Mill Road Surgery

Updated 29 November 2017

Mill Road Surgery is a practice situated in Cambridge, Cambridgeshire. There is also a branch surgery in nearby Cherry Hinton. It is contracted to provide alternative primary medical services to approximately 6,000 registered patients.

According to information taken from Public Health England, the practice population has a larger percentage of adults aged between 20 and 44 years old in comparison to the national average for practices in England. The practice is in an urban area with a mixed level of deprivation, although overall income deprivation levels affecting older people and children were below national averages.

The practice clinical team consists of four GP partners (three male, one female), one salaried female GP, one GP in training (female), two practice nurses and two healthcare assistants. They are supported by a practice manager, a practice secretary and teams of reception, administration and secretarial staff, each with their own leads.

The practice was a training practice and supported medical students and registrars through their development. We spoke with one trainee doctor who commented that they felt well supported and had adequate learning time allocated to them.

The practice offered appointments from 8.30am to 12.30pm and from 1.30pm to 6pm Monday to Friday. Appointments were also available at the branch surgery in Cherry Hinton between 8.30am and 12.30pm and from 1.30pm to 5pm Monday to Friday. The practice offered extended hours’ appointments from 7am until 8am on Monday and Thursday and from 6.30pm to 7.30pm on Thursday. Out-of-hours care was provided by Herts Urgent Care via the NHS 111 service.

Updated 29 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Mill Road Surgery on 31 October 2016. The overall rating for the practice was good with a rating of requires improvement for providing effective services. We then carried out an announced focussed inspection on 17 October 2017 to confirm that the practice had made improvements on the recommendations that we identified in our previous inspection on 31 October 2016. This report covers our findings in relation to those recommendations.

The reports on the 31 October 2016 and 17 October 2017 inspections can be found by selecting the ‘all reports’ link for Mill Road Surgery on our website at www.cqc.org.uk.

Overall the practice remains rated as good.

Our key findings were as follows:

• The practice used the information collected for the Quality and Outcomes Framework (QOF) and performance against national screening programs to monitor outcomes for patients. The most recent published results showed that the practice had achieved 96% of the total number of points available, with 7% exception reporting. (QOF is a system intended to improve the quality of general practice and reward good practice. Exception reporting is the removal of patients from QOF calculations where, for example, the patients decline or do not respond to invitations to attend a review of their condition or when a medicine is not appropriate).

• Data showed the practice performed lower than local and national averages for bowel and breast cancer screening rates.
• Cervical screening rates were above local and national averages, as was exception reporting for this indicator.
• The practice’s performance on child immunisations had not improved; however, the practice maintained records on the patients that had not attended and shared information with the local health visiting team.
• There was a comprehensive monitoring system of patients taking high risk medicines at the practice. Patients received the appropriate monitoring required with high risk medicines. A database for blood tests and reviews was maintained by the practice manager who reviewed and discussed this with the GPs on a regular basis.
• The practice had reviewed the coding processes and services available for carers. The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 88 patients as carers (1.5% of the practice list). This was an increase from 18 patients at our inspection on 31 October 2016. Written information was available in the waiting room to direct carers to the various avenues of support available to them. One of the receptionists had been made a carers champion who provided additional training for the reception team and engaged with the local carer’s trust.

There was one area where the provider should make improvements:

• Explore further opportunities to support an increase in cancer screening rates and a decrease in exception reporting rates for cervical screening.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 January 2017

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The practice used the information collected for the Quality and Outcomes Framework (QOF) to monitor outcomes for patients (QOF is a system intended to improve the quality of general practice and reward good practice). Data from 2015/2016 showed that performance for diabetes related indicators was 82%, which was below the local average of 90.5% and national average of 90%. Exception reporting for diabetes related indicators was lower at 6% compared to the local average of 13% and the national average of 11% (exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).

• Longer appointments and home visits were available when needed.
• Patients with complex needs had a named GP and a structured annual review to check their health and medicines needs were being met. There was a robust recall system in place to ensure that patients were invited and attended annual reviews.
• For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 9 January 2017

The practice is rated as good 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.
• Immunisation rates were in line with local and national averages for all standard childhood immunisations.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 68%, which was below the local average of 72% and the national average of 74%. Exception reporting for this indicator was 25.4% which was above the local average of 8.6% and above the national average of 6.5%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice offered a full range of contraception services and chlamydia screening.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 9 January 2017

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

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice contacted all patients after their discharge from hospital to address any concerns and assess if the patient needed GP involvement at that time.
• The practice had proactively undertaken full medicine reviews of all the patients that were in care homes.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure, were above local and national averages.

Updated 9 January 2017

The practice is rated as good 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 as well as a full range of health promotion and screening that reflects the needs for this age group.
• Practice staff carried out NHS health checks for patients between the ages of 40 and 74 years. The practice was able to refer patients to a health trainer to encourage lifestyle changes.
• The practice offered additional healthcare services in house, reducing the need for outpatient referral and therefore improving patient convenience. For example, the practice employed a counsellor for one day a week who could provide sessions for patients up to an hour at the time per patient.

Updated 9 January 2017

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

• The practice had 28 registered patients with dementia, of which 26 required an annual review, of these 17 had received an annual review in the last 12 months.
• The practice had 78 registered patients experiencing poor mental health, of which 62 required an annual review, of these 43 had received an annual review in the last 12 months.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice 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.
• 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 9 January 2017

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 those with a learning disability. The practice had ten registered patients with a learning disability of which eight required an annual review. Of these eight, three had received a timely review and seven were due one. The practice informed us that invites were sent and that they liaised with the learning disabilities partnership if they had any specific concerns.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• Patients who were carers were identified and signposted to local carers’ groups. However, the practice only had 18 patients registered as carers. The practice did have a lower percentage of patients over the age of 50 compared to the national average.
• The practice informed 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.