Somercotes Medical Centre

Updated 27 March 2017

Somercotes Medical Centre provides primary medical services to approximately 7200 patients through a general medical services contract (GMS). The practice is situated off the main Nottingham Road in Somercotes, a former mining village located to the northeast of Amber Valley Borough.

The premises are purpose built and all services are accessible on the ground floor. The practice has car parking facilities including parking bays for the disabled and is accessible by public transport.

The level of deprivation within the practice population is in line with the national average with the practice population falling into the fifth most deprived decile. Income deprivation affecting children and older people is above the local and national averages.

The clinical team comprises three full-time and two part time GP partners (male and female), one salaried part-time GPs (female), one part-time advanced nurse practitioner and three practice nurses. The practice is a teaching practice for medical students and nurses as well as a training practice for GP registrars. The clinical team is supported by a full time practice manager and a team of reception and administrative staff.

The practice opens from 8am to 6.30pm Monday to Friday. Morning surgery runs from 8.20am to 11.30am daily and afternoon surgery runs from 2.30pm to 5.40pm on Monday and Tuesday; and 3.50pm to 5.40pm Wednesday to Friday.

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 Healthcare United (DHU) via the 111 service.  

Updated 27 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Somercotes Medical Centre on 1 November 2016. Overall the practice is rated as outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report significant events and near misses. All opportunities for learning from internal and external incidents were maximised and shared widely across all staffing groups.

• The practice had clearly defined and embedded systems to minimise risks to patient safety. This included arrangements for safeguarding and medicines management.

• Staff were aware of current evidence based guidance and had the skills and knowledge to deliver effective care and treatment.

• Nationally published data showed the majority of patient outcomes were above local and national averages.

• Clinical audits demonstrated improvement to patient outcomes.

• We observed a strong patient-centred culture and feedback from patients about their care was consistently positive. Patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.

• 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 staff, patients and the patient participation group.

• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result.

• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

• The practice had strong and visible clinical and managerial leadership and governance arrangements.

• The provider was aware of the requirements of the duty of candour.

• The practice held the Royal College of General Practitioners research ready accreditation and was a level one research site practice with the Clinical Research Network. Research Ready is a quality assurance programme, for all research-active UK GP practices.

We saw several areas of outstanding practice including:

• The practice was committed to working with people whose circumstances might make them vulnerable. For example: the practice proactively engaged with vulnerable adult risk management (VARM) multi-agency meetings when this was required and positive outcomes were achieved for patients’. This included mitigating risks to patient’s home environment (for example hoarding and fire) and in some cases respecting their “unwise decisions” as defined by the Mental Capacity Act 2015.

• The practice demonstrated a responsive approach by taking account of the needs of their local population, and not just their registered patients. This enabled services to be delivered closer to home. For example, in response to a need to increase the support provided to carers, the practice staff and Derbyshire Carers Association (DCA) were instrumental in setting up a “carers’ clinic” in the Southern Derbyshire clinical commissioning group area. Carers received an assessment of their needs at any of the 18 participating GP practices and were involved in developing a support plan that focused on positive outcomes they wanted to achieve. Within three months of the project commencing in July 2015, the following measurable results were achieved: the rate of carer identification increased by 281%, the number of active carers on the practice’s register increased by 40% and the number of carers assessments completed with the locality increase by 800%. The British Medical Journal awarded the practice and DCA a commendation as finalists for the "primary care team of the year award" in 2016.

• The Derbyshire county council had awarded the practice the Derbyshire dignity campaign award (previously known as the silver award) in June 2015; in recognition of work undertaken to promote people’s dignity and respect. Somercotes Medical Centre was the first GP practice in the county to achieve the silver award, which is the highest level of dignity award currently available. These awards had been achieved following an assessment process which considered areas such as: patient and staff involvement; respecting people’s right to privacy; as well as listening and supporting people to express their needs and wants. Some of the evidence that led to these awards included the following: reception staff used text speech software to communicate with some patients with hearing impairments; and this enabled the voice of the receptionist to be converted into text of which the patient could read. Some patients with learning disabilities communicated with the practice staff via picture boards which have symbols to represent their views. The national GP patient survey results reinforced this aspect of care was maintained; as the results were above local and national averages.

• A free in-house acupuncture clinic for patients. Records reviewed showed along with the expertise within the practice in joint injections, the acupuncture service had helped keep referral rates for musculoskeletal problems low, reduced prescribing costs or the need for medicines. Patients were very complimentary of this service and the impact it had on reducing chronic pain for example.

  Professor Steve Field (CBE FRCP FFPH FRCGP)

  Chief Inspector of General Practice

Updated 27 March 2017

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

• Care and treatment for people with long term conditions reflected current evidence-based practice. Nationally reported data showed the practice performed highly when compared to other practices with a QOF achievement of 100% for all long term conditions. This included asthma, stroke and chronic obstructive pulmonary disease.

• Performance for diabetes related indicators was 100% which was above the local average of 92.9% and the national average of 89.9%. This was achieved with an exception reporting rate of 18% which was slightly above the local average of 14% and the national average of 12%. A specialist diabetes nurse attended the practice to support patients with complex needs.

• Nursing staff had lead roles in long-term disease management and had received specific training to do so. This included spirometry, a test that can help diagnose various lung conditions.

• All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met.

• The named GP worked with other health and social care professionals to deliver a multi-disciplinary package of care for patients with the most complex needs.

• Patients at risk of hospital admission were identified as a priority. The attached care co-ordinator worked with practice staff and other services to plan and deliver patient care, particularly for patients discharged following a hospital admission.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health and a

• Longer appointments and home visits were available when needed.

Updated 27 March 2017

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

• A wide range of artwork completed by children and young people from local schools and colleges was displayed in the community gallery within the practice. The gallery was set up to “promote wellbeing, interest in the arts, community spirit and make the medical centre a more pleasant place to be”.

• The practice team actively went out to speak to local primary and secondary schools to engage children in their healthcare. GPs had been involved in sexual health education at local schools and had also taken part in “aspiration days” aimed at encouraging pupils to consider careers in healthcare.

• The practice hosted a weekly counselling service for children aged 11 to 17 years (Safespeak) and this service was provided by Relate charity. Access to this service was via self-referral or referral by a clinician.

• The practice worked with midwives, health visitors and school nurses to support this population group and safeguard patients against the risk of harm or abuse.

• Staff had received training in safeguarding children that was relevant to their role and felt confident in reporting any concerns.

• Appointments were available outside of school hours and emergency processes were in place for acutely ill children and young people.

• The premises were suitable for children and babies. Children had access to a play area, toys, puzzles and a book exchange program. The practice welcomed mothers who wished to breastfeed on site and baby changing facilities were available.

• A family planning service was provided including contraception advice and long acting injectable contraception.

• Vaccination rates for childhood immunisations were mostly in line with or above local averages. For example, immunisation rates for the vaccinations given to five year olds ranged from 74% to 99% compared to the local average of 72% to 98% and national average of 81% to 95%.

Updated 27 March 2017

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

• Nationally reported data showed patient outcomes for conditions commonly found in older people were above local and national averages. For example, an achievement of 100% was attained for clinical indicators relating to osteoporosis, rheumatoid arthritis and heart failure.

• The care of older people was managed in a holistic way and patients were involved 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.

• The practice carried out structured annual medicine reviews for older patients.

• The practice offered proactive and personalised care to meet the needs of older people. This included home visits, urgent appointments for those with enhanced needs and a named GP for patients aged 75 years and over, to provide continuity of care.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

• Influenza, pneumococcal and shingles vaccinations were offered in accordance with national guidance. Practice supplied data for 2015/16 showed for people aged 65 years and over: 77% had received an influenza vaccination and 65% had been vaccinated against pneumonia.

Updated 27 March 2017

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

• The needs of this population group 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 offered telephone consultations, 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.

• The practice hosted the Live Life Better Derbyshire service for patients to receive advice and support with weight management, exercise programs and smoking cessation.

• The 2015/16 QOF data showed approximately 92% of patients aged 15 or over recorded as current smokers had a record of an offer of support and treatment within the preceding 24 months. This was above the CCG average of 87% and national average of 88%.

• A total of 88% of patients with hypertension had a blood pressure reading measured in the preceding 12 months, which was above the local average of 84.4% and national average of 82.9%. This was achieved with an exception reporting rate of 3% which was in line with the local and national rate of 4%.

• The uptake rate for cancer screening programmes was above or in line with local and national averages. For example, 85.3% of eligible females had received cervical cancer screening, which was above the local average of 83% and the national average of 81.4%. This was achieved with a low exception reporting rate of 3% compared to the local average of 4% and national average of 6.5%.

• Flu vaccination rates for ‘at risk’ patients under 65 was at 57% which was above the local average of 52.5% and national average of 53.22%.

• The practice offered a full range of health promotion that reflects the needs for this age group. This included NHS health checks for patients aged 40-74, travel advice and immunisation and occupational health checks.

Updated 27 March 2017

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

The 2015/16 nationally reported data showed good outcomes were achieved for patients.

• 98% of patients experiencing poor mental health were involved in developing their care plan in preceding 12 months which was 5.3% above the local average and 9.3% above the national average. The exception reporting rate was 8.9% which was below the local average of 20.4% and national average of 12.7%.

• 93.3% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was 8.2% above the local average and 9.6% above the national average. This was achieved with a 0% exception reporting rate compared to the local rate of 7.9% and the national rate of 6.8%.

• Staff we spoke with had a good understanding of how to support patients with mental health needs and dementia; and had received relevant training.

• The practice had created a community gallery to encourage patients to use art as therapy and positive feedback was received from patients in respect of improved mental well-being.

• The practice hosted regular counselling and psychological therapy sessions to ensure patients had ease of access to emotional support when needed.

• Patients experiencing poor mental health could access onsite clinics facilitated by the community psychiatrist nurse and a mental health support worker provided assessment and support in areas such as housing, education, benefits and volunteering opportunistic.

• The practice had participated in a research study looking at whether hypertension medicines could safely be withdrawn in dementia patients without the return of hypertension and also had an effective system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• The practice offered an assessment to patients at risk of dementia and carried out advance care planning for patients living with dementia.

• The practice signposted and provided information to patients about how they could access various support groups and voluntary organisations.

Updated 27 March 2017

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

• The practice held a register of patients living in vulnerable circumstances including travellers, people with a learning disability and homeless people. There were arrangements in place to allow people with no fixed address to register or be seen at the practice.

• The practice team knew patients and their families very well, and this helped them to provide responsive care and provide additional support if this became necessary.

• The GP lead for “vulnerable patients” facilitated periodic meetings with the practice team to review the care needs of these patients and to ensure appropriate safeguards were in place to minimise the risk of deteriorating health, harm or abuse. GPs participated in the multi-disciplinary vulnerable adult risk management meetings wherever possible.

• Staff we spoke were aware of their responsibilities regarding identifying, reporting and recording safeguarding concerns. They had received training in safeguarding vulnerable adults, the Mental Capacity Act 2005 and Deprivation of Liberty safeguards (DOLs).

• People were supported to make decisions and where appropriate, their mental capacity was assessed and recorded.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. We saw evidence of GPs participating in best interest decision meetings in accordance with legislation.

• The practice carried out annual health checks for patients with a learning disability and facilitated cervical screening for female patients within their home when needed.

• Significant event analysis was undertaken for patients with learning disabilities in line with the confidential inquiry into premature death of people with learning disabilities.

• Patients had access to information about how to access various support groups and voluntary organisations in a range of accessible formats.

• The practice worked with local food banks and staff offered food bank vouchers to patients who required emergency food supplies or were experiencing financial difficulty.