Peartree Medical Centre

Updated 8 December 2016

Peartree Medical Centre provides primary medical services to 4522 patients through a primary medical services contract (GMS). The practice is located in Normanton, near to Derby city centre. The practice has car parking facilities and is accessible by public transport.

The practice team has a comprehensive understanding of the practice population and community demographics specifically the barriers to care and treatment. This includes high deprivation levels within the Normanton area which are significantly above the national average, religious, cultural, language and literacy barriers. The level of deprivation within the practice population is rated one which is the most deprived decile. People living in more deprived areas tend to have greater need for health services. A range of strategies including patient educational sessions are proactively facilitated by the practice as part of an on-going programme to tackle health inequalities.

The clinical team comprises two GP partners and three nurses. The practice used regular locum GPs and nurses to provide additional cover when needed. The clinical team is supported by a full time practice manager, a senior receptionist, an interpreter, an apprentice and a team of reception and administrative staff.

The practice opens from 8am to 6.30pm Monday to Friday daily with the exception of Thursday when the practice closes at 8.30pm. GP appointments are available from 8.30am to 6pm. Extended hours appointments are offered from 6.30pm to 8.30pm on Thursday with a practice nurse.

The practice has opted out of providing out-of-hours services to its own patients. This service is provided by Derbyshire Health United and is accessed via 111.

Updated 8 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Peartree Medical Centre on 13 September 2016. Overall the practice is rated as outstanding.

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

• The assessment and management of risks was comprehensive, well embedded and recognised as the responsibility of all staff. This included safeguarding children and vulnerable adults from abuse and health and safety.

• Sufficient staff were employed to meet patient’s needs and this included employing “bank/casual staff” to enable flexible and immediate access to staff in response to service demands.

• Staff had the skills, knowledge and experience to deliver effective care and treatment. They assessed patients’ needs and delivered care in line with current evidence based guidance.

• The practice has consistently maintained a track record of high quality outcomes framework (QOF) performance over the last five years with achievements above 99%. The 2015/16 nationally reported data showed all patient outcomes were in line with or above the local and national averages.

• We saw several examples of collaborative working and sharing of best practice to promote better health outcomes for patients. Specifically, ongoing health education programmes relating to cancer screening, diabetes, stroke and children’s health with demonstrable impact of positive outcomes being achieved for patients.

• Clinical audits and regular reviews of the service were undertaken to drive improvements to patient outcomes.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Significant improvements had been made over the last two years to improve telephone access and availability of appointments. Most patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.

• The practice actively reviewed the management of complaints and made improvements as a result. An annual review was undertaken to detect themes and trends.

• 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.

• A strong ethos of continuous improvement was owned by all staff.

We saw several areas of outstanding practice including:

• There was an open and transparent approach to safety and an effective system for managing and significant events. Significant events were fully investigated and learning was shared with the practice team, other stakeholders and the national reporting and learning system (NRLS). The NRLS ensures the learning gained from the experience of a patient in one part of the country is used to reduce the risk of something similar occurring elsewhere. An annual “significant event analysis and reflection” report was produced and discussed with staff to ensure learning had taken place and changes were embedded.

• There was an on-going programme of patient education and wider external stakeholder engagement to tackle health inequalities affecting patients and the wider community. For example:

• The practice held health educational meetings at least three times a year at the local community centre to improve the take up of breast and bowel screening. The impact of these events and opportunistic screening had resulted in an increased uptake rate of 20% for bowel cancer over the last 14 months. This data was yet to be verified and published nationally. The 2014/15 data showed the practice’s uptake for the cervical screening programme for the preceding five year period was 96% which was significantly above the local average of 84% and the national average of 82%.

• The practice used proactive methods to improve outcomes for patients living with and at risk of diabetes; taking into account their religion. For example: 30 patients had attended a health education event titled “managing your diabetes during Ramadan” at the practice. Some patients had also attended the social cooking project facilitated by the Derby City Public Health team to encourage use of lower levels of saturated fat and salt intake by south Asian families who are at higher risk of developing diabetes. The performance data for diabetes related indicators was 100% compared to the local average of 92.9% and the national average of 89.9%. The practice had double the clinical prevalence of diabetes when compared to the local and national averages.

• The practice had identified patients at high risk of developing diabetes. This enabled the clinicians to support and advise patients on changes required to prevent diabetes developing

• The practice proactively identified and supported its carers with support from Derbyshire Carers Association. A total of 207 patients had been identified as carers and this represented 4.6% of the current practice list. Carers assessments were undertaken from the practice with evidence of personalised support plans being put in place to address the carers needs.

• Innovative approaches were used to gather feedback from the practice population. For example, the patient participation group (PPG) consisted of at least 30 active members. It was unique in that it comprised of a main group including both men and women; and a ladies only PPG meeting was facilitated for female Asian patients in response to underrepresentation in the main group, cultural, religious and personal preferences. At the time of the inspection at least nine female members attended the meetings. This removed barriers to gender inequality and promoted holistic feedback for the practice team which it acted upon.

• The practice team had a proactive approach to understanding the cultural diversity and language needs of its practice population to ensure equal access to services and continuity of care. Since 2003, the practice has employed an interpreter (four days a week) who speaks Urdu, Mirpur Punjabi and Hindi and some other Asian dialects less proficiently. An evaluation of their role demonstrated a high level of satisfaction by patients and positive outcomes for clinicians whose first language was not English. For example, the interpreter had been supported with additional training on medical terminology and procedures to ensure consistent explanations were clearly given to patients and clinicians times was efficiently managed during the appointment. The interpreter also regularly signposted patients to a range of services that deal with benefits, housing and education. The telephone system had also been improved in 2014 and included an automated welcome message and options in Urdu.

However there were areas of practice where the provider should make improvements:

• Continue to review, monitor and act upon patient experience data to continually drive service improvement.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 8 December 2016

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

• Nationally reported data showed all patient outcomes for long term conditions were above local and national averages.

• The prevalence of diabetes within the practice population is double the local and national averages. As a result, a range of successful strategies were employed to monitor the health of patients with a diagnosis of diabetes and / or at risk of diabetes. This also included taking into account religious factors such as fasting during Ramadan.

• Clinical staff had lead roles in chronic disease management and an effective system was in place to invite and follow up patients who failed to attend health reviews and appointments.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. The practice worked closely with other health social care professionals to ensure a multi-disciplinary package of care was in place for people with complex long term conditions. This included district nurses and the community matron.

• A range of health education events were hosted within the practice and facilitated in the local community centres in collaboration with other stakeholders. This was aimed at empowering patients with knowledge about managing their conditions effectively and or attending relevant screening.

• Patients at risk of hospital admission were identified as a priority and effective care planning took place. In addition, hospital admission rates for most departments were below the local averages.

• Home visits were available when needed and patients could be seen in one extended appointment to prevent the need for multiple visits.

Updated 8 December 2016

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

• Patients had access to educational sessions on children health issues which were facilitated by the practice team in liaison with other external stakeholders such as Sure Start and Derby city council public health team. For example, a “free and fun event titled healthy kids are happy kids” had been facilitated at the local Indian community centre to educate and promote child health and wellbeing with over 70 people (children and adults) in attendance.

• The practice team prioritised the safeguarding of children and families. This included being signed up to the “prevent strategy” which is about safeguarding people and communities from the threat of radicalisation. Staff we spoke were aware of their responsibilities to report concerns.

• Children at risk of abuse, hospital admission, living in disadvantaged circumstances or deteriorating health needs had their health and social care needs discussed at regular multi-disciplinary meetings attended by the health visitor.

• The practice team reviewed all new births on a quarterly basis to ensure post-natal care was in place for the mothers.

• We saw positive examples of joint working with the midwives. For example, the midwife and GP reviewed the care of expectant mothers with gestational diabetes and / or at risk of delivering a baby with foetal abnormalities.

• Childhood Immunisation rates were comparable to the local averages.

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

• All patients aged under 12 were guaranteed a same day appointment or telephone consultations. The benchmarking data produced 31 March 2016 showed the hospital admission rate for children under five years was below the local average.

Updated 8 December 2016

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. This included a 100% achievement for rheumatoid arthritis and osteoporosis with all patients having received a face to face annual review.

• Patients aged 75 years and over had a named GP to provide continuity of care. The practice had reviewed the medical records of these patients and found they had all been seen by a clinician in the previous 12 months.

• An annual health check was offered to patients to ensure their health needs were being met. This included influenza, pneumococcal and shingles vaccinations in accordance with national guidance.
• The practice identified frail and vulnerable patients including those at high risk of hospital admission. Monthly multi-disciplinary meetings were held to plan and deliver care appropriate to their needs.

• Care plans were also in place for older patients with complex needs and this included preventative measures to ensure the person was supported within their own home.

• The practice was responsive to the needs of older people. This included access to a practice employed interpreter for those whose first language was not English, home visits and same day appointments.

Updated 8 December 2016

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.

• Patients had access to a range of health checks and health promotion information. For example, community based health educational meetings were held at least three times a year at the local community centre, resulting in improved uptake rates for breast and bowel screening. In addition, a range of health promotion material was available on the practice website.

• The practice offered extended hours surgeries with a practice nurse between 6.30pm and 8.30pm on Thursdays for patients who found it difficult to attend during normal working hours.

• Telephone consultations were available each day for those patients who had difficulty attending the practice due, for example, to work commitments.

• Patients had access to online services for booking GP appointments, requesting repeat prescriptions and for prescriptions to be sent directly to the pharmacy of their choice (electronic prescribing service).

• A text reminder service was used to help reduce non-attendance for appointments and promote patient education.

Updated 8 December 2016

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

The 2015/16 nationally published data showed:

• All patients with a severe mental health condition had a documented care plan in the last 12 months which was above the local average of 92.8% and the national average of 88.8%. This was achieved with no patients being exception reported compared to a local exception rate of 20.4% and national exception rate of 12.7%.

• All patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months which was above the local average of 85.2% and national average of 83.8%. The exception reporting rate for this indicator was 15.4% compared to a local exception rate of 7.9% and national exception rate of 6.8%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• Patients at risk of dementia were referred to the local memory assessment service and advance care planning for patients with dementia took place.

• Patients had access to a counsellor and psychiatrist who provided regular sessions within the practice; as well as information about 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 dementia. They had received training in dementia awareness, the Mental Capacity Act and consent.

Updated 8 December 2016

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 those with a learning disability at risk of deteriorating health due to severe cold conditions.

• There were 33 patients on the learning disability register for adults, and all of these had received an annual health check in the last twelve months.

• Patients were offered longer appointments and home visits to facilitate a holistic assessment of their needs.

• The practice had identified 207 patients with carers’ responsibilities and this represented 4.6% of the practice list size. The practice had engaged a local carers organisation to undertake carers assessments within the practice and provide training for staff. Personalised support plans were put in place for the carers.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients including those receiving end of life care.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. They 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.

• “Winter awareness” workshops were hosted within the practice in collaboration with other stakeholders. This was aimed at ensuring patients stayed warm during the winter months with adequate provisions of food and medicines; and had information on free services such as snow clearing.

• The practice had systems in place to comply with the accessible information standard aimed to ensure that people who have a disability, impairment or sensory loss received information in a format they can read and understand.