Crich Medical Practice

Updated 22 September 2016

Crich Medical Practice provides general medical services to approximately 7,240 patients, and is run by a partnership of five GPs (three male and two female) which has been a stable partnership for more than five years.

As the practice is a training practice, GP Registrars work at the practice throughout the year. (GP Registrars are fully qualified doctors who are receiving additional training to work as a GP)

There are currently two Registrars working at the practice. (both are male )

The main practice is in Crich with a branch surgery at Holloway and one at South Wingfield. Patients can attend either the main practice or one of the branch practices.

We visited one of the branch surgeries to speak with some staff as part of this inspection but did not make a full inspection of the premises at either of the branch surgeries.

The practice team includes administrative staff, a Lead nurse, two practice nurses, two health care assistants and a team of dispensers.

The practice holds the General Medical Services (GMS) contract to deliver essential primary care services. The practice is open between 8am and 6.30pm Monday to Friday with telephone lines open from 8.30am to 6pm. Appointments at all practices are generally available from 8.30am to 11.30am and 3.30pm to 6pm daily.

The practice does not provide out-of-hours services to the patients registered there. During the evenings and at weekends an out-of-hours service is provided by Derbyshire Health United. Contact is via the NHS 111 telephone number.

Updated 22 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Crich Medical Practice on 23 August 2016 Overall the practice is rated as good.

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

• The practice had systems in place to enable staff to effectively report and record significant events. Learning from significant events was reviewed monthly and shared internally and externally.
• Risks to patients and staff were assessed and managed. However, the practice were in the process of confirming hepatitis B imunisation status for some staff as their immunisation record had not been kept up to date in the preceding year.
• Staff delivered care and treatment in line with evidence based guidance and local guidelines. Training had been provided for staff to ensure they had the skills and knowledge required to deliver effective care and treatment for patients.
• Feedback from patients was that they were treated with kindness, dignity and respect and were involved in decisions about their care.
• Information about services and how to complain was available and easy to understand. Complaints were dealt with promptly and the practice demonstrated they were keen to meet with complainants to ensure issues were resolved as quickly as possible.
• Patients said they generally found it easy to make an appointment even though the practice did not offer evening appointments.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Adjustments had been made to the premises to ensure these were suitable for patients with a disability. However, the branch surgeries were in need of updating and this was being planned.
• There was a clear leadership structure which all staff were aware of. Staff told us they felt supported by the lead GP and the practice manager. The practice proactively sought feedback from staff and patients, and we heard about examples where the practice had acted on suggestions for improvement.
• The practice worked closely with their patient participation group (PPG) to identify areas for improvement. The practice was responsive to suggestions from their PPG and was working with them to increase patient engagement in the online services.

The areas where the provider should make improvement are:

• To strengthen some risk assessments to ensure that risks to staff and patients are mitigated whilst new practices are being embedded.
• To strengthen recording of staff immunisation status, staff training, and DBS checks.
• To formalise infection control audits and action plans and review progress regularly to ensure that recommendations made are completed. Ensure that planned refurbishment of branch practices meets with infection control standards.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 September 2016

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

• Nursing staff had roles in chronic disease management who worked with patients’ named GP to provide a structured annual review 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.
• The practice had achieved 91% of QOF points for diabetes related indicators, which was 2% below the CCG average and 1% above the national average.Exception reporting at 12% was 1% lower than the CCG average and 2% lower than the national average.
• The practice had recognised that improvements could be made to diabetes care, and had provided additional training for one of the practice nurses. The practice had since been able to provide joint clinics with as visiting diabetic nurse, and a pre-diabetes clinic to advise patients who may be at risk of developing diabetes.
• The practice recognised that leg ulcers were taking a considerable amount of nursing time, and employed a practice nurse who was a nurse on a Burns Ward bringing useful experience to the team.
• The practice offered a 24 hour BP monitoring service for the management of hypertension
• They provided DMARD monitoring as part of the Shared Care scheme for patients with rheumatoid arthritis.
• They provided anticoagulation (Warfarin) service within the practice and in patients own homefor patients who were housebound.

• The practice had a Carers Co-ordinator who provided written information and advice to patients identified as Carers and monthly carers clinics where they could obtain advice and support

Updated 22 September 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.
• The practice had a dedicated child safeguarding lead and staff were aware of who this was.

• Staff had received training in child safeguarding at a level relevant to their role
• Immunisation rates at 98-100% were higher than both CCG and national averages for all standard childhood immunisations. There was a dedicated member of staff who followed up non- attenders to ensure they received another appointment that was convienient to them.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies. Same day appointments were available for children where a parent or carer felt there was an urgent need.
• The practice worked closely with an on-site midwife and health visitor who told us that they had a positive relationship with the practice.
• They provided 6 week mother and baby checks and a contraceptive advice, IUD (coil) fitting and implant service with a female GP with expertise in this area.

Updated 22 September 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. For example;

• They utilised the services of a care co-ordinator to facilitate multi disciplinary meetings with a GP, district nurse, community matron, social services and mental health team to discuss and plan care for vulnerable elderly patients so that referrals could be made to access the most appropriate care quickly. Referrals included the social care team, community physiotherapy, occupational therapy service and falls team.
• The practice had two branch surgeries, predominantly to serve local communities where public transport is limited
• They offered home visits to housebound patients for urgent visits and routine visits, including biannual visits for medication reviews
• The practice provided regular Care Home patient reviews by their usual doctor in addition to urgent visits as needed. They also visited the care home on a monthly basis to conduct a ward round whereby patients ongoing care was discussed, medicines reviewed and discussions with relatives as required.

• They provided a medicines delivery service from their dispensaries to patients unable to collect their own medicines. For those patients who were not eligible for this service but were housebound, very sick or vulnerable, a GP would deliver these to them personally in exceptional circumstances.
• In addition to regular medication reviews, they performed DRUMS (Dispensing Review of Use of Medications) as part of a quality assurance scheme for our dispensing patients over the age or 65 and on three or more medications
• They had engaged with the Unplanned Admissions DES and maintained care plans for 2% of patients with multiple health problems or with frequent admissions, including all local care home residents
• They offered a monthly carers clinic to provide support to identified carers
• They encouraged patients to engage with local groups including a walking club and weekly lunch club.
• They hosted an on-site hearing clinic provided by a local company fortnightly.

Updated 22 September 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. For example;

• The practice was proactive in offering online services for booking appointments and requesting presriptions
• They had recruited an additional health care assistant (HCA) and provided training to support the provision of NHS health checks for patients.
• They provided an on-site phlebotomy service and contributed financially towards a phlebotomy service at the local hospital which offered early opening times from 7.30am each weekday morning for ease of access.
• They provided telephone appointments and call backs when requested during the day.
• They hosted an on-site Citizens Advice clinic monthly
• They provided a travel clinic including Yellow Fever vaccination

Updated 22 September 2016

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

• A total of 88% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was the same as the CCG and national averages.
• The practice offered an annual health check for patients with a serious mental health condition. A total of 93% of patients with a serious mental health condition had a comprehensive care plan documented in their record in the preceding year.This was 1% above the CCG average and 5% above the national average. Exceprion reporting at 26% was 5% higher than the CCG average and 13% higher than the national average.
• 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.
• 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. The practice maintained strong links with their local Care Home where a majority of patients have a dementia related illness, and involved the local Older Adults mental health team and Dementia team where required.
• The practice had recently collaborated with other local practices to obtain funding for a Community Psychiatric Nurse who will provide regular in house clinics soon.

Updated 22 September 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 and those who were housebound or isolated.
• The practice offered longer appointments for patients with a learning disability and 60 minute health checks.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients and utilised the services of a care coordinator to facilitate care and referrals to community sevices and support, including 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 held monthly safeguarding meetings attended by GPs, Macmillan Nurse, Health Visitor, and District Nurses