Sett Valley Medical Centre

Updated 11 October 2016

Sett Valley Medical Centre provides care to approximately 10,756 patients in New Mills, a town situated approximately eight miles south east of Stockport in the High Peak area of North Derbyshire. The practice has a branch site based in the small village of Hayfield, located approximately four miles away (The Old Bank Surgery, Market Street, Hayfield, High Peak, Derbyshire. SK22 2EP).

The practice provides primary care medical services via a Personal Medical Services (PMS) contract commissioned by NHS England and North Derbyshire Clinical Commissioning Group (CCG). The main site operates from a purpose-built two storey detached building constructed in 1991. The building was extended in 1993 to add a pharmacy and a dental practice, which are independent providers but the practice retains landlord responsibilities for the whole building.

The practice is run by a partnership of five GPs (three males and two females), and the partners employ a female salaried GP. A second salaried GP is due to start working at the practice in September 2016.

The nursing team comprises of two advanced nurse practitioners, a nurse practitioner, four practice nurses, and two health care assistants. The clinical team is supported by a practice manager, an assistant practice manager and a team of six administrative and reception staff including a reception manager. One of the members of the administration team also works as the practice care co-ordinator. The practice also employs two cleaning staff.

In addition, the practice contracts an independent part-time community matron and independent part-time pharmacist to work at the practice.

The partnership is an established training practice and a GP registrar (a qualified doctor who is completing training to become a GP) works within the practice. It is also a teaching practice and accommodates placements for medical, nursing and midwifery students.

The practice age profile shows slightly higher numbers of patients aged in the 45-70 years range. The registered patient population are predominantly of white British background, and the practice is ranked in the third lowest decile for deprivation status. However, New Mills East is the second most deprived ward within the High Peak area. New Mills is a commuter town for larger areas including Stockport and Manchester, but local employment consists of light industry including a confectionery manufacturer, which is the largest employer in the town. The previous industrial heritage of the town which included textiles and open cast coal mines led to a relatively high prevalence of occupational diseases including lung and cardiovascular related illnesses. The branch site, which is a converted bank, serves a rural community in a small building with one consulting room and one treatment room.

The practice is the most northerly sited practice in the county and is sited some miles from the commissioner’s base in Chesterfield. Due to its location, the practice has more established links with secondary care providers in Stockport and this can create some difficulties in terms of service configuration and development.

The practice’s main site opens from 8am until 6.30pm every Monday, Tuesday, Thursday and Friday. Extended hours opening operates every Wednesday when the practice opens from 6.45am until 8pm. Scheduled GP morning appointments times are available from 9.00am until approximately 11.10am with later appointments being added for ‘on the day’ consultations further to triage. Afternoon GP surgeries run approximately from 3.45pm to 6.10pm. On Wednesdays, GP and nurse led commuter clinics operate from 6.50am to 9.40am, and from 5.25pm until 7.45pm. The practice closes one Wednesday afternoon on most months of the year for staff training.

The practice has opted out of providing out-of-hours services to its own patients. When the practice is closed, patients with urgent needs are directed via the 111 service to a locally based out-of-hours and walk-in urgent care centre in New Mills operated by Derbyshire Health United (DHU). This is situated directly opposite the surgery.  This opens from 6.30pm to 10.30pm each weekday, and from 9.30am until 10.30pm at weekends and bank holidays. Patients also have access to the minor injuries unit in Buxton. The nearest Accident and Emergency (A&E) units are based in Macclesfield and Stockport. 

Updated 11 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sett Valley Medical Centre on 21 July 2016. Overall the practice is rated as outstanding.

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

• There was an effective system in place for the reporting and recording of significant events. Learning was applied from events to enhance the delivery of safe care to patients.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. An ongoing programme of clinical audit reviewed patient care and ensured actions were implemented to improve services as a result.
• The practice planned and co-ordinated patient care with the wider multi-disciplinary team to deliver effective and responsive care to keep vulnerable patients safe.
• The practice was committed to staff training and development and the practice team had the skills, knowledge and experience to deliver high quality care and treatment. The practice had an effective appraisal system in place.
• There was a good staff skill mix in place which included three nurse practitioner roles. The practice also contracted a pharmacist and a community matron to provide weekly sessional input at the practice.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. The practice analysed and acted on feedback received from patients.
• Patients provided generally positive views on their experience in making an appointment to see a GP or nurse.
• Longer appointments were available for those patients with more complex needs. An advanced nurse practitioner triaged calls and ensured that any patient requiring an urgent appointment was seen on the same day.
• The practice had good facilities and was well-equipped to treat patients and meet their needs.
• There was a clear leadership structure in place and the practice had a governance framework which supported the delivery of good quality care. Regular practice meetings occurred, and staff said that GPs and managers were approachable and always had time to talk with them.
• The practice had a clear vision for the future and included the practice team in reviewing and planning service delivery. The aspirations of the partners were in line with the CCG strategy of delivering high quality care closer to the patient’s home.
• Information about how to complain was available upon request and was easy to understand. Improvements were made to the quality of care as a result of any complaints received.

We saw the following areas of outstanding practice:

• The practice had worked in collaboration with the UK Sepsis Trust over the last 18 months to promote the awareness and treatment of sepsis in primary care. This recognised that the early identification of symptoms and the use of effective safety netting was paramount within the primary care setting. This had led to the publication of an article written by the advanced nurse practitioner in the British Journal of General Practice in March 2016. A second project was underway to assess GP perception and knowledge of sepsis prior to the publication of NICE guidance on sepsis in July 2016. The ANP and GPs delivered training on sepsis to other primary care colleagues within their area, and aspired to influence a national sepsis promotional campaign.

• The practice was located in a semi-rural location and had configured its services to be responsive to the needs of their own patients and the wider patient community. For example, the practice provided a vasectomy service which enabled patients from other practices to receive this service, and to improve patient choice and access to local treatment.

The areas where the provider should make improvement are:

• Develop cleaning schedules to determine the extent and frequency of cleaning for each room, and review how this will be monitored.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 October 2016

• The practice achieved 99.98% for diabetes QOF related indicators, in line with the local average of 96.7% and above the national average of 89.2%. This was achieved with a marginally lower exception reporting rate at 11.8% (local 13.4%; national 10.8%).

• The practice undertook annual reviews for patients on their long-term conditions registers. For example, 72% of patients with chronic obstructive airways disease (COPD) had received a review of their condition in the last 12 months.
• QOF achievement for 2014-15 for asthma and atrial fibrillation were below the CCG and national averages. However, the practice was able to explain the lower achievement and had developed actions to enhance their performance.
• The majority of diabetes care was provided in-house and this included the initiation of insulin. A weekly internal multi-disciplinary meeting reviewed complex patients with diabetes. Specialists were occasionally invited to the meeting for training purposes.
• The practice had established a pre-diabetes register and had delivered a programme of support for these patients since March 2016. The aim of this nurse-led programme was to reduce the associated cardiovascular risk factors which could result from diabetes. For example, by educating patients regarding diet, the promotion of an active lifestyle, and the proactive self-management of their condition.

• The partners contracted a community matron to plan and oversee the management of their most vulnerable patients, including those who were at risk of a hospital admission. A practice-employed care co-ordinator worked with other services and agencies to plan and deliver patient care, particularly for those patients being discharged following a hospital admission.
• The practice provided a range of services on site for patients with a long-term condition. This included spirometry (to assess breathing difficulties); foot checks for patients with diabetes; and INR monitoring both at the surgery and in patients’ homes. INR testing measures the length of time taken for the blood to clot to ensure that patients taking particular medicines were kept safe.
• A specialist respiratory nurse attended the practice each month to review patients with complex breathing difficulties.

Updated 11 October 2016

• A GP led clinic for six week baby checks was provided at the surgery. This helped to identify any concerns with the baby and to promote the child immunisation programme. It also provided an opportunity to review the parents for issues such as post-natal depression. The midwife held an ante-natal clinic on site every week.
• Childhood immunisation rates were high with rates for the vaccinations given to children at five years of age ranging from 96% to 100% (local average 96.5% to 99.1%).
• The health visitor attended a meeting with the lead GP for child safeguarding once a month to discuss any child safeguarding concerns. Child protection alerts were used on the clinical system to ensure clinicians were able to actively monitor any concerns.
• Appointments were available outside of school hours.
• Requests for child consultations were prioritised. Telephone advice was offered to parents when required.
• There was an established teenager clinic which provided support on issues such as sexual health, healthy eating, and psychological concerns.
• Family planning services were provided to fit and remove intrauterine devices (coils) and implants, and advice and support was available for all aspects of contraception.
• The practice had baby changing facilities, and provided a low table and chairs with toys for younger children. The practice welcomed mothers who wished to breastfeed on site.

Updated 11 October 2016

• The practice had developed a number of in-house services to prevent older patients from travelling to hospitals which were located some miles away with infrequent local public transport provision. The services included blood tests, 24 hour blood pressure and ECG monitoring, and hearing tests. In addition, some NHS out-patient clinics were held in a nearby town including rheumatology and gynaecology, through an independent initiative developed by the practice and two other local GP practices.
• The practice contracted a community matron who managed a ‘virtual ward’ of vulnerable older patients with the aim of supporting these patients to be cared for in their own homes, and to avoid unnecessary admissions into hospital.

• The practice worked closely with the wider health and care teams to plan and the co-ordinate care to best meet their patients’ needs.
• Longer appointment times were available and home visits were available for those unable to attend the surgery.
• An advanced nurse practitioner undertook weekly visits to two local care homes for older patients, one of which specialised in the care of dementia.
• Uptake of the flu vaccination for patients aged over 65 was 69% which was in line with local (73.9%) and national (70.5%) averages.

Updated 11 October 2016

• The practice offered on-line booking for appointments and requests for repeat prescriptions. The practice provided electronic prescribing so that patients on repeat medicines could collect them directly from their preferred pharmacy.
• Extended hours’ GP consultations were available at the main site. Early morning and evening appointments were available as a commuter clinic on one day each week to accommodate the needs of working people.
• Clinics for patients with diabetes were held three times each week, including one evening to provide more flexibility for working patients.
• The practice promoted health screening programmes to keep patients safe. Although performance for cervical and breast screening was slightly lower than average figures, the practice was able to explain this and describe how this was being addressed,
• The practice offered health checks for new patients and NHS health checks for patients aged 40-74.
• The practice held a ‘Fit and Trim Club’ for weight management run by an experienced practice nurse.

Updated 11 October 2016

• The practice achieved 99.4% for mental health related indicators in QOF, which was 1.3% above the CCG and 6.6% above the national averages, with exception reporting rates generally in line with averages.
• 96.2% of patients with poor mental health had a documented care plan during 2014-15. This was 2.9% higher than the CCG average and 7.9% higher than the national average, although exception reporting rates were higher.
• The practice provided access to a cognitive behavioural therapist twice a week at the main site, and once a week at their branch. CBT is a technique used to empower patients to resolve problems by changing their thinking and behaviours.
• The practice had a lead GP for mental health. The practice had established good links with the mental health care team and crisis team. A community psychiatric nurse (CPN) attended the multi-disciplinary meetings on approximately a monthly basis to review and discuss any patients with ongoing mental health needs.
• Appointments were available on the day for patients experiencing acute mental health difficulties.
• 84.1% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. This was in line with local and national averages, although the practice had achieved slightly lower exception reporting rates.
• A visiting consultant specialising in older age psychiatry provided memory clinics at the practice once a fortnight. In addition, patients could see an Adult Psychiatrist at the health centre, sited opposite the surgery
• The practice undertook a significant event review in the event of a mental health-related death, or on cases which were deemed appropriate in terms of any lessons learnt.

Updated 11 October 2016

• The practice had searched their clinical system to check for patients who had not been seen by the practice for some time, and reviewed their status. This led to the identification of some vulnerable patients who required support and care planning to keep them safe and well. For example, a patient with learning disability who was managing alone following the death of their carer.
• The practice had undertaken an annual health review in the last 12 months for 32% of patients with a learning disability. The practice had identified the reasons for this comparatively low achievement and had a plan of action to address this.
• Longer appointments and home visits were offered to vulnerable patients when required. For example, patients with a learning disability might be seen in their home or at a day centre, if attendance at the practice caused them anxiety.
• The practice provided high quality end of life care. Patients with palliative care needs were reviewed at weekly multi-disciplinary team meetings, and had supporting care plans in place. Community nursing staff informed us that the GPs were caring and highly responsive to these patients, and ensured that any needs were acted upon promptly.
• Clinicians attended case conferences and vulnerable adults’ review meetings to discuss their most vulnerable patients. We were provided with an example of how vulnerable patients who smoked were at risk from a potential fire. This led to joint working with the local fire service and the installation of sprinkler systems in vulnerable patients’ homes.
• Staff had received adult safeguarding training and were aware how to report any concerns relating to vulnerable patients. There was a designated lead GP for adult safeguarding.
• The practice staff had received training from the Alzheimer’s Society to become ‘Dementia Friends’. This had initiated a successful ‘tea dance’ event at the end of 2015 attended by patients with dementia and their carers. Over 70 people attended this successful event, which provided excellent support for carers. There were plans to repeat this in the future.