Elmswood Surgery

Updated 9 August 2016

Elmswood Surgery provides primary medical services to approximately 9000 patients through a general medical services (GMS) contract. The practice is located in close proximity to Nottingham city centre, serving the suburban population of the Sherwood area.

The practice was formed in 1948 at the beginning of the NHS. It has been located within premises owned by NHS Property Services since 1986 which are shared with other local community health services.

The practice deprivation scores indicated people living in the area were significantly less deprived than the CCG average, but in line with the national deprivation average. Data shows proportion of patients aged 65 years and above registered at the practice is slightly higher than the national average, and the proportion of 0 to 40 year olds is broadly in line with local and national averages.

The practice team comprises six GP partners, four practice nurses, a healthcare assistant, a phlebotomist, a practice manager and the administrative/reception team. There are three female GPs and three male GPs. It is a training practice for doctors training to become GPs and currently has one GP registrar.

The practice is open between 8.30am and 6.30pm Monday to Friday. Appointment times start at 8.30am and the latest appointment offered at 6.15pm daily. The practice does not provide the extended hours service.

When the surgery is closed, patients are advised to dial NHS 111 and they will be put through to the out of hours service which is provided by Nottingham Emergency Medical Services.

Updated 9 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Elmswood Surgery on 1 June 2016. Overall the practice is rated as Good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events and near misses, and we saw evidence that learning was applied.

• The practice used proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, education courses for patients with long term conditions such as diabetes and working with the local diabetes specialist nurse to improve the wellbeing of patients.

• There was easy access to appointments for patients with a range of appointments on offer including telephone consultations. The practice had invested in increasing the number of appointment telephone lines reducing, reducing waiting times for patients calling to book appointments or speak to a GP. This was evident from the above average patient satisfaction results from the national survey.

• Feedback from patients about their care was consistently positive. Data from the GP survey was consistently high and this included confidence in care provided by GPs and nurses, where 98% of patients surveyed said they had confidence and trust in the last GP they saw or spoke to, and 100% of patients felt the same about the nurses.

• 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 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 (PPG).
• Services were tailored to meet the needs of their patients, particularly vulnerable patients. We saw evidence of good practice in encouraging cervical smears in patients with learning disabilities. Patients were offered a settling in appointment in addition to longer appointments of 40 minutes.
• The practice actively reviewed complaints to see if there were any recurrent themes, and identified issues where learning could be applied to improve patient experiences in the future.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision was documented and reviewed by the management on a regular basis.

• The practice had strong and visible clinical and managerial leadership and governance arrangements, and staff told us that they were well-supported and felt valued by the partners.

We observed some outstanding features in the following area:

The practice used clinical audits to drive improvements in the provision of cervical smear tests in eligible women with learning disabilities registered at the practice. Results showed an increase in uptake from 16% in 2015 to 36% in 2016, with all eligible patients having been reviewed and reasons recorded for exclusions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 August 2016

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

• The practice had a recall system for patients with long term conditions, audited on a monthly basis to identify patients who are due for a review.

• A structured annual review was carried out to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• All clinical staff had lead roles in specific disease areas for chronic disease management and patients at risk of hospital admission were identified as a priority.

• There was evidence of coordinated care with multi-disciplinary teams between the nursing staff and community matrons, diabetic specialist nurses and heart failure nurses to improve the outcomes for the patients.

• There were a large number of leaflets providing education and self-care advice and patients were directed to online resources. The practice actively encouraged patient education sessions for patients with conditions such as diabetes, for example, a type 2 diabetes insulin course. A specialist diabetes nurse visited the practice monthly to review complex patients and provide support to the nursing staff.

• QOF achievement on indicators for diabetes was consistently in line with CCG averages. For example, the percentage of patients with diabetes on the register who had their blood pressure taken within the preceding 12 months was 89.5%, compared to a CCG average of 89.1% and national average of 91.4%.

• QOF achievement on indicators for atrial fibrillation and chronic obstructive pulmonary disease were broadly in line with national averages. The practice achieved 100% on atrial fibrillation, compared to a CCG average of 97.2% and national average of 98.5%. Their exception reporting rate was 12.2%, comparable to a CCG average of 15.2% and national average of 11%.

• Longer appointments and home visits were available and offered when needed.

• The practice promoted self-referral to services such as podiatry, physiotherapy and psychological therapies, whose clinics were offered in the practice premises.

Updated 9 August 2016

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

• The practice worked closely with midwives, health visitors and family nurses attached to the practice. There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances.

• The practice held meetings every three months with the health visitor, and also reviewed any children on a child protection plan at their clinical meetings.

• Immunisation rates were consistently above the CCG averages for standard childhood immunisations. Vaccination rates for children under two years old ranged from 93.1% to 99% compared against a CCG average ranging from 91.1% to 96.3%. Vaccination rates for five year olds ranged from 91.4% to 97.8%, compared to the CCG average of 86.9% to 95.4%.

• The premises were suitable for children and babies. Baby changing facilities were available and the practice accommodated mothers who wished to breastfeed.

• Appointments were available outside of school hours with urgent appointments available on the day for children and babies.

• A joint weekly baby clinic was offered with a GP, nurse and health visitor present. This allowed mothers and babies attending for the eight week check to have their post-natal check, baby check and first immunisation done in one visit. In addition, a three week post-natal check appointment was offered to ensure contraception, physical and mental health needs of new mothers were attended to.

• There was a full range of family planning services offered including fitting of intra-uterine devices (coil) and contraceptive implant fitting.

Updated 9 August 2016

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

• The practice had a slightly higher elderly population with 20% aged over 65, compared to a national average of 17.1%. They offered proactive, personalised care to meet the needs of the older people in its population.

• The practice was responsive to the needs of older people, and offered home visits, same day telephone appointments and urgent appointments for those with enhanced needs. Phlebotomy home visits were offered where required.

• There were approximately 65 patients registered with the practice who were resident in eight care homes for the elderly, with needs ranging from neurological, mental health and nursing care. Feedback from one care home indicated a named GP carried out regular review visits and responded to urgent requests promptly when required to ensure continuity of care.

• The care home told us the GPs worked effectively with multi-disciplinary teams including district nurses, dieticians and local mental health teams to ensure patient needs were met and referrals to other services were made promptly.

• All over 75s had a named GP for continuity of care.

• Practice supplied data showed 2159 patients were given flu vaccinations. This included 67% of patients aged 65 and over.

• Shingles vaccination clinics were offered to patients over 70 years old.

• The practice had good access for wheelchairs and height adjustable couches for patients who may need them.

Updated 9 August 2016

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

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. This included access to telephone appointments at the end of every morning surgery.

• Flu clinics were offered on Saturdays for the convenience of working patients.

• The practice was proactive in offering online services such as online prescription requests, appointments, and accessing medical records. Staff told us there was high usage of online access to appointments. Appointments could be booked up to four weeks in advance.

• Mobile phone text reminders were used for appointments, including the option to cancel an appointment via text.

• There was a full range of health promotion and screening information in the practice that reflects the needs for this population group. Services offered from the premises included phlebotomy, sexual health, dermatoscopy and minor surgery provided by the practice in-house, and ultrasound, physiotherapy, diabetes education, and counselling provided by commissioned services.

• The practice’s uptake for cervical screening for eligible patients was 81.4%, which was in line with the CCG average of 81.3% and the national average of 81.8%. Breast and bowel cancer screening data was broadly in line with CCG and national averages.

• There was an active PPG affiliated to the National Association for Patient Participation, who held monthly meetings which alternated between afternoon and evening to allow working patients to participate. There was also a virtual group of approximately 150 patients.

• There were services tailored to the needs of younger patients. For example, the practice offered a meningitis vaccination for students going to university for the first time up to 25 years old. There was a greater demand for urgent appointments from this group, therefore the practice offered them appointments in the same session they had made their request. For example, if a patient telephoned for an appointment in the morning, an appointment would be made for them during the course of the morning on the same day.

• A sexual health check including chlamydia screening was offered to 15 to 24 year old patients.

Updated 9 August 2016

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

• There were 82% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the CCG and national averages of 84% in 2014/15.

• Practice supplied data indicated 96% of patients with severe mental illness had their care reviewed in a face to face meeting in 2015/16.

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

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations, for example Nottingham Wellbeing and Recovery College.

• 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.

• Patients were encouraged to self-refer to counselling services. Patients requiring regular follow up were seen by a psychiatrist who held regular clinic in the premises.

• There were clinics by Last Orders Alcohol Service provided once a month from the practice premises.

• The PPG had engaged the Alzheimer’s Society to provide a talk to raise awareness of mental health services.

• Information on drug and alcohol services was available in the reception area.

Updated 9 August 2016

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

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability. They had significantly higher numbers of patients with learning disabilities and patients in residential care compared to local practices.

• Practice supplied data indicated there were 80 patients on their learning disabilities register, and 94% had been reviewed in a face to face appointment in 2015/16.

• Patients with a learning disability were telephoned to invite them for a review, instead of writing to them. The practice routinely offered them a settling in appointment and longer appointments of 40 minutes with a practice nurse followed by 20 minutes with a GP for the review. Referrals were made to a Learning Disabilities Nurse as appropriate to support patients.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. Formal multidisciplinary meetings were held monthly to discuss patients at high risk of admission to hospital, and informally discussed on an almost daily basis with the community matrons who are based in the same building.

• GPs told us they made regular updates to the electronic notes used by the out of hours service for end of life care patients to ensure other health professionals seeing them had the most up to date information at all times.

• 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. Staff 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.

• All staff had received training in domestic violence.

• Staff told us they were aware of how to access interpreting and text talk services for their patients with hearing impairment and an interpreter could be arranged for those who could not speak in English through Language Line.

• There were no homeless patients registered with the practice although staff told us they would register homeless patients if they presented themselves and offer them the practice address for their correspondence.