The Uppingham Surgery

Updated 23 June 2017

The Uppingham Surgery is located on the outskirts of the small market town of Uppingham in Rutland. The practice has one location registered with the Care Quality Commission (CQC) which is The Uppingham Surgery, Northgate, Uppingham. LE15 9EG

The practice operates from its main location at Uppingham and three branch surgeries located at;

Kings Lane, Barrowden, LE15 8EF which was open four half days a week.

Kirby Road, Gretton, NN17 3DB which was open three half days a week.

The Ketton Centre, High Street, Ketton, PE9 3RH which was open three half days a week.

It is a dispensing practice to patients living more than 1.6km from a pharmacy.

It practice has approximately 11,000 patients and the practice’s services are commissioned by East Leicestershire and Rutland Clinical Commissioning Group (CCG) through a General Medical Services Contract (GMS). The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities.

The service is provided by five GP partners (two female and three male) and three salaried GPs (female), one nurse manager, two nurses, two health care assistants and two phlebotomists, They are supported by a team of dispensers, management, administration, patient service staff and maintenance staff.

The practice is a GP training practice. GP Registrars are fully qualified doctors who already have experience of hospital medicine and gain general practice experience by being based within the practice.

The location we inspected on 9 May 2017 was The Uppingham Surgery, Northgate, Uppingham. LE15 9EG.

The Uppingham practice is open between 8am to 6.15pm Monday to Friday. From 8am to 8.15am and 6pm to 6.30pm patients can contact the surgery via a mobile number which is available on the practice website.

The practice offered extended hours at the Uppingham Surgery on Monday 6.30pm to 7.30pm and Tuesday and Wednesday 7.30am to 8am.

When the practice is closed out-of-hours GP services are provided by Derbyshire Health United which is accessed by telephoning the NHS111 service.

Updated 23 June 2017

Letter from the Chief Inspector of General Practice

We had previously carried out an announced comprehensive inspection at this practice on 28 September 2016 and found breaches of regulation and rated the practice as ‘Requires improvement’ in the safe and well-led key question. The practice was rated as ‘Requires improvement’ overall. The full comprehensive report on the 29 September inspection can be found by selecting the ‘all reports’ link for The Uppingham Surgery on our website at www.cqc.org.uk.

Specifically we found that;

• The practice did not have a clear or consistent system for reporting, recording and monitoring significant events, incidents and accidents.

• The systems and process to address the risks associated with fire and legionella were not implemented well enough to help ensure people were kept safe.

• There was no clear process in place to alert health care professionals that patients were being prescribed disease modifying drugs in secondary care.

• The provider had not have systems in place to ensure that staff were properly recruited.

• The practice had a governance framework in place which supported the delivery of the strategy and quality care. However, we found the systems and processes in place with regard to significant events, monitoring of risk and staff recruitment were not effective

This inspection was an announced focused inspection carried out on 9 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 29 September 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

.

The practice is now rated as ‘Good’ in the safe and well-led key questions and ‘Good’ overall.

Our key findings were as follows:

• There were systems for recording, monitoring, acting, reviewing and learning from significant events.

• There were systems to assess and monitor the potential risk from fire and legionella.

• Systems had been improved to help ensure that patient notes were summarised in a timely manner.

• There was a clear process in place for the management of disease modifying drugs prescribed for patients in secondary care.

• Staff were recruited only after the necessary checks had been made.

In addition we found that:

• Blank prescription pads were managed in line with national guidance.

• Random spot checking of the cleaning efficacy at all four surgeries had been introduced.

• Meeting agenda across all staff groups were formalised and discussions recorded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 June 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 29 September 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• Nursing 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.

• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was150/90 mmHg or less was 95.5% which was 4.9% higher than the CCG average and 4.2% higher than the national average. Exception reporting was 3% which was 2.9% lower than the CCG average and 2.5% lower than the national average.

• The percentage of patients with asthma, on the register, who had had an asthma review in the preceding 12 months that includes an assessment of asthma was 77.3% which was 3.7% higher than the CCG average and 1.7% higher than the national average. Exception reporting was 4.1% which was 7.8% lower than the CCG average and 3.8% lower than the national average.

• The percentage of patients with hypertension in whom the last blood pressure reading (measured in the preceding 12 months) was 150/90 mmHg or less was 88.5% which was 5.7% higher than the CCG average and 5.6% higher than the national average. Exception reporting was 2.7% which was 1.4% lower than the CCG average and 1.2% lower than the national average.

• The percentage of patients with COPD who had had a review, undertaken by a healthcare professional was 94% which was 6.4% above the CCG average and 4.4% the national average. Exception reporting was 2.4% which was 12.5% lower than the CCG average and 9.1% lower than national average.

• Patients had a named GP and the practice had a system in place for recalling patients for a structure 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 multidisciplinary package of care.

Updated 23 June 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 29 September 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• 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, and we saw evidence to confirm this.

• The practice’s uptake for the cervical screening programme was 86% which was higher than the CCG average of 78% and the national average of 74%.

• Childhood immunisation rates for the vaccinations given were comparable to CCG/national averages.

• 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 had 700 boarding school pupils of Uppingham School as patients. They provided specific clinics and access to this group of young people.

Updated 23 June 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 29 September 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• 6% of patients registered with the practice were over 80 years of age and 1.1% over 90 years of age.

• The practice offered proactive, personalised care to meet the needs of 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.

• 2.7% of patients who had been assessed as being at risk which was higher than the required national average of 2%.

• The practice had a programme of risk-stratified proactive care planning, with designated doctors for each of the five care homes where patients registered with the practice lived.

Updated 23 June 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 29 September 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• 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 reflected the needs of this patient group.

• 95% of patients who responded to the national GP survey said the last appointment they got was convenient. This was higher the CCG average of 92% and national average of 92%.

• 78% of patients who responded to the national GP survey feel they don’t normally have to wait too long to be seen. This was higher than the CCG average of 59% and national average of 58%.

• The practice encouraged patients to attend national screening programmes for bowel and breast cancer screening. The practice had an uptake of 68% of those eligible for bowel screening which was higher than the CCG average of 64% and national average of 58%.

• The practice had an uptake of 83% of those eligible for breast screening which was the same as the CCG average but higher than the national average of 72%.

Updated 23 June 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 29 September 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice offered guided self-referral to for common mental health problems. The practice had a mental health coordinator who reviewed patients through a recall system.

• Healthcare professionals specialising in drug and alcohol misuse visited the practice to see patients.

• They provided advice packs for patients diagnosed with dementia and offered support through the dementia advisor for those going through the diagnostic pathway. Practice staff had undergone Dementia Friends training.

• 88% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was above the CCG average of 83% and national average of 84%.

• The practice held a ‘Memory Matters’ dementia event in August 2015 which provided advice for people with dementia, carer support and screening memory assessments; it resulted in three new diagnoses and referrals.

• The practice had been recognised for the work they had done and had received a Dementia Champions award.

• 90% of patients who had been diagnosed with depression had their care reviewed in the last year.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

Updated 23 June 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 29 September 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• 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 looked after a specialist residential home for people with Prader-Willi Syndrome. For this vulnerable group and their carers the practice provide designated sessions in a safe familiar environment of a branch surgery, as well as a GP annual review at their residence.

• 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 and the documentation of safeguarding concerns.