This practice is rated as Good overall. (Previous rating November 2017 – Requires improvement)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at St Thomas Road Surgery on 4 December 2018. This inspection was planned and undertaken as part of our inspection programme and as part of a wider inspection of the provider (One Medicare Ltd). The provider had agreed to contribute to our Primary Care at Scale project.

At this inspection we found:

• Effective systems were in place to promote adult and child safeguarding.
• Safety checks of equipment and the premises were taking place.
• The premises were clean and infection control guidance was being followed.
• Medicines were safely managed.
• There was a backlog of medical records that required summarising.
• The practice team reviewed significant events to learn and share best practice.
• The practice ensured that care and treatment was delivered according to evidence-based guidelines.
• The practice had systems in place to improve performance in the Quality and Outcomes Framework (QOF). QOF Performance in the area of diabetes, cancer screening and childhood immunisation rates continued to be a challenge for the practice.
• The practice was rated below both the local Clinical Commissioning Group (CCG) and national averages in the GP Patient Survey. However, patients were observed to be treated with kindness and recent practice surveys showed positive patient feedback. Patients spoken to and comments cards received were generally positive regarding the practice.
• Feedback regarding access to appointments was mixed. The practice was aware of this and were working to improve access.
• Complaints were mostly managed appropriately, however, improvements could be made.
• We found a supportive culture within the practice.
• The practice had a vision and values in place and staff were observed to act in line with them.
• Governance arrangements were in place.
• Patient feedback mechanisms were in place and were continuing to be developed.

There were some areas where the provider should make improvements:

• The practice should put measures in place to ensure that all patient records are summarised in a timely manner to support safe and effective care.
• The practice should continue to work to improve QOF performance in the area of diabetes and to improve cancer screening and childhood immunisation rates.
• The practice should continue to identify patients who are caring for others, so that their needs can be assessed and support provided accordingly.
• The practice should review and improve the information provided to complainants on who to escalate complaints to in the event of remaining dissatisfied, to accurately reflect the provider’s policy in all cases.
• The practice should continue to develop the information available for patients whose first language is not English. This should include patient feedback mechanisms.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

This practice is rated as requires improvement overall. (Previous inspection December 2014 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Requires improvement

Are services responsive? – Requires improvement

Are services well-led? – Requires improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are all rated as requires improvement. This is because the rating of requires improvement in the key questions for caring and for well-led applies to all population groups.

Older People – Requires improvement

People with long-term conditions – Requires improvement

Families, children and young people – Requires improvement

Working age people (including those recently retired and students – Requires improvement

People whose circumstances may make them vulnerable – Requires improvement

People experiencing poor mental health (including people with dementia) - Requires improvement

We carried out an announced comprehensive inspection at St Thomas Road surgery on 29 November 2017 as part of our inspection programme. This inspection was carried out under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes. The practice made use of internal reviews of incidents and complaints. Learning was shared at practice level and with the One Medicare Ltd group and used to make improvements.
• There was a suite of policies and procedures to govern activity within the practice. These were aligned with One Medicare Ltd policies which were accessible to all staff, including locum GPs. However, we found that the procedure relating to the management of PGDs at practice level was not always fully adhered to with regards to authorisation in a timely manner.
• The practice used a programme of audit to review the effectiveness and appropriateness of the care it provided. Clinicians used evidence- based guidelines to inform care.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• The practice had a staff member who was a lead for PREVENT (preventing radicalisation and extremist training) to make staff aware of their responsibilities in reporting unusual behaviour
• Appropriate monitoring of high risk medicines was taking place, however, improvements could be made to clinician’s records within patients notes to ensure that GPs involved in patients care were clear about the arrangements.
• The practice had engaged with the public health team to improve attendance for cervical smear testing by providing educational events and a ladies gift was offered as an incentive to attend. This had significantly improved to 80% which is in line with the national average.
• The practice were aware of the challenges they faced in delivering the childhood immunisation programme and had provided educational sessions for new parents to improve this.
• They had worked hard to educate patients in the importance of health screening and had achieved 100% of available QoF points in all public health indicators and improved health promotion awareness.
• Staff knew about improvement methods and had the skills to use them. Nurses had access to monthly clinical supervision jointly with Derby Urgent Care Centre and were given time to attend sessions.
• The practice were aware of the importance of educating patients about the dangers of over- prescribing antibiotics. They had achieved and exceeded the targets set by SDCCG for prescribing certain antibiotics, and were the lowest prescriber of these medicines out of 55 practices.
• The practice were involved in a research project aimed at identifying the specific needs of Asian women suffering with post-natal depression.

The areas where the provider must make improvements are:

• Establish effective systems and processes within the practice to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Continue with work already in progress to identify patients who are caring for others so that their needs can be assessed.
• Continue to monitor actions being taken to address the issues highlighted in the national GP survey in order to improve patient satisfaction, including appointment access and those in relation to consultations with GPs and nurses.

• Continue with work to improve performance in relation to childhood immunisations.

• Continue to review systems for recall of patients with long term conditions to ensure appropriate monitoring and follow up.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Derby Open Access Centre on 08 December 2014 when we looked at both the walk-in service and the GP service for registered patients. Overall the practice is rated as good.

Specifically, we found both parts of the service offered by the practice to be good at providing safe, well-led, effective, responsive and caring services. It was also good for providing services for older people, people with long-term conditions, mothers, babies, children and young people. It was also good for providing services for people in vulnerable circumstances who may have poor access to primary care and people experiencing poor mental health. It was outstanding for providing services for working-age people and those recently retired.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services was available and easy to understand.
• Patients said they found it easy to make an appointment with a GP or a nurse and that there was continuity of care, with urgent appointments available the same day or through the walk-in service.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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.

We saw one area of outstanding practice:

• The practice had evolved an outreach programme where seasonal, bespoke sessions were held in community venues, such as school halls and business premises around two to three times each month. The most recent programmes prior to our inspection were the provision of flu vaccinations and the provision of health checks at various community venues. In this way the practice had helped to identify people from the area who had previously unidentified health concerns and encouraged them to seek advice from their own GPs. Whilst the opening hours offered by the walk-in service was good for working age people, we judged it to be outstanding for this population group due to the additional service provided by the outreach work.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should:

• Ensure that effective arrangements are made for patients to speak with reception staff in private if they choose to and that the availability of these arrangements is communicated to patients.
• Take steps to initiate a system that proactively identifies patients who are caring for others so that their needs can be assessed.
• Make information available in the waiting area and in a form that patients can take away with them about how to make a complaint.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice