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for Dr Hale and Partners on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 31 August 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 13 and 18 October 2016. This report covers our findings in relation to those requirements and additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• The whole practice team were engaged in reviewing and improving safety and safeguarding systems and positive outcomes were achieved for patients.

• Effective systems were in place for managing nationally available patient safety information to ensure patients were kept safe. This included maintaining detailed records to evidence the receipt of and actions taken in respect of Medicines Health and Regulatory Authority (MHRA) alerts.

• Safeguarding arrangements operated effectively and were embedded within the practice to protect children and vulnerable adults from abuse and risk of harm.

• Clinical audits and feedback received from the clinical commissioning group nurse lead was used to assess the improvements made to safeguarding arrangements and outcomes for patients.

• The practice continued to proactively identify carers with approximately 1% of carers identified.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 February 2017

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

• Nursing staff had lead roles in chronic disease management and regular clinics were held for patients with conditions such as asthma and diabetes.

• Patients with diabetes could have their insulin treatment initiated at the practice and where appropriate, patients were referred for a six week education programme to equip them with the skills and knowledge to better manage their diabetes.

• Patients with a diagnosis of chronic obstructive pulmonary disease were offered anticipatory medicines to reduce incidences of exacerbation where appropriate.

• An effective recall system was in place to ensure patients were offered a structured annual review to check their health and medicines needs were being met.

• Patients with more complex needs and at risk of hospital admission were identified as a priority. The named GP worked with relevant health and social care professionals to deliver a multidisciplinary package of care.

• The in-house pharmacist carried out medicine reviews supported by the GPs and an in-house phlebotomy service was also provided.

Updated 27 February 2017

The practice is rated as good for the care of families, children and young people.

• We received positive feedback from the midwife and, health visitor about the joint working and multi-disciplinary working with practice staff.

• The practice was proactive in promoting health education in children and young people in a “fun and welcoming environment”. For example, careers in general practice were promoted to sixth form students by offering them work experience and an annual event was facilitated where children from the local primary school visited Lister house surgery.

• A flexible appointment system ensured that children could be seen on the same day when this was indicated. Appointments were available outside of school hours and a telephone triage was utilised to ensure those with urgent requirements were dealt with promptly.

• The practice website included “new parent information” which included guidance on registering the new baby and immunisations. Immunisation rates were broadly in line with local and national averages for most standard childhood immunisations.

• Ante-natal appointments were available with community midwives and post-natal checks were provided within the practice by the nurse and GP.

• Family planning services were provided including the fitting and removal of intrauterine devices (coils).

• The practice had baby changing facilities and welcomed mothers who breast feed.

Updated 27 February 2017

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

• Patients aged 75 years and over had a named GP and were offered vaccinations in line with national guidance.

• Older patients at risk of admission to hospital, living with dementia and / or frail were discussed at multi-disciplinary meetings hosted by the practice. Care plans were put in place for patients with complex needs.

• Feedback from care homes confirmed the practice team offered proactive and personalised care to meet the needs of older people in its population.

• The GP lead and / or attached community matron carried out care home visits and home visits to people who were housebound as part of a collaborative community services project, to ensure patients received a comprehensive and holistic review of their care needs.

• The practice employed a specialist nurse practitioner who coordinated the care of residents living in care homes with support from the GPs. The nurse carried out regular home visits which ensured continuity of care and also undertook a wide range of health reviews.

• The practice employed a community support worker whose role included signposting patients to appropriate clinical or social care.

• The practice was responsive to the needs of older people and offered urgent appointments for those with enhanced needs.

• Nationally reported data showed patient outcomes for conditions commonly found in older people, including osteoporosis and heart failure were in line with or above local and national averages. Lower values were achieved for rheumatoid arthritis.

Updated 27 February 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• Lister House surgery was open from 7am to 7pm Monday to Friday within which extended hours were provided. Patients were reminded about their appointments via text messages if they had signed up for the service.

• Patients could book GP appointments online and request repeat prescriptions at a time that was convenient for them. The practice also undertook electronic prescribing so that prescriptions could be sent directly to the pharmacy of the patient’s choice.

• Telephone consultations were available each day for patients who had difficulty attending the practice due to work or educational commitments.

• The practice was proactive in offering a full range of health promotion and screening service that reflected the needs for this age group. This included healthy lifestyle advice, cancer screening and NHS health checks for patients aged 40-74.

• Health promotion information was available in the waiting room and on the practice website. This included information on minor illnesses and first aid.

• The practice provided travel clinic services and was a registered yellow fever centre.

• Two of the GPs were instrumental in facilitating the community musculoskeletal triage and treatment service from the practice. This service was accessible to patients registered with other practices and was supported by an onsite physiotherapy services. This was an outstanding feature of the practice.

Updated 27 February 2017

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

• The 2015/16 data showed all (100%) patients diagnosed with dementia had their care reviewed in a face to face meeting compared to the local average of 85% and the national average of 84%. The exception reporting rate for this indicator was 7% which was in line with the local average of 8% and the national average of 7%.

• The practice team and patient participation group had a good understanding of how to support patients with dementia and their carers. This included hosting a dementia café within the practice, carrying out advanced care planning where appropriate and engaging in the dementia screening pilot in collaboration with specialist nurses. The dementia diagnosis rate was 70% compared to a local average of 59%.

• The 2015/16 data showed 99.3% of patients on the practice’s mental health register had received an annual health check compared to the local average of 92.8% and the national average of 88.7%. The exception reporting rate for this indicator was about 10% which was below the local average of 20% and the national average of 13%.

• The practice employed a mental health nurse and a community support worker who were able to see patients for extended appointments and at their home. Follow up appointments were organised where appropriate to establish continuity of care and a supportive service.

• Patients were given advice and / or signposted to various support groups and voluntary organisations for support.

• The practice regularly worked with multi-disciplinary teams and care home providers in the case management of patients experiencing poor mental health including people with dementia. This included following up patients who had attended accident and emergency and participating in a locally commissioned services framework project on psychosis.

Updated 27 February 2017

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

• Staff had received training in how to recognise signs of abuse in vulnerable adults and demonstrated awareness of the appropriate action to take if concerns were noted. However, improvements were required to ensure the practice had  identified vulnerable adults within the practice population and effective systems were embedded in respect of information sharing and documentation of safeguarding concerns.
• The practice had 172 patients on its learning disability register and longer appointments were offered for their health reviews. At the time of inspection, 68 patients (40%) had received an annual health check and a further 21 (12%) patients had appointments planned.
• The reception team maintained a ‘special patient list” which included patients that had particular challenges accessing services. For example, people with hearing impairments or from the deaf community, those experiencing poor mental health or at risk of isolation. At the time of inspection about 50 patients had been identified and arrangements were in place to help them access services when needed.
• Homeless people in Derby city could access services at this practice and were signposted to other agencies for support if needed.
• In liaison with other stakeholders, the patient participation group (PPG) and practice had hosted an alcohol and drug awareness drop in session in August 2016 and regular carers events. The practice had identified 0.8% of its practice population as carers.
• Patients and their carers were informed about how to access various support groups and voluntary organisations.
• Translation services were available for patients and this included a practice employed Slovak Romani interpreter to cater for communication needs of about 4000 patients.
• The citizens’ advice bureau offered on-site appointments for patients at the practice.
• The practice’s registration booklet took account of the accessible information standard and asked patients if they had any specific needs. For example; British sign language, braille, large print, as well as their preferred contact method and other support needed.
• Clinical staff regularly worked with other health and social care professionals in the case management of vulnerable patients.