Background to this inspection
Updated
31 October 2019
Lime Grove Medical Centre is registered with the Care Quality Commission as a partnership consisting of three GPs and an advanced clinical practitioner. It is registered to carry out the following regulated activities - diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures, and the treatment of disease, disorder or injury.
Lime Grove Medical Centre is a semi-rural practice situated in Matlock, a town in Derbyshire on the south-eastern edge of the Peak District. The practice has a contract with NHS Derby and Derbyshire CCG to provide General Medical Services (GMS) and offers a range of local enhanced services.
The practice has 8,190 registered patients. The age profile is mostly in line with local and national averages but with a higher proportion of older patients. The percentage of people in the 65+ year age group at 24% is above the CCG average of 20.5%, and the national average of 17.3%.
Average life expectancy is 81 years for men and 84 years for women, compared to the national average of 79 and 83 years respectively.
The general practice profile shows that 47% of patients registered at the practice have a long-standing health condition, compared to 54% locally and 51% nationally.
The practice scored seven on the deprivation measurement scale; the deprivation scale goes from one to 10, with one being the most deprived. People living in more deprived areas tend to have greater need for health services.
The National General Practice Profile describes the practice ethnicity as being predominantly white at 98.7% of the registered patients, with 0.7% mixed race, 0.6% Asian, and 0.1% black.
In addition to the three male GP partners, there are five salaried GPs working at the practice (two male GPs and three female GPs). There is a female advanced clinical practitioner who is also a partner. The nursing team consists of three nurse practitioners and two practice nurses, supported by three healthcare assistants. A part-time pharmacist is employed by the practice.
The non-clinical team is led by a practice manager, supported by a reception manager and office manager. There is a team of four administrative and secretarial staff, and nine reception staff. The practice also employs a care coordinator.
The practice opens Monday to Friday until 6.30pm with extended hours opening on Thursday evening from 6.30pm to 8pm. Opening times vary according to the day as the practice opens at 7am on Tuesday and Thursdays, 7.30am on Mondays and Wednesdays, and 8am on Fridays. However, appointments can only be booked from 8am on all days.
The surgery closes on a Wednesday afternoon on most months for staff training. When the practice is closed, out of hours cover for emergencies is provided by Derbyshire Health United (DHU).
Updated
31 October 2019
We carried out an announced focused inspection at Lime Grove Medical Centre on 2 October 2019 as part of our inspection programme.
We carried out an inspection of this service due to the length of time since the last inspection. The previous inspection took place in October 2014 and the report can be found on our website at www.cqc.org.uk. The practice was previously rated as good overall.
Following our annual review of the information available to us, including information provided by the practice, we focused our inspection on the following key questions:
- Effective
- Responsive
- Well-led
Because of the assurance received from our review of information we carried forward the ratings for the following key questions:
We based our judgement of the quality of care at this service on a combination of:
- what we found when we inspected
- information from our ongoing monitoring of data about services and
- information from the provider, patients, the public and other organisations.
We have rated this practice as good overall; the well-led domain was rated as being outstanding. We rated the practice as outstanding for the population groups of older people and mental health, and good for all other population groups.
We found that:
- Patients received effective care and treatment that met their needs.
- The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
We rated the practice as outstanding for providing well-led services because:
- There was evidence of proactive leadership with a commitment to improve outcomes for both patients and staff. The partnership drove continuous improvement and innovation.
- Objectives were stretching, challenging and innovative, whilst remaining achievable. There was a clear and proactive approach to seek out and embed new ways of providing care and treatment.
- A collaborative approach was taken to work with other organisations to improve care outcomes.
- Governance and performance management arrangements were proactively reviewed to reflect best practice.
- Staff were proud of the practice as a place to work and spoke highly of the positive culture. There were high levels of constructive staff engagement, and staff at all levels were actively encouraged to raise concerns.
In addition, we identified the following outstanding features:
- There was an emphasis on quality improvement within the practice. Topics were selected based on identified areas for development, new guidance or a desire to enhance services to patients. We saw that projects were based on recognised guidance and were planned with inbuilt reviews and ongoing staff and patient feedback where appropriate. For example, an appointment and access improvement programme was undertaken in response to access difficulties. In the first six months, the average time to book a routine appointment fell from 22 days to 10, and same day access accounted for 21% of appointment capacity whereas there had been none six months previously. Additionally, there was reduced pressure on telephone triage by 21%.
- The practice had created their own tool called Sortcode to identify older and vulnerable patients based upon an analysis of hospital admissions, Accident and Emergency (A&E) attendances, visits to see patients in their own homes, out of hours contacts, and case management over a defined timescale. Those identified were added to the community matron caseload and were also reviewed by one of the practice’s own nurse practitioners whose role was focused on supporting patients within their own home. The practice was able to demonstrate the impact of this by comparative data for their locality and the CCG. For example:
- out-of-hours activity for 2018-19 showed contacts at 29.9 per 1,000 patients compared to the CCG figure of 46.8
- emergency admission rates from April to October 2019 were 69.7 per 1,000 patients, compared to the locality average of 82.1.
- A&E attendances from April to October 2019 were 127.1 per 1,000 patients compared to the locality average of 160.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care