Carterknowle and Dore Medical Practice

Updated 28 November 2016

Carterknowle and Dore Medical Practice has a purpose built branch site at Dore which is three miles from the main site which is a converted victorian house in the S7 district of Sheffield. The practice accepts patients from Abbeydale, Millhouses, Ecclesall, Dore, Whirlow, Totley and Bradway and part of Woodseats. Public Health England data shows the practice population has a higher than average number of patients aged over 40 years old compared to the England average and the catchment area has been identified as one of the 10th least deprived areas nationally.

The practice provides General Medical Services (GMS) under a contract with NHS England for 12420 patients in the NHS Sheffield Clinical Commissioning Group (CCG) area. It also offers a range of enhanced services such as minor surgery, anticoagulation monitoring and childhood vaccination and immunisations.

Carterknowle and Dore have four GP partners (one female, three male), three salaried GPs (one male, two female), two female nurse practitioners, three practice nurses, three healthcare assistants, two healthcare assistant apprentices, two practice managers and an experienced team of reception and administration staff. The practice is a teaching and training practice for medical students and physician associates.

The practice and branch site are open 8.30am to 5.30pm Monday to Friday with the exception of Thursdays when the practice closes at 12.30pm. The Sheffield GP Collaborative provides cover when the practice is closed on a Thursday afternoon. Extended hours are offered on a Tuesday evening until 8.30pm at the main site and on a Wednesday evening until 8.45pm at the branch site. Morning and afternoon appointments are offered daily Monday to Friday at both sites with the exception of Thursday afternoon when there are no afternoon appointments.

When the practice is closed between 6.30pm and 8am patients are directed to contact the NHS 111 service. The Sheffield GP Collaborative provides cover when the practice is closed between 8am and 6.30pm. For example, at lunchtime. Patients are informed of this when they telephone the practice number.

As part of the Care Quality Commission (Registration) Regulations 2009: Regulation 15, we noted the regulated activities the practice were undertaking did not reflect the registration. The GP told us this would be reviewed immediately.

Updated 28 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Carterknowle and Dore Medical Practice on 21 September 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.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they were able to make a routine appointment with a named GP if they were willing to wait although urgent appointments were available the same day through the telephone triage system.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

• The practice had arranged, independent to the locally commissioned service, an extra collection of pathology samples from the practice to the laboratory at the end of the day. This meant the practice could offer late afternoon appointments for blood tests to patients who were not able to attend during the day.

The areas where the provider should make improvement are:

• Ensure staff who perform chaperone duties follow the practice’s own chaperone policy with regards to recording the event.

• Improve the security arrangements for the clinical waste storage bins stored outside the practice.

• Consider how to promote to patients that there is a private area available should they wish to discuss confidential issues away from the front desk and review ways to reduce hearing what is being said at the reception desk in the waiting room.

• Review and develop an action plan to address low satisfaction scores identified on the latest national patient survey with regard to access.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 28 November 2016

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

• Nursing staff had lead roles in long term condition management and patients at risk of hospital admission were identified as a priority.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. The practice had developed a recall system to fall on the patient’s birthday month, to include an appointment with the healthcare assistant, practice nurse and GP. 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.

Updated 28 November 2016

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

• 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. Immunisation rates were relatively high for all standard childhood immunisations.

• Staff told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

• Data showed 92% of women eligible for a cervical screening test had received one in the previous five years compared to the national average of 82%.

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

• We saw positive examples of joint working with midwives and health visitors. The practice held bi-monthly safeguarding meetings with health visitors at the practice.

Updated 28 November 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• The practice offered an annual review and three monthly telephone reviews to patients who had been identified as being at risk of a hospital admission. The practice had also utilised an activation tool to measure patient s' skills, confidence and knowledge of managing their own health.

• The practice was responsive to the needs of older people, and offered home visits by the GPs, nurses and healthcare assistants as required. Urgent appointments for those with enhanced needs were available through the telephone triage system.

• The practice provided medical care and weekly routine GP visits to patients who resided in three local care homes.

• The practice had developed a ‘fridge sheet’ of emergency contact telephone numbers to use in the event of an emergency. This covered incidences relating to health, safety issues and concerns, legal and financial contacts. The practice had also implemented with the support of their PPG a leaflet detailing local activities, lunch clubs and support groups to aid isolation and potential loneliness. These were given to patients as part of their care planning review appointment.

• The percentage of patients aged 65 or over who received a seasonal flu vaccination was 80%, higher than the national average of 73%.

Updated 28 November 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.

• The practice offered evening appointments two evenings a week. Tuesday evening until 8.30pm at the main site and Wednesday evening until 8.45pm at the branch site. The practice also offered weekend and evening appointments at a local practice through the Sheffield satellite clinical scheme.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group. For example, the practice offered GP telephone consultations and an on-line consultation appointment service where patients could email the practice for non urgent advice and receive a response the same day.

• The practice utilised a social media site to keep patients up to date with what was new at the practice. For example, the seasonal flu appointment campaign.

• The practice had arranged, independent to the locally commissioned service, an extra collection of pathology samples from the practice to the laboratory at the end of the day. This meant the practice could offer late afternoon appointments for blood tests to patients who were not able to attend during the day.

Updated 28 November 2016

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

• Of those patients diagnosed with dementia, 86% had received a face to face review of their care in the last 12 months, which is comparable to the national average of 84%.

• Of those patients diagnosed with a mental health condition, 89% had a comprehensive care plan reviewed in the last 12 months, which is comparable to the national average of 90%.

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

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

• The practice had advised patients experiencing poor mental health 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 those living with dementia.

• The practice hosted Improving Access to Psychological Therapies Programme (IAPT), a counselling service to support patients’ needs.

Updated 28 November 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.

• The practice offered longer appointments for patients with a learning disability and used easy to read pictoral appointment letters to send to patients with learning disabilities about their appointment.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• 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.

• The practice is registered as a place of safety under the Sheffield Safe Places Scheme and displayed a sign in the window regarding this. Staff told us patients seeking help would be offered a drink and the use of a telephone to ring support services.

• The practice had developed a ‘fridge sheet’ of emergency contacts and the telephone numbers of local support services. This was given to patients as part of their care planning review appointment.