Letter from the Chief Inspector of General Practice

NEMS Platform One was initially inspected on 30 June 2015 under the provider’s previous registration; NEMS Healthcare Ltd. The overall rating was outstanding. In 2016 the provider’s legal entity changed from NEMS Healthcare Ltd to NEMS Community Benefit Services Limited, requiring the provider to re-register, which is considered a new registration.

In view of the above changes we carried out an announced comprehensive inspection at NEMS Platform One on 28 July 2017. Overall the practice is rated as outstanding.

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

• The practice was commissioned with the aim of engaging with hard to reach groups. The patient population was very diverse and included a high number of people who were vulnerable or had complex needs. It also had a high transient population.

• The staff team understood their patient population well and offered a wide range of services to meet patients’ needs and enable them to be treated locally. They were extremely responsive in engaging with vulnerable and hard to reach groups, to improve their welfare and reduce health inequalities.

• Feedback from patients about their care and the way staff treated them was consistently positive.

• Comprehensive systems were in place to place to protect patients from abuse and avoidable harm. Staff understood and fulfilled their responsibilities to raise concerns and report incidents. Opportunities for learning from incidents were maximised.

• The triage and appointment system was flexible and responsive; the staff team were continually reviewing this to meet patients' needs.
• The practice had undergone considerable changes and adopted alternative ways of working to ensure the services were effective. For example, the management of medicines had been strengthened following the appointment of two clinical pharmacists to the staff team.
• The practice team were forward thinking and part of local pilot schemes to improve outcomes for patients.
• The practice had effective clinical and managerial leadership and governance arrangements, which put patient safety and welfare at the heart of what they did. The culture and leadership promoted the delivery of high-quality, compassionate care.
• The premises were designed to meet the patient population, and were well equipped to treat patients and meet their needs.
• The practice actively sought feedback from staff and patients, which it acted on to improve the services. Information about how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.

We saw several areas of outstanding practice:

• To meet patients’ needs the practice provided several key services that were additional to the provider’s contract and performance requirements. For example, 24% of patients had a mental illness, many of who had complex needs. The practice had developed its own primary care mental health services, which included a lead GP and two nurses, one of which was a prescriber. This offered a broad range of services and enabled patients to be treated locally, and reduced the need for them to attend various other services. It also provided personal support and timely intervention to ensure that patients received appropriate care, reducing referrals to secondary services.  

• The practice registered 350 homeless people; some of whom were reluctant to attend main stream health services. To enable more people to access primary care services, the practice had established a weekly GP drop in clinic at one of the main day centres in Nottingham in partnership with the homeless team. The 

  clinic had been running since June 2017 and

  was available to anyone attending the centre. The service was enabling people alternative access to healthcare. On average the GP saw 4 patients a week and provided advice to around 3 people a week. 60% of patients were registered with the practice, 30% registered as a temporary patient and 10% registered permanently. 

• In response to the high numbers of patients who had a substance misuse diagnosis, the GP lead for substance misuse held a weekly shared care clinic at both practices with a specialist drug worker from the central recovery team. The branch clinic was also available to patients from other practices and offered evening appointments to support people who worked. The flexible service enabled people to be treated locally and provided timely access to treatment. It also provided holistic care helping patients towards recovery and reducing harm from substance misuse. One of the practice pharmacist's was being mentored to set up prescription medicine misuse clinics with the support of the GPs, which will offer support to patients at other times of the week.

The provider should make the following improvements:

• Identify further patients who are carers and direct them to support available to enable them to carry out their role.

• Ensure that information available at the practice relating to the translation service and UK health services is accessible to non-English speaking patients in different languages.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice