Riversdale Surgery

Updated 7 July 2016

Riversdale surgery provides primary medical services to approximately 14,000 patients through a General Medical Services (GMS) contract. Services are provided to patients from a single site which occupies purpose built premises in Belper.

The practice is run by a partnership between eight GPs (five male and three female) and there is one salaried GP who is female and a registrar who is male. The practice is a training practice for undergraduate medical students and GP registrars.

The practice has a nurse practitioner, three part-time practice nurses and one part-time health care assistant. The clinical team is supported by a full-time practice manager and a team of administrative, secretarial and reception staff.

The community nursing team who treat patients registered with the practice are based on site.

The registered practice population are predominantly of white British background, and are ranked in the eighth least deprived decile and income deprivation affecting children is about half the national average. The practice has an age profile which is much lower than national averages for babies and children and significantly higher for people over 65 years.

The practice is open from 8am to 6.30pm on Monday to Friday. The consultation times for morning GP appointments start at 8.30am to 11am and afternoon appointments are offered from 2pm until 6pm. The practice sees additional patients at the end of the clinic session if necessary and home visits and telephone consultations are provided throughout the day.

The practice has opted out of providing out-of-hours services to its own patients. This service is provided by Derbyshire health United through the 111 system.

Updated 7 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Riversdale Surgery on 27 April 2016. Overall the practice is rated as good

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were utilised.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example; they had received funding to work with four other practices in the locality on a project to improve outcomes for the older population.
• Feedback from patients about their care was consistently positive.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example; they hosted monthly carers clinics at the practice provided by an external agency.
• The practice had identified areas where they could improve care for patients and had worked proactively and collaboratively to make amendments to their systems and processes and developed new ones.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example; the practice installed handrails to improve disabled access
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with practice staff and was regularly reviewed
• The practice had strong and visible clinical and managerial leadership and robust governance arrangements

We saw an area of outstanding practice:

The practice worked in collaboration with four local practices on a project to drive improvement in care for  older people and reduce emergency admissions from  care homes. This had resulted in an 8% reduction in  emergency admissions in the preceding 12 months.

We saw an area where the provider should make improvements;

• The practice should consider more proactive ways to identify carers on their register.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 July 2016

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

• Patients with a long term condition had a named GP who worked collaboratively with the nursing staff who had lead roles in chronic disease management. They used structured reviews to check their health and medicines needs were being met which were conducted each year or more often where required.

• The practice had received funding for a community pharmacist and an advanced nurse practitioner to manage patients with long term conditions. This was as a result of their participation in a local project. The funding had also enabled district nurses who were based at the practice to receive training in chronic disease management
• The practice provided in-house diagnostic tests, for example spirometry and electro cardiogram (ECG) (Spirometry is a test to check breathing and ECG check the heart rate)

• The practice had achieved 100% of QOF points for heart failure related indicators which was same as the CCG average and 2% above the national average. They had an exception rate of 4% which was better than CCG or national averages.
• They had achieved 97% of QOF points for indicators relating to chronic obstructive pulmonary disease (COPD), which was slightly above CCG and national averages, however, their exception reporting rate for the indicator relating to providing a face to face review for patients diagnosed COPD in the preceding year was 31% which was 15% higher than the CCG average and 20% above the national average. The practice told us that they had included all those patients who were housebound in their exception report for this indicator because they had been unable to conduct a review in the patient’s own home. However, they had acted on this and had recruited an advanced nurse practitioner to conduct these reviews and assist with chronic disease management.
• Longer appointments and home visits were available when needed.
• Appointments for blood tests and medicines reviews were amalgamated into a single appointment where possible using a newly developed computerised system that added new requests to patient’s plans to avoid multiple visits to the practice.

Updated 7 July 2016

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

• There was a dedicated lead GP for child protection working closely with the health visiting and school nursing teams to identify and discuss children at risk.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• Appointments were available outside of school hours and the premises were suitable for children and babies. Same day access was available for children.
• 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.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Health visitors were located at the practice and liaised regularly with GPs and other relevant staff.
• We were told about positive examples of joint working with midwives, health visitors
• The practice provided clinics for contraception and sexual health advice and offered long acting contraception services and emergency contraception
• Minor injuries were treated at the surgery and physiotherapy was available which could be accessed by self-referral.
• Patients with problems relating to alcohol intake could be referred to support services

Updated 7 July 2016

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

• The practice were innovative in developing practice that improved care for older people; for example, they participated in a locally based project to enable collaborative working with other local surgeries to improve community care for patients, especially the frail elderly. This had resulted in a reduction in hospital admissions from care homes from 22% to 10%. This had been achieved during the preceding eight months since the project started.
• The practice offered proactive, personalised care to meet the needs of older people through multi-disciplinary meetings which were led by a care coordinator and included the social care team, community nursing team and mental health team.
• Relevant staff had received training on FEAT (frail and elderly assessment team) which focussed on developing ways to work proactively with the frail and elderly in order to avoid unplanned admissions and to access specialist input locally.
• The practice offered an enhanced service to three care homes and also cared for patients in a further six care homes in their locality as they took the approach that patients were able to choose what care home they wanted to go to and therefore should receive the same high quality care. They conducted monthly ward rounds and made urgent visits where required.
• The practice offered home visits and urgent appointments for those with enhanced needs.
• The practice made use of the intermediate care team based at a local hospital to gain early access to services such as occupational therapy, physiotherapy and the falls clinic.

Updated 7 July 2016

The practice is rated as outstanding 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.

• The practice was proactive in offering online services to book routine appointments and to order repeat prescriptions.
• They offered a full range of health promotion and screening that reflects the needs for this age group.
• Health checks for people over 40 were proactively conducted to assess risk of cardio vascular disease. The practice provided information that demonstrated they were best performing surgery in the locality for this activity.
• A computerised system was implemented to reduce the number of attendances required for blood tests and medicines reviews.

Updated 7 July 2016

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

• 79% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the CCG and national averages.
• The practice carried out advance care planning for patients with dementia and care plans were shared with carers and regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. These were led by a care coordinator who co-ordinated services to ensure patients were able to benefit from the health and care support services available.
• The practice had told patients experiencing poor mental health about how to access 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 7 July 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 homeless people and those with a learning disability.
• The practice offered longer appointments and annual health checks for patients with a learning disability. They were registered as a safe haven for people with a learning disability where they could go if they needed help.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients and told them about how to access various support groups and voluntary organisations.

• 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.
• They hosted monthly carers clinics at the practice and had recently introduced an annual health check for carers.