Archived: The Peninsula Practice

Updated 14 January 2016

The Peninsula practice is situated in Alderton, in the county of Suffolk. The practice provides services for approximately 3,880 patients. It is one of six surgeries which form the Deben Health Group, a group of local GP practices. The Peninsula practice holds a General Medical Services (GMS) contract and has a branch practice in the village of Orford and provided services one afternoon a week (Monday) from a branch location in the village of Hollesley. As part of our inspection we visited the Orford branch as well.

According to Public Health England information, the patient population has a lower than average number of patients aged under 18 compared to the practice average across England. It has a higher proportion of patients aged 65+, 75+ and 85+ compared to the practice average across England. Income deprivation affecting children and older people is significantly lower than the practice average across England.

The practice has two GP partners both female, one male salaried GP and one nurse practitioner. There were also two practice nurses and a health care assistant. The practice also employs a practice manager, a dispensary team and a reception/administration and secretarial team.

The Peninsula practice is a training practice and had one third year GP trainee at the time of our inspection. The practice also acted as research hub in cooperation with other practices from the Deben Health Group.

The practice’s opening times at the Alderton location at the time of the inspection were 08:00 to 14.30 Monday and Tuesday and 08:00 to 18:30 Wednesday to Friday. The practice’s opening times at the Orford location at the time of the inspection were 08:00 to 18.30 on Monday, 14:00 to 18:30 on Tuesday and 08:00 to 13:00 Wednesday to Friday.

Appointments with GPs can be booked 12 weeks ahead, and with nurses 16 weeks ahead. The practice has opted out of providing GP services to patients outside of normal working hours such as nights and weekends. During these times GP services are provided by Care UK.

Updated 14 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Peninsula Practice on 2nd December 2015. Overall the practice is rated as outstanding.

Specifically, we found the practice to be outstanding for providing safe, effective, responsive and well-led, services. It was also outstanding for providing services for older people, people with long term conditions, working age people and for families, children and young people. Those in vulnerable circumstances and people experiencing poor mental health also receive outstanding care.

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.
• 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 several areas of outstanding practice including:

• The practice reviewed significant events on a six monthly basis to ensure continuation of safety and shared outcomes of these events with staff and amongst other local practices.

• The practice provided a self-funded medication delivery service for those patients that were unable to collect themselves.

• Staff were well supported through stress level and morale assessments, regular appraisals and by undertaken continuous assessments of how staff felt they fitted in the organisation by asking staff where they felt they were situated on “The Peninsula Tree”. Staff safety had also been considered as the highest priority and was reflected in arrangements such as responding to intruder alarms at the practice.

• The practice acted as research hub in cooperation with other local practices and a Clinical Research Network nurse. This had led to increased understanding of the topics covered in the research. For example, a diabetes study to develop a deeper understanding of the importance of patient education and holistic care with their diabetes.

• The practice worked closely with a local trust – the Orford Trust – and AGE UK to offer support and advice to patients and their carers.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 14 January 2016

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

Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed, this included visits to undertake flu vaccinations.

All these patients underwent a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

One of the nurses worked closely with, and under the supervision of, the diabetes specialist at the local hospital. Through this collaboration the nurse was able to attend to more complex diabetic patients and provide the required care in the community, eradicating the need for the patient to attend the hospital.

The practice undertook a multitude of audits, of which several focussed on improving care and safety for patients with long term conditions.

Data showed the practice scored continually high on patient outcomes in this population group.

Updated 14 January 2016

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

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. Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals. Appointments were available outside of school hours and the premises were suitable for children and babies. At the time of our inspection the practice cared for 23 pregnant women and 56 patients that were under one year old.

The practice’s GPs acted as the medical officers for a local international school. In the eight months previous to our inspection the practice had been proactive in recognising the challenges in a student population with mixed international backgrounds and had engaged with the clinical staff at the school to develop a more proactive service provision.

We saw good examples of joint working with midwives. The practice had a room available for privacy for breast feeding mothers.

The practice undertook a multitude of audits, of which two focussed on coil fitting and cytology

Updated 14 January 2016

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

Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

An AGE UK advisor visited the practice on a monthly basis offering 45 minute appointments for patients or their carers for advice on services or to offer support.

The practice undertook a multitude of audits, of which several focussed on improving care and safety for older people.

Weekly ward rounds were undertaken at a local residential home. The practice worked closely with a local trust, Orford Trust, to provide short term provisions of respite or care for those patients that were in need in the form of a nurse or carer.

Updated 14 January 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 offered telephone advice for patients that chose to use this service. Appointments with GPs could be booked 12 weeks ahead, and with nurses 16 weeks ahead ensuring patients could plan ahead.

The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group. At time of inspection, 61% of the practice population was of working age.

Updated 14 January 2016

The practice is rated as outstanding for the care of people experiencing poor mental health including people with dementia

The practice had 30 registered patients with dementia of which 27 required a care plan, of these 25 (92.5%) had received an annual review since April 2015. 61.5% of mental health patients had a care review recorded since April 2015. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

An AGE UK advisor visited the practice on a monthly basis offering 45 minute appointments for patients or their carers for advice on services or to offer support.

The practice hosted weekly clinics for a mental health link worker from the Suffolk well-being service and a local Trust funded private counsellor visited one of the branches on a weekly basis to see NHS patients.

Updated 14 January 2016

The practice is rated as outstanding 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, travellers and those with a learning disability and patients’ notes were highlighted to make staff aware. It had carried out annual health checks for people with a learning disability and 100% of these patients had up to date care plans. The practice offered longer appointments for this patient group and was flexible in offering appointments to suit the patient in or outside normal clinic hours. Patients that did not attend were given special consideration to attend a new appointment and were supported by the receptionists who ensured communication with the patient the day before their appointment as well as on the day itself.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients 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.

The practice worked closely with social services and a local farm, which facilitated a stimulating environment for learning disability patients on referral from the practice.

The practice was subcontracted by Care UK to provide GP care to two local prisons. To ensure a continuous good standard of care in these facilities the practice worked with closely with the prison healthcare team and two other local practices to provide continuous GP cover. The practice GPs were actively involved in providing monthly feedback on audits for pain behaviour that were undertaken in the prison.

One of the GPs was drug and alcohol trained and proactively managed and supported patients with chaotic behaviour.