Goyt Valley Medical & Dental Practice

Updated 9 November 2016

Goyt Valley Medical Practice provides care to approximately 8,200 patients in the High Peak area of North Derbyshire.

We visited the main site in Whaley Bridge for our inspection. There is also a branch site at Eccles Road, Chapel-en-le-Frith, High Peak, Derbyshire. SK23 9EQ.

The practice provides primary care medical services via a Personal Medical Services (PMS) contract commissioned by NHS England and North Derbyshire Clinical Commissioning Group (CCG). The site at Whaley Bridge operates from a purpose built two-storey building constructed approximately 30 years ago, and this was extended in 2006 to accommodate a dental service. All patient services are provided on the ground floor of the building, whilst the upper floor is utilised for administration.

The practice is run by a partnership of two GPs (one male and one female) who employ a full-time female salaried GP. This GP will shortly be joining the partnership.

The nursing team consists of two nurse practitioners, two practice nurses and two health care assistants. The practice directly employ a mental health support worker. The clinical team is supported by a practice manager, an administrator, a care co-ordinator, and a team of 15 administrative and reception staff.

A community pharmacist has been working in the practice since August 2016. This role has been initially funded as part of a national pilot project to provide pharmacy input within GP practices.

The registered patient population are predominantly of white British background with an age profile which is generally consistent with local averages, but has higher numbers of older people compared to the national average. The practice is ranked in the second least deprived decile and whilst situated in an area of relatively high affluence, it also serves an area with a prevalence of some industrial-related illnesses. The practice population includes commuters who work in nearby areas including Manchester, and a number of families from the farming community.

The practice’s main site opens daily from 8am until 6.30pm, with additional extended hours being provided each Tuesday evening when the practice is open until 7.30pm. The branch site in Chapel-en-le-Frith opens every morning, and until 5pm each Monday, Wednesday and Friday afternoon. The practice closes on one Wednesday afternoon each month for staff training.

GP consultations commence each morning from approximately 8.30am to 11.30am. Afternoon GP surgeries usually run between 2.15pm until approximately 6pm. The last GP appointment during extended hours on Tuesday evenings is available at 7.15pm.

The practice has opted out of providing out-of-hours services for its own patients. When the practice is closed, patients with urgent needs are directed via the 111 service to a locally based out-of-hours and walk-in urgent care centre in New Mills, operated by Derbyshire Health United (DHU). Patients also have access to a minor injuries unit in nearby Buxton. The closest Accident and Emergency (A&E) units are based in Macclesfield and Stockport.

Updated 9 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Goyt Valley Medical Practice on 20 September 2016. Overall, the practice is rated as outstanding.

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

• Patients overwhelmingly told us they received excellent care and were treated with compassion, dignity and respect. They also said they were involved in their care and decisions about their treatment. This was corroborated bythe outcomes of the latest national GP patient survey, friends and family test results, and CQC comment cards.
• There was an effective system in place for the reporting and recording of significant events. Learning was applied from events to enhance the delivery of safe care to patients.
• Clinicians kept themselves updated on new and revised guidance and discussed this at clinical meetings. Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Feedback from patients we spoke with on the day, and from CQC comment cards, demonstrated that people had excellent access to GP appointments.
• We saw evidence of an active programme of clinical audit that reviewed care and ensured actions were implemented to enhance outcomes for patients.
• The practice planned and co-ordinated patient care with the wider health and social care multi-disciplinary team to deliver effective and responsive care and keep vulnerable patients safe. Regular meetings took place to discuss and review patients’ needs.
• The practice had an appraisal system in place and supported staff training and development. The practice team had the skills, knowledge and experience to deliver high quality care and treatment.
• Longer appointments were available for those patients with more complex needs, and there was greater flexibility in offering appointments for vulnerable patients such as those with a learning disability.
• The practice had good facilities and was well-equipped to treat patients and meet their needs. The premises were accessible for patients with impaired mobility.
• There was a clear leadership structure in place and the practice had a governance framework which supported the delivery of good quality care. Regular practice meetings occurred, and staff said they felt valued and that GPs and managers were approachable and always had time to talk with them.
• The partnership had a clear vision for the future of the service, and were engaged with their Clinical Commissioning Group (CCG) in order to progress this.
• The practice had an open and transparent approach when dealing with complaints. Information about how to complain was available, and improvements were made to the quality of care as a result of any complaints received.
• The practice patient participation group (PPG) was active and helped to champion the patient voice to influence developments within the practice.

We saw the following areas of outstanding practice:

• The nurse practitioners provided on-the-day assessment and care for patients presenting with new and acute conditions, and minor illnesses. They undertook home visits and one provided regular input at a local care home for patients with dementia. This alleviated pressure on GPs allowing them more time for complex consultations and produced positive outcomes for patients. For example, input to the care home demonstrated effectiveness through the reduction in contacts with the out of hours’ service and hospital admissions. Over a 12 month period, hospital admissions fell from 67 to 43, and contact with the out of hours’ service reduced from 23 to 17 patients. There was also a decrease in falls at the home from 56 between January to March 2014, to 24 in the corresponding period the following year.
• The practice directly employed a mental health support worker. Data for emergency admissions for mental health over a three year period showed low figures for the practice. These were the lowest within their locality and one of the lowest within their CCG. The practice were able to provide evidence that over the last two years, only four of 22 patients at high risk of hospitalisation had been admitted, with two of the admissions being outside of the practice’s direct control.
• The practice demonstrated a responsive approach by taking account of the needs of their local population, and not just their registered patients. This enabled services to be delivered closer to patient’s homes.

The areas where the provider should make improvement are:

• Review the need to take emergency medicines on home visits, or consider a risk assessment to be completed for this.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 November 2016

The practice is rated as outstanding for providing responsive and well-led services. The impact of this affected the quality of services provided to all patient groups and this led to an outstanding rating for all population groups.

• The practice undertook annual reviews for patients on their long-term conditions registers, including a review of their prescribed medicines.
• QOF achievements for clinical indicators were generally in line with CCG averages, and above national averages. For example, the practice achieved 96.8% for diabetes related indicators, in comparison to local and national averages of 96.7% and 89.2% respectively.
• A GP with a special interest in diabetes attended the practice each month to review patients with complex needs. In addition, a specialist diabetes nurse attended the practice bi- monthly to undertake a joint clinic with the practice nurse to assist with the management of other complex patients with diabetes. This process had helped to upskill the practice’s nursing team in treating patients with diabetes. Performance data demonstrated the effectiveness of care including lower referrals to secondary care.
• The practice funded a specialist respiratory nurse to provide two days of clinical input each month. This nurse saw complex patients with breathing problems with the practice nurse. This provided additional expertise as well as providing a training development opportunity for the nursing team.
• The recall system was co-ordinated by the administration team, and we saw data that showed that patients received regular reviews of their condition including their prescribed medicines.
• Patients with multiple conditions were usually reviewed in one appointment to avoid them having to make several visits to the practice.
• There was a lead designated GP or nurse for the clinical domains within QOF.

Updated 9 November 2016

The practice is rated as outstanding for providing responsive and well-led services. The impact of this affected the quality of services provided to all patient groups and this led to an outstanding rating for all population groups.

• Same day rapid access was provided for babies or children who were ill.
• The midwife held a weekly ante-natal clinic and saw new mothers for a post-natal review at the practice.
• Childhood immunisation rates were in line with local averages. Rates for the vaccinations given to children up to five years of age ranged from 94.1% to 100% (local averages 95.2% to 99.1%).
• The practice had an identified lead GP for child safeguarding. The health visitor attended the practice multi-disciplinary team meetings on a monthly basis to review and discuss any child safeguarding concerns. Child protection alerts were used on the clinical system to ensure clinicians were able to actively monitor any concerns.
• Family planning services were provided on site. A clinic was held weekly between 5-6pm to enable better access for patients.
• The practice had baby changing facilities, and a small play area was available for children. The practice welcomed mothers who wished to breastfeed on site, and offered a private room to facilitate this if requested.

Updated 9 November 2016

The practice is rated as outstanding for providing responsive and well-led services. The impact of this affected the quality of services provided to all patient groups and this led to an outstanding rating for all population groups.

• The practice directly employed their own care co-ordinator to facilitate the planning of care for patients being discharged from hospital, or to provide support to help patients remain in their own home.

• The needs of older people with more complex needs were reviewed via weekly care co-ordinator meetings and a monthly multi-disciplinary team meeting.
• Patients requiring support from clinical services such as physiotherapy were referred through a single point of access to ensure they received the individual care they needed.
• Longer appointment times could be arranged for patients with complex care needs at the request of the GP, or if reception staff knew patients might require additional time, they were booked in towards the end of the consulting session. Home visits were provided for those unable to attend the surgery.
• Due to the semi-rural location of the practice, transport links could be problematic for some patients. However, access to a local voluntary transport scheme provided patients with an opportunity to get to and from the practice more easily. Patients had to pay for fuel costs only.
• Uptake of the flu vaccination for patients aged over 65 was 72.8%, which was in line with local (73.9%) and national (70.5%) averages. 

Updated 9 November 2016

The practice is rated as outstanding for providing responsive and well-led services. The impact of this affected the quality of services provided to all patient groups and this led to an outstanding rating for all population groups.

• The practice had identified that a large proportion of their patients were commuters, and designed access to accommodate this. This was facilitated by a system of triage, extended hours sessions, and telephone consultations. For example, the practice offered extended hours consultations each Tuesday evening to enable improved access for working patients.
• The practice offered on-line booking for appointments and requests for repeat prescriptions. The practice provided electronic prescribing so that patients on repeat medicines could collect them directly from their preferred pharmacy.
• The practice promoted health screening programmes to keep patients safe. NHS health checks were available.

Updated 9 November 2016

The practice is rated as outstanding for providing responsive and well-led services. The impact of this affected the quality of services provided to all patient groups and this led to an outstanding rating for all population groups.

• The practice directly employed a mental health support worker to provide social and mental health care and support for patients with poor mental health, including patients in their own home and within a local care home. The support worker could accompany patients to attend appointments to reduce their anxiety, and help with tasks such as completing forms to enable them to receive support for their condition. Data demonstrated the practice had the lowest rate of emergency admissions for mental health in the locality, and amongst the lowest across the CCG area.
• A nurse practitioner visited a care home specialising in dementia care twice each week. This care was supported up by named GPs, the mental health support worker, and the practice pharmacist. We were provided with examples of excellent patient care such as supporting patients and staff to enable a patient to have a dignified death within their care home setting. The impact of the nurse’s input was supported by data showing reduced hospital admissions and access to out of hours care.
• The practice achieved 97.7% for mental health related indicators in QOF, which was 0.4% below the CCG and 4.9% above the national averages. Exception reporting rates for mental health related indicators were generally slightly higher than local and national rates.
• 89.1% of patients with severe and enduring mental health problems had a comprehensive care plan documented in the preceding 12 months according to 2014-15 QOF data. This was slightly below the CCG average and marginally above the national average of 88.5%.
• There was access to counselling and associated talking therapies’ services on site for one-and-a-half days each week. Patients could self-refer to this service as well as being referred by the GP.
• A psychiatrist saw complex mental health patients at the practice once a month. A community psychiatric nurse also attended these sessions.
• The practice worked with local community mental health teams and representatives regularly attended the multi-disciplinary team meetings.
• 74% of people diagnosed with dementia had had their care reviewed in a face-to-face meeting in the last 12 months. This was below local and national averages by approximately 10%. Exception reporting rates were lower at 5.6%, compared to the local and national averages of 8.8% and 8.3% respectively.
• Staff had received dementia awareness training from the Alzheimer’s Society at a team meeting. The practice had plans to develop dementia friends training in the future. 

Updated 9 November 2016

The practice is rated as outstanding for providing responsive and well-led services. The impact of this affected the quality of services provided to all patient groups and this led to an outstanding rating for all population groups.

• Patients with end-of-life care needs were reviewed at monthly multi-disciplinary team meetings. The practice worked closely with the district nursing team to deliver responsive and caring treatment and support to patients and their families.
• The practice proactively referred patients to the ‘Wrap-around Care Project’. This provided a point of first contact to access the voluntary sector within the locality. Services available included befriending, transport and shopping with the aim of keeping people independent in their own homes, or to regain confidence following a hospital discharge. The practice kept these patients under regular review to ensure their needs were being met.
• Staff had received adult safeguarding training and were aware how to report any concerns relating to vulnerable patients. There was a designated lead GP for adult safeguarding.
• The practice had undertaken an annual health review in the last 12 months for 50% of patients with a learning disability. The practice used symbols and pictures within letters to enable better understanding for patients with a learning disability.
• Travellers who resided on boats and barges at a nearby canal were able to register with the practice to ensure they had access to health care services.