Castle Street Medical Centre

Updated 30 December 2016

Castle Street Medical Centre provides primary medical services to approximately 3192 patients through a general medical services contract (GMS).

The practice is located in recently extended premises in Bolsover Derbyshire. All facilities are on the ground floor including consulting and treatment rooms. The practice has car parking including parking for patients with a disability.

The level of deprivation within the practice population is below the national average with the practice falling into the 4th most deprived decile. The level of deprivation affecting older people is in line with the local and national average, however the level of deprivation effecting children is above the national average.

The clinical team is comprised of four salaried GPs (two female, two male), two practice nurses, a healthcare assistant and a phlebotomist. The clinical team is supported by a practice manager, reception and administrative staff. The practice is a teaching and a training practice for medical students.

In July 2016 the practice became part of the Derbyshire Community Health Services NHS foundation trust (DCHS) in a strategic step to ensure the future of the practice and centralise some management function.

The surgery is open from 8am to 6.30pm Monday to Friday. Consulting times vary but are usually from 8.30am to 11.30 am each morning and 3.30pm to 6pm each afternoon. Early morning appointments were available on a Monday from 7.30am and an evening session with a GP and HCA was run on a Thursday until 7.30pm.

The practice has opted out of providing out-of-hours services to its own patients. This service is provided by Derbyshire Health United and is accessed via 111.

Updated 30 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Castle Street Medical Centre on 31 October 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety within the practice. Effective systems were in place to report, record and learn from significant events. Learning was shared with staff and external stakeholders where appropriate.

• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• Outcomes for patients were generally above or in line with local and national averages.

• Training was provided for staff which equipped them with the skills, knowledge and experience to deliver effective care and treatment.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Patients told us they were able to get an appointment with a GP when they needed one, with urgent appointments available on the same day.

• Feedback from patients and those close to them was overwhelmingly positive about the care they received and how staff treated them.We were told of several examples where staff had gone the extra mile to deliver care that exceeded their expectations. There was a strong, visible, patient centered culture in the practice and staff were highly motivated and inspired to provide care in a kind manner which promoted education and self-management of long term conditions which always took patients cultural, religious and social needs into account.

• 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 learning from complaints was shared with staff and stakeholders.

• The practice worked closely with the Patients Participation Group (PPG) to maintain an effective line of communication with patients and develop areas of the practice.This had led to several links to community groups and the PPG had developed a guide to the town which was available to residents through the library.

• The practice had good facilities and was well equipped to treat patients and meet their needs. Recent expansion had ensured space was available in which to provide a range of services to patients.

• The practice was a training practice and had retained two trainees once qualified, who had trained within the practice.The practice had identified this as key to good succession planning and was looking at training people from specialties such as pharmacists to encourage them into general practice.

• The recent merger with a trust had been seen by staff as a positive step in securing the future of the practice and allowing further development and closer working with other practices provided by the trust.

• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 December 2016

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

• Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators was 98.9% which was 10% above the CCG average and 9% above the national average. The exception reporting rate for diabetes indicators was in line with local and national averages.

• The practice ran an anticoagulation clinic which included home visits to ensure services were available locally for patients.

• The practice had taken part in a CCG pilot to reduce the admissions of patients with lung disease by issuing nebulisers for home use.

• Longer appointments and home visits were available when needed.

• The practice had effective systems in place to recall patients and staff took every opportunity to encourage screening and reviews.

• All these patients had a named GP and were offered a structured annual review to check their health and medicines needs were being met.

• The practice was involved in the development of advice leaflets to ensure patients had a good level of understanding and were able to increasingly self-manage their conditions.

• For patients with the most complex needs, practice staff worked with relevant health and care professionals to deliver a multidisciplinary package of care. Regular multidisciplinary meetings were hosted by the practice. The practice had a CCG employed care coordinator who monitored and managed care to patients with complex needs and following discharge.

Updated 30 December 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 child safeguarding lead and staff were aware of who they were.

• 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 GP lead for safeguarding liaised with other health and care professionals to discuss children at risk.

• Immunisation rates were relatively high for all standard childhood immunisations and the practice worked with health visitors to follow up children who did not attend for immunisations.

• A baby change room was available and, if required, a private room for breast feeding would be made available.

• The Practice had completed the annual Joint Safeguarding Children and Adults Assurance Framework Self-Assessment for Independent Contractors to ensure effective systems were in place to responded to vulnerable patients and integrated with other agencies.

• The practice worked closely with local schools where possible, and held a healthy eating competition as part of an open day.

• Chlamydia testing kits were available at the entrance to the surgery and contraceptive and sexual health advice appointments were available with the practice nurse.

• Urgent appointments were available on a daily basis to accommodate children who were unwell.

Updated 30 December 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. Regular multidisciplinary meetings were held to review frail patients and care plans reviewed, at a minimum, every six months by the named GP, care coordinator and community staff to identify those at risk of hospital admission and plan and deliver care appropriate to their needs.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. This included home visits in collaboration with community teams, if identified as beneficial for patients, to assist in joint working and reduce appointments.

• The practice worked closely with carers in providing services to patients ensuring appointments were convenient, to both the carer and patient, as well as including them in meetings

• A designated GP visited local care homes and residential homes to allow for regular monitoring of patients.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure were in line with or above local and national averages.

Updated 30 December 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.

• Appointments could be made and cancelled on line as well as management of repeat prescriptions. In addition the practice used the website as a way of gathering patient feedback through surveys.

• GP telephone appointments could be made where appropriate for patients with difficulty attending the practice.

• The practice and PPG were promoting the online services encouraging the availability of appointment s through the website.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group. Uptake rates for screening were above the national average. For example, the uptake rate for cervical cancer screening was 85% compared with the national average of 81%.

The practice offered NHS health checks, new patient checks and hypertension checks during the evening appointments on a Thursday.

Updated 30 December 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 95% which was 1.4% above the CCG average and 2.1% above the national average. The exception reporting rate for mental health related indicators was in line with local and national averages.

• The number of patients with a diagnosis of dementia who had their care reviewed in a face-to-face review in the last 12 months was 94.1% which was 7.5% above the local average and 10.3% above the national average. This was achieved with an exception reporting rate of 8.1%, 0.1% higher than the CCG average and 1.3% above the national average.

• An ‘at risk of dementia’ read code is placed on patients records if appropriate to ensure early diagnosis through opportunistic screening.

• Dementia packs were available for newly diagnosed patients.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The PPG champion dementia care and awareness and regularly publish articles in local magazines on how and where to get support locally.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations including talking therapies.

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

Updated 30 December 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.

• There were longer appointments available with a named clinician for patients with a learning disability. In cases of annual reviews patients with a learning difficulty had access to 45 minute appointments with the nurse followed by a GP appointment.

• Health checks were offered to carers as part of the learning disability review.

• As part of a project in collaboration with Derbyshire County Council and the Police the practice had become a ‘Safe Haven’ for vulnerable people and the reception staff had undertaken training for this.

• Each clinical room had a copy of the Mental Capacity Act poster in addition to regular training for staff.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. Regular multidisciplinary meetings were hosted by the practice. In addition the practice held regular meetings to discuss patients on their palliative care register.

• End of life wishes were shared with the out of hours service and anticipatory drugs placed on the clinical system automatically to aid in palliative care.

• A carers support group met monthly at the practice and provided emotional support and guidance as well as a forum in which to reduce isolation.

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.