Archived: Radford Medical Practice Also known as Student Health Centre, Nottingham Trent University

Updated 19 March 2015

Radford Medical Centre (also known as the student health centre) provides primary medical services to a total of 13,395 students attending Nottingham Trent University. We inspected the practice during the first term and about 3,500 new patients had registered during this period. We found 95% of the registered patients were under the age of 25; and comprised of international and home students. The highest percentage of international students speak French and Mandarin Chinese.

Radford Medical Centre holds a Personal Medical Services (PMS) contract which has been agreed with NHS England. Some of the agreed services include: minor surgery, alcohol advice, as well as sexual health and chlamydia screening. The practice also offers travel vaccinations and care for patients with asthma and diabetes.

The practice is managed by Radford Medical Practice – Kaur, which also manages Radford Health Centre, in Ilkeston Road. We did not inspect Radford Health Centre as it is registered in its own right as a separate location. We found most staff worked at both the student and Radford health centres.

The practice employs four GP partners and two part time salaried GPs. Three of the GPs are female and three are male. The nursing staff comprises of one full-time nurse, two part-time nurses and one part-time healthcare assistant. The administrative staff includes a practice manager, assistant manager, seven receptionists and two temporary staff assisting with the student registration process.

Radford Medical Centre is involved in the training of medical students. The practice has opted out of providing out-of-hours service to their patients; and this service is provided by Nottingham Emergency Medical Services (NEMS). The practice offers reduced surgery sessions during university holidays and patients can always access the Radford surgery out of term time.

Updated 19 March 2015

Letter from the Chief Inspector of General Practice

We inspected Radford Medical Practice on 03 November 2014, as part of our new comprehensive inspection programme. The practice had not previously been inspected.

The provider has a total patient list size of 16,700; with 13,400 registered students at the practice we inspected and 3,300 patients registered at the other location.

Our key findings were as follows:

• Patients reported good access to the practice and continuity of care, with urgent appointments being made available on most occasions.
• The appointment system was flexible and enabled patients to access care and treatment outside university and working hours.
• The practice had appropriate systems in place to keep patients safe.
• The practice was caring and patients were treated with kindness and respect.
• An open culture and team based approach was promoted within the practice. Staff felt well supported with their professional development and enabled to carry out their work effectively.
• The practice staff were all committed to improving the quality of care and services provided for the student population.
• The practice was proactive in promoting health promotion, screening and prevention. This included:
• opportunistic “roadshows” in student halls of residence where sexual health, alcohol and drug use information and advice was provided;
• integrated work with Nottingham Trent University and Public Health in cases of health outbreaks:
• chlamydia treatment and then making referrals to a local health centre for contact tracing. Contact tracing involves finding and informing the contacts of a person with an infection so they can get information, testing and treatment.
• Information and advice on sexual health was provided in different formats and languages including French, Arabic and Chinese.

All these initiatives had made a positive impact on patient’s awareness of health promotion and disease prevention.

However, there were also areas of practice where the provider needed to make improvements.

Action the provider should take to improve

• The practice should ensure that a yearly infection control audit is completed.

• The practice should ensure clear signage for the self-monitoring BP machine is in place for students to easily access the service.

• The practice should ensure that all staff receive training updates in line with the provider’s stipulated frequency so as to be assured that staff have up to date knowledge to perform their roles.
• The practice should ensure that changes made to processes and systems after significant event findings are reviewed to evaluate impact in quality improvement.
• The practice should ensure the recording of all clinical meetings where patient information and NICE guidelines are discussed to strengthen the evidence of case management work undertaken and peer support.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 19 March 2015

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

Most of the patients we spoke with were complimentary of the care they had received and felt their health care needs were being managed safely. They confirmed they were able to access appointments when needed and to see the same doctor for their condition, which was important for continuity of care.

The practice had identified asthma, diabetes, epilepsy, hyperthyroidism and rheumatoid arthritis as the main long term conditions the student population experienced; and there was a lead clinician for each condition. The GPs participated in clinical audit work and referred to the National Institute for Health and Clinical Excellence (NICE) guidelines to improve patient care. GPs and nurses carried out regular reviews to check that patient’s health and medication needs were being met.

Some of the staff we spoke with acknowledged the challenges in meeting the care needs of some students as they did not always attend their GP or nurse appointments. As a result of this, the practice was proactive in engaging patients in the management of their own care; and follow-up letters or phone calls were made where patients had missed their appointments. We found the recall systems to be robust and effective in monitoring patient reviews and attendance.

For patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. This included support from the community diabetic nurse specialist and comprehensive care planning for all patients with diabetes.

The practice also offered enhanced services for warfarin anti-coagulation monitoring, patient testing for dermatology, gastroenterology, rheumatology and respiratory medicine. The practice had emergency processes in place to ensure appropriate referrals were made for patients whose health deteriorated suddenly. Longer appointments and home visits were available when needed.

Updated 19 March 2015

A rating is not applied as the practice did not have registered families, children and young people.

At the time of our inspection, Radford Medical Practice provided care and treatment to the student population attending Nottingham Trent University and all the students were above the age of 17.

Updated 19 March 2015

A rating is not applied for older people as the practice did not have registered patients over the age of 75.

At the time of our inspection, Radford Medical Practice provided care and treatment to the student population attending Nottingham Trent University; and 95% of the students were below the age of 25.

Updated 19 March 2015

The practice is rated as good for the care of working-age people (including students).

The practice had identified the needs of the student population and adjusted the services it offered to ensure they were accessible and flexible. This included: appointments being available outside of university timetables (early morning, lunchtime and evening); GP telephone consultations; and on line services for requesting repeat prescriptions and booking appointments. Most of the students we spoke with were happy with these services and appreciated the convenience of the practice being located on campus.

We found some very good aspects of practice in relation to the practice’s proactive approach to health promotion, screening and prevention. This included: opportunistic “roadshows” in student halls of residence where sexual health, alcohol and drug use information and advice was provided; integrated work with Nottingham Trent University and Public Health in cases of health outbreaks; and chlamydia treatment and contact tracing in liaison with other sexual health centres. Contact tracing involves finding and informing the contacts of a person with an infection so they can get information, testing and treatment.

Information and advice on sexual health was provided in different formats and languages including French, Arabic and Chinese. All these initiatives had made a positive impact on patient’s awareness of health promotion and disease prevention.

We found other tailored services for the student population included: a weekly sexual health drop in service, a contraceptive service, weight management reviews, smoking advice, travel health and immunisation. The practice was also registered as a yellow fever centre. Most students we spoke with were aware that a chaperone policy was in place and they could request for a chaperone when having intimate examinations.

The practice offered a ‘choose and book’ service for patients referred to secondary services, which provided greater flexibility over when and where their test took place. Patients could also refer themselves for physiotherapy, chiropody and talking therapy services.

Students were able to easily register with the practice and were encouraged to do so before starting university in September. For example, an information pack was sent to the home address of all new students who had expressed an interest in registering with a local doctor. This initiative was to ensure that students were fully registered by the time they arrived in Nottingham.

Updated 19 March 2015

The practice is rated good for the care of people experiencing poor mental health. There were no registered patients with a diagnosis of dementia at the time of our inspection.

The practice maintained a register of patients with mental health needs and depression. These patients received an annual health check to ensure their health needs were being met. Suitable re-call systems were in place to monitor patient attendance for their appointments, and where required follow-up action was taken. Patients were signposted to various support groups, university counselling services and psychological / talking therapies. GPs also provided reports for disability allowance entitlement for the students.

The practice had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff were flexible in meeting patient’s requests for appointment times; and longer appointments and home visits were offered when needed.

The practice had identified the need to improve the case management of students experiencing poor mental health so as to ensure a coordinated approach to their care and treatment. As a result, multi-disciplinary meetings with counsellors, the university student support service and a professor in psychiatry had been planned for 11 November 2014. These meetings were previously held once a term.

Staff were also due to attend mental health first aid training in November 2014. GPs we spoke with demonstrated awareness of working within the principles of the Mental Health Act (1983/2007) and Mental Capacity Act to ensure patients received safe and effective care.

The practice is currently involved in a project looking at young people that are at risk of self-harm. As part of the project the practice is working towards developing self-help literature. While this was a good and innovative initiative, we could not evaluate the impact on patient care as the project had not been completed. Patients could still access information on self-harm from the practice website.

Updated 19 March 2015

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

The practice’s vulnerable patients included: students at risk of abuse; international students; and students with mild learning difficulties, dyslexia, autism and / or attention deficit hyperactivity disorder (ADHD). The practice worked in liaison with Nottingham Trent University staff, police and multi-disciplinary agencies to support more vulnerable patients. Medicines and health reviews were offered to patients, and where needed students were supported to complete health related forms.

The practice had suitable systems in place to provide patients with safeguarding information and to respond to cases of potential abuse. Leaflets about support groups related to domestic violence, alcohol and drug misuse were also available in the practice for patients to access. Staff had received training in safeguarding of vulnerable adults and were aware of their responsibilities regarding information sharing and documenting safeguarding concerns.

The practice had effective systems in place to ensure international students were supported in understanding the UK health system. This included joint working arrangements with Nottingham Trent University international office and student support services. For example, international students were provided with leaflets covering areas such as the role of GPs, their function as gatekeepers to the health services, how to register and how to access emergency services.

The practice had access to interpreting and translation services for patients who do not speak English as a first language; and longer appointments were offered. Students were prompted to choose a language of their choice when using the self-check in machine to confirm arrival for their appointment. One international student we spoke with gave positive feedback about the support they had received to register with the practice, as well as the care and treatment provided.