North Leverton Surgery

Updated 20 December 2017

The provider of the service is a partnership known as Dr Gemma Maria Brownson and Dr James Richard Reader.

The practice provides services for 2,666 patents within the Bassetlaw CCG under a General Medical Services (GMS) contract.

The practice is situated in a purpose built building. Car parking is available on site or on the road outside the practice. There is an on-site dispensary serving all but one of the practice patients.

There is a higher than average patient population aged over 50 years and lower than average under 45 year old patient population compared to the national average.

There is one female GP partner and one male GP partner. The practice is supported by a practice manager, two practice nurses, a phlebotomist, five dispensers, and an administration and reception team.

The practice and the dispensary is open Monday to Friday 8am to 1pm and 2pm to 6.30pm. Telephone lines are open 8am to 6.30pm Monday to Friday. GP appointments are available Monday to Friday 9am to 12.30pm and 4pm to 5.50pm. A phlebotomy service is provided Tuesday 8.30am to 1pm.

When the practice is closed between 6.30pm and 8am patients are directed to contact the NHS 111 service.

Updated 20 December 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at North Leverton Surgery on 23 May 2017. The overall rating for the practice was Good but with Requires Improvement for safety. The full comprehensive report on the May 2017 inspection can be found by selecting the ‘all reports’ link for North Leverton Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 14 November 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 23 May 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as Good.

Our key findings were as follows:

The provider had made the following improvements to address legal requirements :

• Procedures were in place to ensure medicines provided in compliance aids were packaged safely to reduce the risk of patient harm.
• Medicine fridge temperature monitoring had been improved in relation to provision and resetting of thermometers to maintain the effectiveness and safety of the medicines.
• Security arrangements for keys to the dispensary and controlled drug storage area had been improved.
• Procedures had been implemented in accordance with regulations for controlled drugs which require destruction.
• Records for controlled drug stock had been improved and accurate records were maintained.

The provider had also made improvements in the following areas:

• The fire risk assessment action plan had been reviewed and action had been completed to improve fire safety.
• The legionella risk assessment action plan had been reviewed and measures were being taken to minimise risk.
• Procedures were in place to try to improve uptake for childhood vaccinations. The practice had developed protocols to support practice when patients did not attend for routine vaccination. This included sending three letters to invite them to attend for vaccination and putting alerts on the electronic patient records. Where patients did not attend for vaccination after three letters the clinicians were informed and, where clinicians felt this was necessary, the patients were referred to the health visitor. Following discussion at the inspection staff said they would also add this area as a standing agenda item to their practice meetings to ensure ongoing monitoring of patients who did not attend.
• Systems had been improved to assist the practice to identify carers. They had developed a carers leaflet and patient questionnaire which was included in new patient packs; they had developed a template for clinicians to assist them to identify and record carers and developed a carer’s protocol to support practice. One of the practice administrators monitored the numbers of carers on the register monthly. We observed the number of carers identified had increased from 18 (0.6% of the patient list) at the last inspection to 42 (1.5% of the patient list). We observed a variety of information to support carers was displayed in the practice and these patients were invited for flu vaccines. Organisations which could offer advice for carers, such the local Social Prescribing Team, were invited to the flu clinics.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 5 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 95% similar to the CCG average of 98% and national average of 90%.

• 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 5 July 2017

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

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.

• Immunisation rates were below average in some areas relating to childhood immunisations. For example, measles, mumps and rubella vaccine (MMR) rates for five year olds ranged from 38% to 42% which was below the CCG average of 48% to 50% and national average of 88% to 94%. The practice achieved two out of four 90% target rates for vaccines given to under two year olds with vaccination rates ranging from 69% to 100% for this group.

• 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.

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

Updated 5 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.

• Where older patients had complex needs, the practice shared summary care records with local care services.

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

Updated 5 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, although the practice did not offer extended hours they told us later appointments would be offered to working people.

• 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.

Updated 5 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 had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• Performance for mental health related indicators was 97% similar to the CCG average of 99% and national average of 92%.

• 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.

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

Updated 5 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 had 32 patients with learning disabilities which equated to 1% of the patient population compared to the national average of 0.5%. The practice ensured these patients were regularly reviewed and monitored uptake of annual health checks monthly. The NHS England target for uptake of annual health checks for patients with a learning disability is 75%. During 2016/17 the practice achieved 97% uptake. Reviews were conducted in the patient’s home or at the surgery. The practice provided a wide range of information in easy ready format to enable patients with a learning disability to be involved with their care. The GPs and a member of the administration team had completed learning disability training on annual basis. The practice offered longer appointments for patients with a learning disability and provided support for patients living in local care homes.

• 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.