Royal Primary Care Chesterfield West

Updated 20 July 2022

Royal Primary Care Chesterfield West is located in Chesterfield, Derbyshire at:

Ashgate Road

Chesterfield

S40 4AA

The practice has two branch practices:

Royal Primary Care Holme Hall

Wardgate Way

Chesterfield

S40 4SL

Royal Primary Care Old Whittington

High Street

Old Whittington

Chesterfield

S41 9JZ

We visited all three sites as part of our inspection.

The practice is part of Royal Primary Care which operates as the Division of Primary Care for Chesterfield Royal Hospital NHS Foundation Trust. The Trust is registered with the CQC to carry out a range of regulated activities which includes those regulated activities we would usually expect to see for primary care providers: diagnostic and screening procedures, maternity and midwifery services, family planning, treatment of disease, disorder or injury and surgical procedures. These are delivered from all practice sites.

The practice offers services from both a main practice and two branch practices. Patients can access services at all three practices.

The practice is situated within the NHS Derby and Derbyshire Clinical Commissioning Group (CCG) and delivers Personal Medical Services (PMS) to a patient population of approximately 13,538. This is part of a contract held with NHS England. The practice is part of Chesterfield and Dronfield Primary Care Network (PCN), a wider network of 12 GP practices that work collaboratively to deliver primary care services.

Information published by Public Health England shows that deprivation within the practice population group is in the fifth decile (five of 10). The lower the decile, the more deprived the practice population is relative to others.

According to the latest available data, the ethnic make-up of the practice area is, 96.5% White, 1.5% Asian, 0.8% Black and 1.1% Mixed.

The age distribution of the practice population demonstrates a higher proportion of older patients, and lower numbers of younger patients compared to local and national averages:

• The percentage of older people registered with the practice is 21% which is comparable with the CCG average of 20.4% however, above the national average of 17.7%.
• The percentage of young people registered with the practice is 16.8% which is below the CCG average of 19.4% and the national average of 20%.

There is a team of seven GPs who provide cover at the practices. The practice has a team of four practice nurses, three health care assistants, two advanced nurse practitioners, a primary first contact paramedic, a mental health practitioner, a phlebotomist, a clinical pharmacist and a pharmacy technician. The clinical team are supported at the practices by a team of reception and administration staff. The practice team is supported by a sector clinical lead, sector lead nurse and deputy practice manager. They are supported by the wider senior management team including the practice operations manager, business manager and quality improvement manager.

The main practice is open between 8am to 6.30pm Monday to Friday. Opening times at the branch practices vary. The practice offers a range of appointment types including book on the day, telephone consultations and advance appointments.

Extended access is provided locally by Chesterfield and Dronfield PCN, where late evening and weekend appointments are available. Out of hours services are provided by Derbyshire Health United.

Updated 20 July 2022

We carried out an announced inspection at Royal Primary Care Chesterfield West on 4 and 5 July 2022. Overall, the practice is rated as good and good in the key questions safe, effective, caring and well-led. We rated the practice as requires improvement for providing a responsive service.

This was the first inspection of Royal Primary Care Chesterfield West since it registered with the CQC on 30 October 2020.

Why we carried out this inspection.

This inspection was a comprehensive inspection and included the key questions safe, effective, caring , responsive and well-led.

How we carried out the inspection

Throughout the pandemic the CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

• Conducting staff interviews using video conferencing
• Completing clinical searches on the practice’s patient records system and discussing findings with the provider on 30 June 2022.
• Reviewing patient records to identify issues and clarify actions taken by the provider
• Requesting evidence from the provider
• A short site visit

Our findings

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.

We found that:

• The practice had systems in place to provide care in a way that kept patients safe and protected them from avoidable harm. However, some of the systems were not always fully embedded into practice. For example, adding alerts to the records of all family members of children with a known safeguarding concern; documenting that counselling had been offered to patients on the risks of two medicines that could potentially cause abnormal fetal development in women of child bearing age; having oversight of all staff immunisation records.
• Patients received effective care and treatment that met their needs.
• The practice offered in house services to provide faster access to care and treatment and potentially reduce the burden on secondary care. For example, a pain clinic and a dedicated mental health team.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice had adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic.
• The practice was aware of the challenges for patients trying to access appointments. In response to this they had recently introduced new systems to support patients and had plans in place to review the effectiveness of this change.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

However, we rated the practice as requires improvement for responsive. This was because:

• Patient satisfaction with access to appointments in the national patient survey was significantly below the national average. This was supported by a large number of patient complaints received by the CQC.

Whilst we found no breaches of regulations, the provider should:

• Add alerts to all the records of family members living in the same household as children with a known safeguarding concern.
• Embed into practice clinical supervision of non-clinical prescribers.
• Clearly document that patients of child-bearing age, prescribed two medicines that could potentially cause abnormal fetal development, have been informed of potential risks.
• Have oversight of the two systems used to monitor staff immunisation status.
• Monitor the impact of new initiatives to improve access to appointments for patients and act on those findings.

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