Rise Park Surgery

Updated 5 October 2016

Rise Park Surgery, provides primary medical services to approximately 7100 patients through a general medical services contract (GMS), this is a nationally agreed contract with NHS England.

Services were provided from a surgery located in purpose built premises in the heart of Rise Park, a suburb of Nottingham, at Off Revelstoke Way, Rise Park, Nottingham, NG5 5EB. The main surgery has car parking, parking for the disabled and is accessible by public transport. All consulting rooms are on the ground floor.

The practice age profile has a higher number of patients aged over 65. For example, 19% of the practice population are aged 65 and above, compared to the CCG average of 11%, and the national average of 17%.The level of deprivation within the practice population is in line with the national average. Income deprivation affecting children is below the local average but above the national average and the level effecting older people is below both the local and national averages.

The clinical team comprises of four GP partners (one male and three female), two salaried GPs, two practice nurses, a health care assistant and phlebotomy staff. The clinical team is supported by a business manager, a patient services manager, and a range of reception and administrative staff.

The practice is an accredited training practice for GP registrars and teaching practice for first, second and fifth year medical students on clinical attachments. At the time of the inspection there was one GP registrar and one GP fellow working in the practice. (A GP registrar is a qualified doctor who is training to become a GP through a period of working and training in a practice).

The surgery opens from 8.30am to 6.30pm on Monday to Friday. In addition the practice opens at 7am on a Thursday for early appointments and remains open until 7.30pm on a Tuesday. Normal consulting times are from 8.30am to 12pm and from 3.30pm to 6pm Monday to Friday.

The practice has opted out of providing out-of-hours services to its own patients. This service is provided by Nottingham Emergency Medical Services (NEMS).

Updated 5 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rise Park Surgery on 9 August 2016. Overall the practice is rated as good.

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

• The practice demonstrated an open and transparent approach to safety. There were systems in place to enable staff to report and record significant events. Learning from significant events was shared with relevant staff.

• Risks to patients were assessed and well managed. There were arrangements in place to review risks on an ongoing basis to ensure patients and staff were kept safe.
• Staff delivered care and treatment in line with evidence based guidance and local guidelines. Training was 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.
• 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.
• Regular clinical audits were undertaken within the practice to drive improvement.
• 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 and patients’ who had complained were kept informed of changes and involved in the process throughout.

• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.

• The practice had good facilities and was well equipped to treat patients and meet their needs. The premises had been updated to ensure they were suitable for patients with a disability.
• There was a clear leadership structure which all staff were aware of. 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.
• The provider was aware of and complied with the requirements of the duty of candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 October 2016

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

• Clinical staff had lead roles in managing patients with long-term conditions and those patients identified as being at risk of admission to hospital were identified as a priority.

• Performance for chronic kidney disease was 100% which was 4% above the CCG average and 5% above the national average. The exception reporting rate for chronic kidney disease related indicators was 9% which was slightly above the CCG average of 8% and the national average of 8%.

• The practice hosted clinics to support patients with a diagnosis of diabetes, those at risk of falls and the stop smoking service.

• Chronic condition reviews were carried out in the patient’s home when required. Longer appointments and home visits were available when needed to facilitate access for these patients.

• Patients with chronic health needs who do not fall into a QOF category were reviewed annually through the medicines recall system.

• For patients with more complex needs, GPs worked with relevant health and social care professionals to deliver a multidisciplinary package of care. The practice worked closely with the community care coordinator to ensure support was in place for patients who required it.

Updated 5 October 2016

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

• Systems were in place to identify children at risk. The practice had a dedicated child safeguarding lead and staff were aware of who these were.

• We saw positive examples of joint working with midwives, health visitors and school nurses with regular meetings being held to discuss children at risk. For example the health visitors hosted a clinic every Tuesday afternoon and often referred directly to GPs to ensure care provided was convenient and prompt for children and their parents.

• Extended hours appointments were offered one morning and one evening a week, to ensure appointments were available outside of school hours.

• A full range of contraception services were available including coil fitting and contraceptive implants.

• Vaccination rates for childhood immunisations were above local averages. For example, rates for the vaccinations given to under two year olds averaged 95.4% compared to the CCG average of 93.1%.

Updated 5 October 2016

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

• Personalised care was offered by the practice to meet the needs of its older population. The practice was responsive to the needs of older people, and offered same day triage, home visits and urgent appointments for those with enhanced needs.

• The practice had always had a personalised list system in place and once patients reach 75 a letter was sent confirming who their named GP was to aid in enquiries, prescriptions and oversight of their care.

• Longer appointments were provided for older people as required.

• The practice worked closely with community teams and charities to ensure there was good provision of care and support was in place when needed.

Updated 5 October 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 offered services which were accessible and flexible. For example extended hours appointments were offered one morning a week from 7am to 8am and one evening a week till 7.30pm to facilitate access for working patients. Appointments were also available with nurses, phlebotomist and healthcare assistants as well as GPs during extended hours

• The practice offered online services including appointment booking and online prescription services.

• A range of health promotion and screening services were offered and promoted that reflected the needs of this age group.

• The practice’s uptake for the cervical screening programme was 87.2%, which was above the CCG average of 81% and the national average of 82%.

• A range of services were offered at the practice to facilitate patient access including minor surgery and joint injections.

• Text messaging was used to confirm appointments and issue reminders.

Updated 5 October 2016

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

• Performance for mental health related indicators was 100% which was 11% above the CCG average and 7% above the national average. The exception reporting rate for mental health related indicators was 14% which was slightly above the CCG average of 11% and the national average of 11%.

• The practice had identified that communication between agencies was key to providing effective care to patients with post-natal depression. They actively screened patients at all stages of pregnancy, communicated with midwives and health visitors and continued support post-natally in conjunction with other agencies when appropriate.

• Monthly multidisciplinary meetings were held within the practice to ensure the needs of vulnerable patients were being met.

• The practice had a system in place to follow up patients who had attended A&E who may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 5 October 2016

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

• The practice offered longer appointments for patients with a learning disability where required.

• Patients on the learning disability register were actively monitored and recalled for an annual review.This appointment was initially with a HCA for physical assessment and then a GP for review.

• All staff had received domestic violence training from ‘Identify and Referral to Improve Service’ (IRIS).

• Information was available which informed vulnerable patients about how to access local and national support groups and voluntary organisations.

• Translation services were provided where these were required and various pieces of information and signage were available in more than one language.

• In order to effectively support vulnerable patients, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care. This included social support for concerns around loneliness and financial issues.

• 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.