The Ingham Practice

Updated 12 April 2017

The Ingham Practice provides primary medical services to approximately 3,385 patients and is situated in a rural village in Lincolnshire. The practice is located in a purpose built health centre since 1995, all clinical areas are located on the ground floor and are accessible to patients with disabilities and those who use wheelchairs. An extension to the premises had recently been completed which included a purpose built minor surgery suite. The practice has an on-site dispensary and dispenses to approximately 98% of the patient list. The newly built minor surgery suite includes a new dispensary area however this was not in use at the time of the inspection, it was expected that it would be used in the future dependent upon requirements. The practice is a member of the dispensing services quality scheme (DSQS).

It is located within the area covered by Lincolnshire West Clinical Commissioning Group (CCG). It is registered with the Care Quality Commission to provide the regulated activities of; the treatment of disease, disorder and injury; diagnostic and screening procedures; maternity and midwifery services and surgical procedures.

At the time of our inspection, the practice employed one senior GP partner who had worked at the practice for approximately 25 years, one part-time locum GP, one advanced nurse practitioner and one locum advanced nurse practitioner, two senior nurses, one practice nurse, one clinical audit nurse, two health care assistants (HCA), one dispensary supervisor, one dispenser and one dispensing assistant, three receptionists and three secretaries. The practice also employed one housekeeper. All staff were supported by a business partner who carries out practice manager duties who is supported by a general manager.

The practice is open from 8am until 6.30pm Monday to Friday. Appointments are available between these times. The practice offers extended hours appointments on a Tuesday each week until 7pm.

The practice has General Medical Services (GMS) contract which is a contract between the GP partners and the CCG under delegated responsibilities from NHS England.

The practice has a higher number of patients between the ages of 45 and 74 years of age compared to the England average.

The practice provides on-line services for patients such as to book routine appointments, ordering repeat prescriptions and access to detailed summary care record.

The practice is part of a federation called ‘IMP healthcare’ which includes a group of practices within NHS Lincolnshire West Clinical Commissioning Group (CCG) who meet on a regular basis.

When the surgery is closed GP out-of-hours services are provided by Lincolnshire Community Health Services NHS Trust which can be contacted via NHS111.

Updated 12 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Ingham Practice on 26 September 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

• Risks to patients were assessed and well managed.

• The practice produced a regular infection prevention and control (IPC) newsletter to ensure all staff were regularly updated regarding related topics.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

• The practice ensured a system of clinical supervision was in place for all members of the nursing team which included a combination of group supervision and also one to one sessions. We saw examples of clinical supervision records during our inspection.

• 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 and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.

• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.

• 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.

• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Review process for significant events to include after death patient reviews.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 April 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.

• Performance for diabetes related indicators was 99% which was higher than the CCG average of 91% and the national average of 90%. Exception reporting rate was 10% which was comparable to the CCG average of 10% and lower than the national average of 12%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multi-disciplinary package of care.

Updated 12 April 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 relatively high 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, and we saw evidence to confirm this.

• The practice’s uptake for the cervical screening programme was 90%, which was higher than the CCG average of 77% and the national average of 74%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

• The practice offered a text reminder service to remind patients of their appointment date and time.

Updated 12 April 2017

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice also encouraged its patients to attend national screening programmes for bowel and breast cancer screening. For example, 75% of female patients aged 50-70 years of age had attended for breast cancer screening within six months of invitation months compared to the CCG average of 78% and the national average of 74%.

• Age Concern primary care navigators attended the practice on a weekly basis to give advice and arranged care and support to patients who required this. 

Updated 12 April 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.

• The practice offered extended hours appointments on a Tuesday each week until 7pm.

Updated 12 April 2017

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

• Performance for mental health related indicators was 100% which was the maximum amount of points available compared to the CCG average of 92% and the national average of 93%. Exception reporting rate was 20% which was higher than the CCG average of 15% and the national average of 11%.

• 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 12 April 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 homeless people, travellers and those with a learning disability.

• 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.

• 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.