Archived: Blue Dykes Surgery - Grassmoor

Updated 29 July 2016

The provider Blue Dykes Surgery has two separate locations registered with the Care Quality Commission. We inspected both locations on the same day and most staff worked at both surgeries.

Blue Dykes Surgery - Grassmoor provides care to 1719 patients through a primary medical care services (PMS) contract commissioned by NHS England and Hardwick Clinical Commissioning Group (CCG). The practice operates from a purpose-built building, in the town of Grassmoor, Chesterfield.

The level of deprivation within the practice population is above the national average. The practice is in the fourth most deprived decile meaning that it has a higher proportion of people living there who are classed as deprived than most areas.

The practice team comprises of two GP partners (one male and one female), a salaried female GP (currently on maternity leave until November 2016) and a range of clinical staff including:

• Two pharmacists

• Four advanced nurse practitioners

• A lead mental health nurse, also qualified as a community psychiatric nurse

• Six practice nurses and a health care assistant

The clinical team is supported by a care coordinator, practice manager, an assistant practice manager and a team of reception and administrative staff.

The practice is open between 8am and 6.30pm on Monday and Friday; 1pm to 6.30pm on a Tuesday and 8am to 1pm on Wednesday and Thursday.

• GP appointments are available on Monday (8am to 12pm), Tuesday (2.30pm to 6.30pm) and Friday (2.30pm to 6.30pm) only; although patients had access to GP appointments at Clay Cross surgery on Wednesday and Thursday.

• Patients also had access to daily appointments with a treatment room nurse, ANP, CPN and healthcare assistant.

The practice has opted out of providing out-of-hours services to its own patients. When the practice is closed patients are directed to Derbyshire Health United (DHU) via the 111 service.  

Updated 29 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Blue Dykes Surgery – Grassmoor on 8 June 2016. Overall the practice is rated as good.

• We inspected the practice at a time when arrangements were in place to work in partnership with the Royal Primary Care from July 2016 to improve the sustainability of the practice and access to GP appointments.

• The practice had an open and transparent approach to safety and an effective system in place for reporting, recording and analysing significant events. Learning was shared widely across all staffing groups.

• Risks to patients were assessed and well managed. This included recruitment checks and procedures for managing medical emergencies.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. The care needs of patients with complex health conditions and / or living in vulnerable circumstances was planned and co-ordinated in collaboration with other health and social care professionals to ensure their safety.

• Patients had access to two GP partners and clinical staff with a wide range of skills, experience and expertise. This included the practice employed community psychiatric nurse, pharmacists, advanced nurse practitioners and practice nurses.

• The practice had an effective programme in place for undertaking clinical audits and we saw evidence of audits driving improvements to patient outcomes.

• Patients were positive about their interactions with staff. They said they were treated with compassion and dignity; and were involved in decisions about their care and treatment.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• Patients told us that access to GP appointments could sometimes be difficult and this was reflected in the results from the national GP patient survey.

• Plans were in place to strengthen the overarching governance arrangements and increase the capacity of clinical leadership. This was to ensure better oversight of the practice’s performance, delivery of services and professional development for clinical staff.

• The system in place for monitoring staff training needed to be strengthened to ensure staff were up to date with their mandatory and refresher training in line with the provider’s procedures.

• Improvements were made to the quality of care as a result of complaints and concerns. All staff were involved in reviewing complaints to identify learning and key themes were also shared with the patient participation group (PPG).

• 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.

However there were areas where improvements should be made:

• Ensure an effective system is in place for monitoring staff training to assure the provider that all staff have completed mandatory and refresher training relevant to their roles.

• Ensure patient experience data (including access to appointments) continues to be reviewed, monitored and acted upon to continually drive service improvement.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 29 July 2016

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

• Nursing staff had lead roles in chronic disease management and data showed the practice performed in line with local and national averages for its management of long term conditions.

• All these patients had a named GP and an annual review was offered to check their health and medicines needs were being met. For those patients with the most complex needs, the named clinician worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• Patients had access to a pharmacist (employed by the practice and CCG) to discuss and review their medicines and ensure their prescription remained appropriate.

• Patients at risk of hospital admission were identified as a priority and regular multidisciplinary meetings were held at the practice to review their care.

• A dedicated member of staff (care coordinator) monitored the support in place for these patients in liaison with the clinical team and other health and social care professionals.

• There were longer appointments and home visits available for patients who had clinical needs which resulted in difficulty attending the practice. For example, some patients taking anti-coagulant medicines were monitored at home by the practice nurses.

Updated 29 July 2016

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

• Childhood immunisation rates were high and comparable to the local averages. For example, vaccination rates for children aged five ranged from 81.8% to 100%, compared to a local average of between 96.2% and 99.6%.

• The practice facilitated monthly meetings with the health visitors to identify and follow-up children living in disadvantaged circumstances, at risk of abuse or deteriorating health.

• The premises were suitable for families, children and young people. For example, the practice had baby changing facilities and a private room was available to mothers who wished to breastfeed onsite.

• GP appointments were limited to three days a week at the practice and some appointments were available outside of school hours. However, parents could access GP appointments for their children on other days at the provider’s Clay Cross surgery. Staff told us same day appointments were available for unwell children.

Updated 29 July 2016

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

• All patients aged 75 years and over had a named GP.

• Influenza, pneumococcal and shingles vaccinations were offered (where necessary) in accordance with national guidance.

• Nationally reported data showed the outcomes of conditions commonly found in older people were mostly comparable to the local and national averages.

• The practice held regular multi-disciplinary meetings to discuss the most vulnerable patients and those with complex care needs. This facilitated effective planning and co-ordination of care to meet the individual needs of patients and also helped to reduce the number of unnecessary hospital admissions.

• The practice provided primary medical services to a local care home for older people. A named nurse or GP attended to the residents care needs and visited at least weekly.

• The practice employed a pharmacist and community psychiatric nurse who carried out home visits for patients that required a review of their medicines or mental health needs.

Updated 29 July 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The main area of concern for patients related to availability of GP appointments at the practice as this was only available three days a week (Monday morning, Tuesday and Friday afternoon). However, patients could also access additional GP appointments from Clay Cross Surgery on the other two days. Patient feedback showed this was not always convenient for some patients.

There were, however, examples of good practice.

• The practice offered NHS health checks for patients aged 40 to 74 and a range of health promotion advice related to diet, smoking and alcohol intake

• Patients had access to national cancer screening programmes; and data showed the uptake rate was comparable to the local and national averages. For example, 55% of patients aged 60 to 69 had been screened for bowel cancer within six months of invitation against a local average of 57% and national average of 55%.

• Patients could book appointments and order repeat prescriptions online.

• Treatment room services were available to patients and they had access to advanced nurse practitioners with particular skills in minor illness, ear conditions and musculoskeletal problems.

• Telephone consultations were offered in addition to extended hour’s services on a Wednesday or Thursday for pre-booked routine appointments at Clay Cross Surgery only

Updated 29 July 2016

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

Benchmarking data for 2014/15 showed:

• 100% of patients with a diagnosed mental health need had a care plan documented in the last 12 months which was above the local average of 91% and national average of 88%. This was achieved with an exception reporting rate of 30% and this was 13.6% above the CCG and 17.4. % above the national average.

• 100% of people diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months which was above the local average of 87% and national average of 85%. This was achieved with an exception reporting rate of 12.5% and this was 2% above the CCG and 4.2% above the national average.

• Patients experiencing poor mental health could access appointments with the practice employed community psychiatric nurse (CPN). The CPN took a lead role in the review and management of these patients to ensure they received coordinated support in the community where possible. Patients were also signposted to various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

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

Updated 29 July 2016

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

• The practice offered longer appointments and annual health checks for patients with a learning disability.

• The practice worked closely with other health care professionals in the case management of vulnerable patients. For example, patients receiving end of life / palliative care were reviewed as part of weekly multi-disciplinary meetings attended by social services, district nurses, a representative from the mental health team and the community matron.

• The practice employed a care coordinator who worked closely with the community matron to ensure patients received appropriate support when needed. For example, ongoing care following an acute relapse, hospital discharge or long term complex conditions.

• The premises were easily accessible for patients with poor mobility or a disability.

• Staff we spoke with knew how to recognise signs of abuse and safeguard patients. Following our inspection, all staff had completed adult and child safeguarding training.

• The practice provided personalised care to carers and this included health checks and signposting to various support groups and voluntary organisations.