Archived: Dr Gordon Jones Also known as Dr G I Jones t/a Ashover Medical Practice

Updated 25 September 2017

The practice is registered with the CQC as a single-handed GP. The registered name of Dr Gordon Jones is also known as Ashover Medical Centre, and it is a dispensing GP practice based in the Derbyshire village of Ashover. The practice has a population of 2253 registered patients, the majority of whom are over the age of 65.

The surgery provides primary care medical services commissioned by NHS England and North Derbyshire Clinical Commissioning Group (CCG). The practice covers a large rural area across Ashover parish, the second largest parish area in England.

The premises operate from a modern purpose built property which is maintained to a high standard. Public transport links to the practices can be problematic due to its rural location.

The practice staff consists of a male lead GP, a practice manager, one female practice nurse, a practice secretary, and eight reception staff who are also qualified to work in the dispensary. Due to the small size of the practice, some staff have been trained to undertake other roles including those of phlebotomist, health care assistant and care co-ordinator. All staff are part time with the exception of the lead GP. There are also three locum GPs (two male and one female) who work regular sessions at the practice

The registered practice population are predominantly of white British background. The practice age profile shows more people aged 65 and above are registered. This group comprises 29.3% of patients compared to a CCG average of 22.1%, and nationally 17.2%. By contrast, those aged 18 and under make up 14% of registered patients (CCG 18.2%, national 20.7%).

Whilst the practice serves a relatively affluent population, there are pockets of deprivation within the surrounding rural communities. It is ranked in the third lowest decile for deprivation. The overall Index of Multiple Deprivation (IMD) score of 13.2 compares against a CCG figure of 18, and national figure of 21.8. The IMD is a measure of relative deprivation for small areas. It is a combined measure of 37 separate indicators which reflects a different aspect of deprivation experienced by individuals living in an area.

The practice opens from 8am until 6.30pm Monday to Friday. Scheduled GP appointments times are available each morning and afternoon, apart from on one Wednesday afternoon on most months when the practice closes for staff training. Extended hours GP appointments are available every Thursday evening between 6.30- 7.30pm. The practice dispensary is also open during the extended hours session.

The practice has opted out of providing out-of-hours services to its own patients. When the practice is closed patients are directed to Derbyshire Health United (DHU) out of hours service via NHS 111.

Updated 25 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced focused inspection at Dr Gordon Jones (Ashover Medical Centre) on 4 August 2017. As this was a focused inspection, the overall rating for the practice remains unchanged as good. The practice was previously inspected in October 2014 and the full report can be found at http://www.cqc.org.uk/location/1-560625044. The inspection in October 2014 rated the practice as being good overall with a good rating for each of the five domains assessed (safe, effective, caring, responsive and well-led services).

We reviewed the caring, responsive and well-led domains as part of our focused inspection. This was because we were aware that the practice had achieved excellent results in the national GP survey since our last inspection. We rated the practice as outstanding for caring and responsive, and good for well-led at our inspection in August 2017.

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

• The practice team demonstrated a strong patient-centred ethos to the way they provided the service at all times. They were passionate about patient care and ensured they did their utmost to deliver responsive, effective and safe care at all times.
• Feedback from patients about their interactions with all practice staff was consistently and strongly positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Patients said they found it easy to make an appointment with a GP and could always contact the practice easily by telephone. Routine appointments could be booked within two days, with urgent appointments being available the same day. The appointment system was flexible to suit individual requirements. Advanced bookings could be made without restriction on timescales.
• Patient experience as measured via the national GP patient survey showed the practice performed more highly than local and national averages in terms of how patients were cared for and how they could access treatment and advice. There had been consistent high performance over the last few years. The latest data published in July 2017 ranked the practice as the top performing practice in their CCG (35 practices) and in the top 20 (of approximately 7,600 practices) in England for a number of indicators.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.
• 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, the practice had made changes to the environment to accommodate the needs of patients with dementia.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and concerns and how they were managed and responded to. Lessons were learnt and improvements made as a result.
• The practice had a clear vision and involved staff and the PPG to actively participate in discussions about the future.
• The practice had strong and visible clinical and managerial leadership supported by effective governance arrangements.
• Staff felt supported by management and turnover was minimal. The practice team worked as a cohesive unit with flexibility to cover roles, which was essential as a small practice. The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 September 2017

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

• Patients at risk of hospital admission were identified as a priority and were reviewed in conjunction with the wider multi-disciplinary team every two weeks to ensure they were receiving the care and support needed.
• The care co-ordinator followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the practice team worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice achieved good outcomes for patients with long-term conditions as reflected within their QOF performance. For 2015-16, this was 97.3% and with one of the lowest exception reporting rates within the CCG at 5.9%.
• The practice worked with specialist nurses and clinicians for expert advice as required

Updated 25 September 2017

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

• Children were always seen the same day. The on call GP would triage individuals upon arrival at the practice.
• The practice ensured any child safeguarding concerns were responded to effectively, and regular liaison took place with the health visitor.
• Immunisation rates were high for all standard childhood immunisations.
• Comment cards included reference that children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies. The practice accommodated young mothers who wished to breastfeed on site, and baby changing facilities were available. A play area and a selection of toys were available. Drawings done by children were placed on the wall of the waiting area creating a child-friendly environment.
• The practice worked with midwives and health visitors to support this population group. For example, in the provision of ante/post-natal and child health surveillance clinics. The health visitor provided a weekly clinic in the practice.
• Chlamydia testing kits were readily available to encourage uptake from younger people

Updated 25 September 2017

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 patients in its population.
• The practice was highly responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs. The GP and practice nurse also accommodated home visits for those who had difficulties getting to the practice due to limited local public transport availability.
• The practice provided care to a local residential unit and assisted living complex for older people. The GP visited this site every day to provide proactive care and avoid potential hospital admissions.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 25 September 2017

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

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours on one evening each week.
• Feedback received from patients demonstrated how the practice accommodated individual needs. For example, a patient told us how the practice stayed open on a Friday night to enable the collection of medicines after their work-day in order to access the treatment needed without delay.

• The practice was proactive in offering online services, as well as a full range of health promotion and health checks that reflected the needs for this age group.
• The practice actively promoted health-screening programmes to keep patients safe. For example, the practice’s uptake for the cervical screening programme was 82.7%, in line with the CCG average of 84.2% and national average of 81.4%.

Updated 25 September 2017

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

• 92% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months. This was 7.1% above the CCG average, and 8.2% above the national average. No patients were exception reported from this indicator (this was 5.9% below the local average, and 6.8% below the national), demonstrating the inclusive approach taken by the practice with their patients.
• The practice achieved 98% for mental health related indicators in QOF, which was 0.3% above the CCG and 5.2% above the national averages. Exception reporting levels were lower than local and national averages.
• 85.7% of patients with severe and enduring mental health problems had a comprehensive care plan documented in the preceding 12 months according to 2015-16 QOF data. This was below the CCG and national averages, although rates of exception reporting were lower.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice staff had all completed training in dementia.
• Further to a visit from the Dementia Friends organisation, the PPG had led on initiatives to respond to the specific needs of patients with this condition. For example, improved signage within the surgery. This had also led the PPG to establish a local weekly walking group to promote healthy living and social inclusion, and this was well-established.

Updated 25 September 2017

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

• The practice held a register of patients living in vulnerable circumstances including homeless people and those with a learning disability.
• End of life care was delivered in a co-ordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• There was a named GP for all vulnerable patients. The practice had a separate number which could be used to access advice or support urgently for these patients.
• The practice offered longer appointments for patients who needed them, for example patients with a learning disability.
• The practice worked collaboratively with other health and social care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• The practice provided care at a local residential school and children’s home for boys aged 9- 16 and over who exhibited a variety of behavioural, emotional and social difficulties. Staff at the home told us that the GP took a flexible approach to engage with their clients, and undertook extensive liaison work with other agencies to ensure that the best care was provided.