North Somercotes Surgery Also known as Marsh Medical Practice

Updated 3 July 2017

North Somercotes Surgery provides primary medical services to approximately 5,727 patients surrounding the village of North Somercotes in Lincolnshire and also includes a large part of coastal East Lincolnshire which includes numerous surrounding villages between the surgeries and the coast. The practice has a branch surgery called ‘Manby Surgery’ located in a nearby village called Manby. The practice has a dispensary on site at both the main and branch surgery and dispenses to 95% of the patient list. Both surgeries are accessible to people using wheelchairs and those with other disabilities and have car parking facilities for both patients and staff.

The practice experiences high numbers of temporary residents who occupy caravan and mobile homes at four nearby caravan sites. These temporary residents are additional to the list of registered patients and can incur an increase of approximately 1200 additional patients per year, particularly between April and September.

The practice is located within the area covered by Lincolnshire East Clinical Commissioning Group (CCG). The practice has a General Medical Services (GMS) contract. 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; family planning; maternity and midwifery services and surgical procedures.

At the time of our inspection the practice employed two female salaried GPs, an operations manager, finance manager, nurse manager, dispensary manager, one nurse practitioner, four practice nurses, three health care assistants (HCAs), phlebotomists and a team of dispensing, reception and administration staff.

North Somercotes Surgery is open from 8am until 6.30pm on a Tuesday, Thursday and Friday and from 8am until 5pm on a Monday and Wednesday. Manby Surgery is open from 8am until 6.30pm on a Monday and a Wednesday, from 8am until 1.30pm on a Tuesday and a Thursday and from 8am until 5pm on a Friday. Appointments are available between these times. Extended hours appointments are available at Manby Surgery.

The practice has a higher than average number of patients between the ages of 50 and 84 years of age and 74% of patients have a long standing health condition compared to the national average of 54%.

The practice provides on-line services for patients such as to book routine appointments, ordering repeat prescriptions and ability to view patient summary care records.

The practice is a training practice for nurse students enrolled on undergraduate and post graduate education programmes with the University of Lincoln.

The practice is part of a federation called ‘East Lincolnshire Federation Group. This federation had been established prior to our inspection and was still in its infancy.

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

Updated 3 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at North Somercotes Surgery on 13 April 2017. 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 a system in place for reporting and recording significant events.

• The practice had clearly defined and embedded systems to minimise risks to patient safety.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.

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

• If families had suffered bereavement, their usual GP sent a letter to the bereaved family member/s or carer of the deceased patient and offered an appointment at a convenient time and access to bereavement services.

• The practice had signed up to the Dispensing Services Quality Scheme (DSQS), which rewarded practices for providing high quality services to patients using their dispensary.

• The practice had been awarded a ‘Lincolnshire Carer’s Quality Award’ due to the success of their carers support programme. The practice had identified 143 patients as carers (2.5% of the practice list). Written information was available to direct carers to the various avenues of support available to them. Older carers were offered timely and appropriate support.

• 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvement are:

• Review the process for medicines incidents or ‘near misses’ to ensure learning from these near misses takes place and evidence and actions taken as a result are documented.

• Address the issues highlighted in the national GP patient survey in order to improve patient satisfaction, including in respect of satisfaction on access to appointments and use of the appointments system and also in respect of consultations with GPs and nurses.

• Review meeting structures to ensure all staff groups including dispensary staff working across both surgeries have the opportunity to attend practice meetings. In particular, to ensure all staff are involved in discussions to enable learning from significant events, complaints, incidents and near misses.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 July 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators was 89% which was comparable to the CCG average of 93% and the national average of 90%. (This included an exception reporting rate of 8% which was lower than the CCG average of 11% and the national average of 12%).

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• All these patients had a named GP and there was a system to recall patients for 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 multidisciplinary package of care.

Updated 3 July 2017

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

• Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us, on the day of inspection, 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.

• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

• Childhood immunisations were carried out in line with the national childhood vaccination programme. Uptake rates for the vaccines given were comparable to CCG/national averages for most vaccines given. For example, rates for the vaccines given to under two year olds ranged from 93% to 97% and five year olds from 80% to 92%.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

• The practice’s uptake for the cervical screening programme was 81%, which was comparable with the national average of 81%.

Updated 3 July 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

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

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

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

• The practice provided a delivery service from their dispensary for patients requiring medications to be delivered to their home address.

Updated 3 July 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours and Saturday appointments.

• 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 an appointment text reminder service for patients.

• The practice provides on-line services for patients such as to book routine appointments, ordering repeat prescriptions and ability to view patient summary care records.

• The practice provided extended hours appointments at the Manby Surgery.

Updated 3 July 2017

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

• The practice carried out advance care planning for patients living with dementia.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• Performance for mental health related indicators was 95% which was higher than the CCG average of 89% and the national average of 93%. (This included an exception reporting rate of 6% which was lower 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 living with dementia.

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

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

Updated 3 July 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.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

• 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.