Dearne Valley Group Practice

Updated 3 May 2016

Dearne Valley Group Practice is a purpose built practice in the village of Thurnscoe on the outskirts of Rotherham, Doncaster and Barnsley. The building has a large car park and disabled access. All patient areas are on the ground floor.

There is a branch practice at The Goldthorpe Centre, Goldthorpe, Rotherham.

On the day of the inspection we visited both the main practice and the branch.

Patients can access both sites and staff work at both sites.

Together the two sites provide care for 6539 patients in the NHS Barnsley Clinical Commissioning Group (CCG) area.

The practice catchment area has been identified as one of the first most deprived areas in England.

There are five GPs, one male and four female (one is a partner), together with two long term locum GPs, a practice nurse, a locum advanced nurse practitioner, two heath care assistants and a phlebotomist.

These are supported by a practice manager who is also a partner, an assistant practice manager and a team of administration and reception staff. They are a training and teaching practice for medical and nursing students and trainee GPs.

The practice, over both sites, is open between 8.00am and 6.00pm daily.

Appointments with GPs and nurses are available between 8:00am and 6.00pm daily and there is a sit and wait service most afternoons at the Thurnscoe site.

The practice provides extended hours from 7.00am to 8.00am on Tuesday, Wednesday and Thursday mornings.

Longer appointments are available for those who need them and home visits and telephone consultations are available as required.

Out of hours services are accessed by calling the practice telephone number or NHS 111.

The practice is registered to provide the following regulated activities; maternity and midwifery services; surgical procedures, family planning, diagnostic and screening procedures and treatment of disease, disorder or injury from The Thurnscoe Centre, Thurnscoe,Rotherham S63 0LT and The Goldthorpe Centre, Goldthorpe Green, Goldthorpe, Rotherham S63 9EH.

Updated 3 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dearne Valley Group Practice on 14 March 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients told us 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 difficult to speak to a receptionist by telephone. The practice manager told us this was a long standing problem and the practice had tried to resolve this in several different ways, such as introducing an automated appointment system. They were working with the owner of the building to improve telephone access and were looking into other ways of providing information to patients.

• Patients were able to make appointments on line and through the automated appointment system which gave them a choice of GP. There was a sit and wait system with one of the GPs most afternoons.
• Patients we spoke with told us there was access to urgent appointments available the same day and that there was continuity of care.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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 registered provider was aware of and complied with the requirements of the Duty of Candour.

The practice was caring and staff went the extra mile for their patients. We saw three areas of outstanding practice to evidence this:

The practice and branch site both had a palliative care co-ordinator. When patients with palliative care needs had been identified, they were allocated a palliative care co-ordinator depending on which of the sites they preferred. They were then given a letter with a photograph of their palliative care co-ordinator on it and a direct telephone number. This was to enable easy access to discuss any care needs, order prescriptions or for advice. This was set up following a complaint that palliative care information could not be found quickly.

The practice had organised community events, such as a coffee morning at a local community centre to raise awareness of health and wellbeing, long term conditions and benefits advice. This had a good response and one patient told us how the advice they received that morning helped them to claim attendance allowance for an older relative. They also organised a baby first aid event with St John’s Ambulance. Both of these events were open to the whole community. The staff held a baking sale to raise money for charity and there were further events being planned for the future.

One significant event discussed a situation where the district nurses could not gain access to a house where a patient was living. One of the GPs and another member of staff investigated and emergency services were called. The patient needed urgent social care, this was arranged whilethe GP bought essential groceries. The staff made the patient comfortable and visited the following day before an urgent package of care was put in place.

The areas where the provider should make improvement are:

To develop and implement an action plan to address the problems for patients with telephone access to the surgery so that they can be assured that patients are able to contact the surgery whenever necessary.

To review the complaints policy to include documentation of responses where complaints have been responded to verbally.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 May 2016

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

• Nursing staff had lead roles in long term condition management, supported a named GP.

• Screening for atrial fibrillation was carried out on site and anticoagulation commenced and monitored without the need for secondary care referral.

• All these patients had a named GP and 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.

• The practice had identified 2% of patients at risk of hospital admission and these were identified as a priority and given a dedicated telephone line.

• Performance for diabetes indicators at 76.7% were 7.4% below the CCG average and 12.5% below the national average. The practice was aware of this and was looking at ways to encourage patients to attend for reviews. Staff told us they would review patients opportunistically if they attended the practice for other reasons, for example, if a patient attended for a blood test and their long term condition review was due, where possible, this would be done at the same time.

• Practice staff held a coffee morning at a local community centre to try and raise awareness of how the practice can improve the health of those in the community and support people with long term conditions. This was open to the whole community and not limited to patients registered at the practice.

• Longer appointments and home visits were available when needed and appointments were available from 7.00am for working patients.

• The practice employed a pharmacist to conduct medication reviews for patients with long term conditions such as diabetes and an additional heath care assistant and a phlebotomist.

Updated 3 May 2016

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 or 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.

• In the last 12 months 63% of patients diagnosed with asthma had a review of their care (CCG average 70%, national average 74%).

• Patients told us children and young people were treated in an age appropriate way and were recognised as individuals, and we saw evidence on the day of the inspection to confirm this.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives and health visitors.

Updated 3 May 2016

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.

Updated 3 May 2016

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.

• 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 3 May 2016

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

• In the last 12 months 84% of patients diagnosed with dementia had their care reviewed in a face to face meeting (CCG average 81%, national average 84%).

• Performance in the mental health indicators is comparable with national averages.

• The practice regularly worked with multidisciplinary teams in the case management of people experiencing poor mental health, including those living with dementia.

• The practice carried out advance care planning for patients living with dementia.

• Patients experiencing poor mental health had been advised 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 those living with dementia. The practice were taking part in a project called Improving Well-being and Health for People With Dementia (WHELD). The practice had identified three patients in a local care home, living with dementia. These patients were visited fortnightly by a GP and the practice staff had made them each a rummage box that included items to trigger memories of their life and initiate conversation. This was done in an attempt to reduce medication and improve wellbeing. Audits were planned to assess impact.

Updated 3 May 2016

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 homeless people, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with multidisciplinary teams in the case management of patients whose circumstances could make them vulnerable.

• Patients whose circumstances could make them vulnerable were advised how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in 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.

• One significant even discussed a situation where the district nurses could not gain access to a house where a patient was living. One of the GPs and another member of staff investigated and emergency services were called. The patient needed urgent social care, this was arranged while the GP bought essential groceries. The staff made the patient comfortable and visited the following day before an urgent package of care was put in place.