The Jessop Medical Practice

Updated 16 December 2016

Jessop Medical Practice provides care to approximately 17,000 patients across two sites. The main site is situated in Leabrooks, a small urban locality in the Amber Valley district of Derbyshire. There is also a branch surgery four miles away at Church Farm, Ripley, Derbyshire. DE5 3TH. We visited the main site at Leabrooks during our inspection.

The practice provides primary care medical services via a General Medical Services (GMS) contract commissioned by NHS England and NHS Southern Derbyshire Clinical Commissioning Group.

The registered patient population are predominantly of white British background. The practice age profile demonstrates slightly higher number of patients aged 40 years and above, and generally lower numbers of people aged below 40 in comparison to the local and national averages. People aged 65 and above comprise 21% of the registered practice population. The practice is ranked in the fifth more deprived decile and serves a mostly residential area. Deprivation scores (2015) at 22.4 were in alignment with the local and national average.

The practice operates from purpose-built premises at each site. The main site at Leabrooks opened in 2011. All patient services within the practice are provided on the ground floor of the building, whilst the upper floor is utilised for administration.

The practice is run by a partnership of 14 members, which consists of 13 GPs partners (seven females and six males) and the practice manager. The partners employ a part-time female salaried GP. The provider is an established training and teaching practice and accommodates GP registrars (a qualified doctor who is completing training to become a GP), and medical students.

The nursing team is led by a full time nurse manager and consists of a nurse practitioner, four practice nurses, and two health care assistants. The clinical team is supported by a practice manager, a deputy practice manager, and two senior receptionists who manage a team of 21 secretarial, administrative and reception staff, including an apprentice.

The practice opens at 7.30am each morning until 8pm on a Monday and from 7.30am until 6.30pm from Tuesday to Friday. The practice closes at 1.30pm for one afternoon on ten months of the year for staff training.

GP consultations commence each morning with extended hours early appointments from 7.30am and the latest GP appointment is available at 5.50pm (7.50pm for extended hours on a Monday evening).

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 Healthcare United (DHU) via the 111 service.  

Updated 16 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Jessop Medical Practice on 21 October 2016. Overall, the practice is rated as outstanding.

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

• There was an effective system in place for the reporting and recording of significant events. Significant events were investigated and learning outcomes were shared with the practice team to enhance the delivery of safe care to patients.
• The practice had systems in place to safeguard children and vulnerable adults.

• Clinicians kept themselves updated on new and revised guidance and discussed this at clinical meetings.
• We saw evidence of an active programme of clinical audit that reviewed care and ensured actions were implemented to enhance outcomes for patients.
• Patients told us they were treated with compassion, dignity and respect. They also said they were involved in their care and decisions about their treatment. This was corroborated bythe outcomes of the latest national GP patient survey and CQC comment cards.
• The practice planned and co-ordinated patient care with the wider health and social care multi-disciplinary team to deliver effective and responsive care to keep vulnerable patients safe. Fortnightly multi-disciplinary meetings took place to discuss and review patients’ needs.
• The practice had an effective appraisal system in place and supported staff training and development.
• The practice team had the skills, knowledge and experience to deliver high quality care and treatment.
• Arrangements were in place to assess and manage risk effectively.
• Feedback from patients we spoke with on the day, and from CQC comment cards, demonstrated that some people had encountered difficulties with regards access to GP appointment. The practice were very aware of this issue and were keeping this under constant review to enhance patient experience on access.
• The practice had good facilities and was well-equipped to treat patients and meet their needs. The premises were accessible for patients with impaired mobility.
• There was a clear leadership structure in place and the practice had a governance framework which supported the delivery of quality care. Regular practice meetings occurred, and staff said that GPs and managers were approachable and always had time to talk with them.
• The partnership had a comprehensive three-year business plan and associated action plan, and the practice proactively engaged with other practices and their Clinical Commissioning Group (CCG).
• The practice had an open and transparent approach when dealing with complaints. Information about how to complain was available, and improvements were made to the quality of care as a result of any complaints received.
• The practice had a patient participation group (PPG) which met on a bi-monthly basis.

We saw a number of areas of outstanding practice including:

• The partners led an innovative and committed team, and promoted a strong inclusive culture with a focus on continuous quality improvement. As a large practice, the partners recognised the importance to prioritise time to build effective relationships and communication within the team, and achieved this through daily ‘catch-up’ and weekly breakfast meetings to enhance their formal operational and governance frameworks.
• Significant events were thoroughly investigated and some of these were shared with the national reporting and learning system (NRLS). The NRLS ensures the learning gained from the experience of a patient in one part of the country is used to reduce the risk of something similar occurring elsewhere. Incidents were also used as a method of selecting appropriate clinical audit topics within the practice.
• We saw that a full cycle audit had been undertaken to review the practice’s efficacy of coding for child safeguarding. The outcomes had been to improve the accuracy of coding, and assistance from the information technology department had ranked entries on the safeguarding register in date order to enable easier access to a list of the most recent cases where concerns had been identified. A second audit in May 2016 had highlighted that when a code was used to identify domestic violence, this needed to automatically generate a child safeguarding alert and add them to the practice’s safeguarding register.
• The practice demonstrated a responsive approach by taking account of the needs of their local population, and not just their registered patients. This enabled services to be delivered closer to patient’s homes. For example, a GP provided a vasectomy service for all patients within their CCG. Access to carers’ clinics and counselling services for younger people were available to people outside of the practice. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 December 2016

• The practice maintained registers of people with long-term conditions, with recall processes to invite patients for reviews of their conditions and medicines. Comprehensive computer templates had been developed to use for reviews which included health promotion information and individual health care plans that were printed and given to the patient.
• Patients with multiple conditions were usually reviewed in one appointment to avoid them having to make several visits to the practice.
• Annual reviews included patients who were housebound or resided in a care home.
• The call and recall system was co-ordinated by the administration team. Patients were seen as part of the routine appointment system, rather than by dedicated clinics. This gave more flexibility for patients in attending at a time that was suitable for them.
• QOF achievements for clinical indicators were generally in line with CCG and national averages. For example, the practice achieved 94.2% for diabetes related indicators, which was 1.1% higher above the CCG average, and 5% above the national average in 2014-15. There was an overall lead GP for QOF, supported by individual GPs acting as clinical leads for specific long-term conditions. The nurse manager was also assigned as the long term conditions nurse.
• The nurse manager was an approved trainer in a defined evidence-based diabetes education programme called X-PERT Diabetes'.
• Joint clinics were held every six weeks with the local diabetes nurse specialist nurse to see more complicated patients to reduce referrals and further enhance the nurse manager's skills. 
• The practice had established effective relationships with the local Borough Council, and worked with the housing officer to offer heating/housing support for individuals with chronic obstructive airways disease.

Updated 16 December 2016

• 18.2% of registered patients were under 18 years old, and the practice adapted its services to meet this groups specific needs.
• Telephone access was available on the day for parents of children and any urgent needs were accommodated by a face-to-face consultation. Children under five were prioritised to be seen. Minor illness appointments were available on the day with the nurse practitioner
• The practice was committed to safeguarding children and young people, with effective child safeguarding arrangements in place. There was a designated lead GP, supported by another GP and dedicated support from one of the administration team. The practice held regular meetings to discuss cases, and routinely invited community midwives, health visitors and school nurses to attend these. Relevant patient records were flagged so that clinicians were aware of children and young people where concerns have been raised. We saw that records were audited regularly to ensure safety.
• The practice provided eight-week baby checks, and postnatal reviews. They also hosted regular midwifery services at both sites, and health visitor clinics including drop-in sessions.
• Childhood immunisation rates were marginally above local averages. Overall rates for the vaccinations schedule given to children up to five years of age ranged from 73.8% to 97.8% (local averages 66.7% to 98%).
• The practice offered a full range of contraception services, including access to emergency contraception and the fitting of intrauterine devices and contraceptive implants. The practice encouraged chlamydia screening uptake with anonymous collection points available.
• The practice provided a vasectomy service for patients registered with the CCG’s practices, creating easier access for local people. There had been 88 vasectomies performed in the past 12 months, from a purpose-built enhanced minor operations suite. The practice had received high levels of positive feedback from patients who had received the service.
• The practice hosted a counselling service for younger people provided by Relate, and were involved with a local pilot to increase capacity to see more patients, with other local practices and schools.
• The practice welcomed mothers who wished to breastfeed on site, and offered a dedicated breastfeeding room for this, which included baby changing facilities. The environment was child friendly, with a play-area in the waiting room, and large accessible consulting rooms which facilitated access for pushchairs.

Updated 16 December 2016

• People aged 65 years and over accounted for 20.7% of the practice’s registered patients which was higher than the CCG average of 17.6% and the national average of 17.1%. Each older person had a named GP and the practice encouraged continuity of care with the same GP whenever possible.
• The practice worked with a care co-ordinator and community matron as part of a multidisciplinary community support team to proactively care for frail patients, and to develop bespoke care plans which were shared with out-of-hours services. These patients were flagged on the practice computer system and were prioritised if they contacted the surgery. Fortnightly multi-disciplinary meetings were held to review vulnerable patients to plan and deliver ongoing care and support appropriate to their individual needs.
• The practice provided medical cover in work-hours for patients admitted to Ripley Community Hospital. Three GPs shared this responsibility, and visited the hospital twice weekly, with additional visits undertaken according to patients’ needs.
• Older patients with multiple health issues received an annual (or more frequent if required) review to re-assess their condition and to ensure the medicines remained suitable for their needs. This would be arranged at the patient’s home if necessary.
• Longer appointment times could be arranged for patients with complex care needs. Home visits were provided for those unable to attend the surgery.
• The practice provided care to over 160 patients across 16 care homes. Each home had at least one named GP to help with continuity of care. We spoke with managers at two of the care homes who told us that they always received a responsive and caring service.
• Uptake of the flu vaccination for patients aged over 65 was 71%, which was in line with the local average of 73% and the national average of 70.5%.
• The premises were suitable for older people, including those with hearing difficulties and wheelchair users. All clinical rooms were on ground floors and the practice entrance had automatic doors. 

Updated 16 December 2016

• The practice provided extended hours consultations from 7.30am each morning and late-opening each Monday until 8pm. This included nurse appointments, for example, to provide cervical screening or reviews of long-term conditions, enabling easier access for working people.
• Telephone consultations and advice were offered each day when this was appropriate, so that patients did not always have to attend the practice for a face-to-face consultation.
• The practice offered on-line booking for appointments and requests for repeat prescriptions. Participation in the electronic prescription scheme meant that patients on repeat medicines could collect them directly from their preferred pharmacy.
• The practice provided new patient health assessment checks and NHS health checks.
• The practice hosted the Live Life Better Derbyshire service who provided advice, support and signposting to assist with smoking cessation, weight management and healthy lifestyle advice.
• The practice actively promoted health-screening programmes to keep patients safe. The practice’s uptake for the cervical screening programme was 83.3%, in line with the CCG average of 83.5% and slightly above the national average of 81.8%. Uptake of breast cancer screening was encouraged, and rates were slightly higher than averages.

Updated 16 December 2016

• The practice provided care for patients diagnosed with a serious mental illness which comprised 1% of their registered patient list, including individuals in two designated care homes. The practice had a designated lead GP for mental health.
• The practice achieved 95.1% for mental health related indicators in QOF, which was 1.8% below the CCG and 2.3% above the national averages. Exception reporting rates at 23.6% were higher compared against local (16.9%) and national rates (11.1%). However, the practice were able to provide data which demonstrated a lower exception reporting rate and data for 2015-16 also showed that the rate had continued to decrease.
• These patients were offered and encouraged to have annual care reviews and care planning. The annual reviews were performed by a GP, often with a support worker present. A template had been developed to include lifestyle measures, cardiovascular risk assessment, and medicines monitoring. 85.9% of patients with severe and enduring mental health problems had a comprehensive care plan documented in the preceding 12 months according to 2014-15 QOF data (CCG average 91.8%;national average of 88.5%).
• The practice had established links with the local consultant adult psychiatrist. Regular discussions took place and the psychiatrist had attended practice meetings to discuss effective ways of joined-up working. The psychiatrist regularly accompanied the lead GP for mental health on joint ward rounds to a home for patients with challenging behaviour to enhance care and provide access to expert advice.
• The practice hosted counselling and psychological therapy services at both sites to ensure these were easily accessible for their patients.
• The practice told patients experiencing poor mental health and patients with dementia about how to access local services, support groups and voluntary organisations. Information was available for patients in the waiting area.
• There were 188 patients (1.1%) registered patients who had been diagnosed with dementia. The health care assistant helped to screen for new patients with an assessment tool. 89.8% of people diagnosed with dementia had had their care reviewed in a face-to-face meeting in the last 12 months. This was in slightly above local and national averages of 85.4% and 84% respectively with aligned exception reporting rates.

Updated 16 December 2016

• The practice provided care to 161 people in local care homes. There were named GP leads for each care home (including establishments for serious mental illness and learning disabilities), and tried wherever possible for the named leads to be involved on any visits to aid continuity and build relationships with the carers/nurses. The practice proactively worked with their medicines management team to review care home patients’ medicines regularly, often on joint visits.

• Patients with end-of-life care needs were reviewed at a quarterly multi-disciplinary team meeting including a lead GP, district nurses, and a Macmillan nurse.
• The practice used care plans for the most vulnerable patients including those at end of life. A template was used for patients at the end of life to ensure key information was available to ensure continuity of care for the patient. This included the patient’s preferred place of care and whether a Do Not Attempt Resuscitation order was in place.
• Newly bereaved relatives or carers were contacted by GPs to offer condolences and see if any support may be required.
• The practice held a register of vulnerable patients and there was a designated lead GP for adult safeguarding. Cases were regularly discussed cases and GPs participated in serious case reviews and vulnerable adult risk management meetings wherever possible. Staff had received adult safeguarding training including domestic violence, PREVENT (radicalisation) and Deprivation of Liberty Safeguards, and were aware how to report any concerns relating to vulnerable patients. Their safeguarding audits had identified improvements which could improve the identification of patients who may be at risk as a result of domestic violence and changes had been implemented to improve the practice systems.
• The practice had 138 people on their learning disability register which was above the national average. The practice had undertaken an annual health review for 75% of their patients with a learning disability in the last 12 months. A specific computer template was available to ensure the reviews were comprehensive, and patients were encouraged to have the flu vaccination.
• Homeless people and refugees could register with the practice, and the practice worked with local services to address individual need.
• The practice had low numbers of patients whose first language was not English. These patients were able to access interpreter services if required.