Grove Medical Practice

Updated 7 June 2016

Cromwell Place Surgery is a largely purpose built practice situated in St Ives, Cambridgeshire. The practice provides services for approximately 10,871 patients. It holds a General Medical Services contract with Cambridgeshire and Peterborough CCG.

According to information taken from Public Health England, the patient population has an age profile which is comparable to the practice average across England. The practice is in an area with a low level of socioeconomic deprivation.

The practice team consists of five full time GP partners, a full time salaried GP, one GP registrar, a practice manager, five practice nurses, three healthcare assistants and a phlebotomist. It also has teams of reception, administration, secretarial, dispensary and domestic staff. The practice is an accredited training and teaching practice, and medical students were present on the day of inspection.

Cromwell Place Surgery is open from 7am to 6pm Monday to Friday.The practice offers routine appointments to patients from 7.10am to 11.10am and from 3.10pm to 5.40pm. There is a clearly defined duty doctor system and other protected appointment slots for urgent care provision throughout the day. Out of hours care is provided by Urgent Care Cambridge via the 111 service.

Updated 7 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cromwell Place Surgery on 12 April 2016. Overall the practice is rated as good.

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.
• The practice had a patient focused culture that ensured risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance, such as the National Institute for Health and Care Excellence (NICE) best practice guidelines. 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. We received strongly positive feedback about both individual staff members and the practice as a whole.
• Staff consistently went over and above to meet the needs of their patients; including going out of their way to make the lives of patients easier. For example, the practice manager had assisted patients to the hospital when they were unable to get patient transport.
• Information about local services and support groups was clearly available to patients. Furthermore, patients we spoke to were aware of how to make a suggestion or a complaint to the practice.
• The practice had good facilities and was well equipped to treat patients and meet their needs. For example, the practice had made further adaptations to the disabled toilet following feedback from patients.
• Patients told us they were able to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• There was a clear leadership structure and staff felt very well supported by management.
• The practice proactively sought feedback from staff and patients, which it acted on. For example, the practice had worked alongside the PPG to address issues with the telephone line following previous concerns regarding telephone access.
• The provider was aware of and complied with the requirements of the duty of candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 June 2016

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

• Both GPs and nursing staff had lead roles in chronic disease management and provided clinics such as diabetes, asthma and chronic obstructive pulmonary disease (COPD).
• The practice used the information collected for the Quality and Outcomes Framework (QOF) to monitor outcomes for patients. Data from 2014/2015 showed that performance for diabetes related indicators was 100%, which was above the CCG and national average by 11%. Exception reporting for diabetes related indicators was 11%, which was lower than the CCG average of 13% and in line the national average of 11%.
• Longer appointments and home visits were available when required.
• Patients with a long term condition had a structured annual review to check their health and medicines needs were being met. There was a robust system in place to ensure that patients were recalled for review.
• 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. We saw evidence of the practice working with a number of healthcare professionals.

Updated 7 June 2016

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 high for all standard childhood immunisations.
• Patients we spoke to confirmed 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 5 years was 85%, which was above the local and national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice had established an effective working relationship with local health visitors and school nurses, who were based outside of the building. There are clear pathways and established lines of communication in respect of any safeguarding issues for this group of patients. There were clear pathways and established lines of communication in respect of any safeguarding issues for this group of patients.
• Practice staff had a good understanding of the Gillick competency testing for children over 16 years of age.

Updated 7 June 2016

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 triaged all home visit requests to facilitate earlier visits where hospital admission may be an outcome.
• 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.
• Hospital admissions avoidance was discussed at monthly multidisciplinary team meetings to reduce unplanned hospital admissions for older patients. There were personalised care plans for patients at high risk of hospital admission to support the reduction of emergency referrals.
• The practice worked collaboratively with local nursing homes to ensure safe and timely care.

Updated 7 June 2016

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. There was a focus on expanding online services and promoting them to this age group.
• The practice was proactive in offering 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 had carried out 171 health checks in the past 12 months.
• The practice had identified that many patients were commuters and would benefit from early appointments. Extended hour appointments with a doctor were provided by appointment between 7am and 8am Monday to Friday.
• Telephone consultations were available on a daily basis with both doctors and nurses.

Updated 7 June 2016

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

• 86% of patients diagnosed with dementia had received a face to face care review in the last 12 months, which was above the CCG and national average of 84%.
• 93% of patients experiencing poor mental health had a comprehensive care plan, which was above the CCG average of 87% and the national average of 88%.
• 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. We also saw these services promoted in patient waiting areas.
• The practice offered in-house counselling services, which also included specialist relationship counselling.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• The PPG had worked with the practice to hold an education evening on dementia. This included a talk from a member of the ‘Dementia Friends’ group. The strategic plan was that St Ives would become a ‘Dementia Friendly Society’.

Updated 7 June 2016

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 carried out annual health reviews 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 proactively identified and signposted to local carers’ groups. Furthermore, the practice was engaged with the Carers’ Prescription Service, which provides respite for carers.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations. For example, the practice was able to signpost patients to local drug and alcohol misuse support groups.
• Staff we spoke to 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.
• Home visits were offered to those patients unable to attend for routine or emergency care, including vaccination.