Archived: Quayside Medical Centre

Updated 2 October 2017

Quayside Medical Centre, 76B Cleethorpe Road, Grimsby, South Humberside, DN31 3EF is a GP practice with an Alternative Provider Medical Services (APMS PMS contract. It has been under the governance of Care Plus Group (North East Lincolnshire) Limited since September 2016.

The practice provides a service to 2,699 patients.

The practice has locum GPs (two are male and one female), two advance nurse practitioners (1 whole time equivalent (w.t.e.)), four practice nurses (2 w.t.e.), two healthcare assistants (1 w.t.e.). They are supported by a practice manager, four reception/ administrative staff and a site coordinator.

The majority of patients are of white British background. The practice population profile is higher than the England average for the 0-4 years and 25-39 years age groups and lower than the England average for the other age groups. The practice scored one on the deprivation measurement scale, the deprivation scale goes from one to ten, with one being the most deprived. People living in more deprived areas tend to have a greater need for health services.

Quayside Medical Centre is open 8 am till 6.30pm Monday to Friday with extended hours offered on Wednesdays until 7.30pm. There is a telephone triage system in place for patients who need to see a GP.

Out of Hours care (from 6.30pm to 8am) is provided through the local out of hours service.

Updated 2 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Quayside Medical Centre on 25 July 2017. Overall the practice is rated as requires improvement.

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

• There was a system in place for reporting and recording significant events. However we found the recording in minutes was limited so staff would learn little from an event.
• The practice had some systems to minimise risks to patient safety. However we found processes were not in place for the review of all high risk medicines. Immediately following the inspection the practice introduced systems for the review for all high risk medicines.

• Staff were aware of current evidence based guidance.
• Results from the national GP patient survey published in July 2017 showed that patient’s satisfaction with how they could access care and treatment was below local and national averages for five out of the six questions. Care Plus Group had been providing services at Quayside from August 2016. At the time of the inspection it was acknowledged that the service was still in a period of transition in terms of process and quality.
• The practice had a practice improvement plan in place which reflected the vision and values and was regularly monitored.
• The most recent published QOF results were 67% of the total number of points available which was lower when compared with the clinical commissioning group (CCG) average of 95% and national average of 95%. Exception report was 10% comparable to the CCG average of 8% and the England average of 10%. Although these figures relate to the previous provider, the provider provided evidence of QOF data for 2016/2017 which had not been published yet showed similar performance.
• Information about services and how to complain was available. We found some evidence that improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider must make improvement are

• Ensure care and treatment is provided in a safe way to patients
• Ensure staff are, suitably trained, competent, and experienced to provide care and treatment to patients.

The areas where the provider should make improvement are

• Ensure learning from significant events is shared appropriately.
• Review the system that identifies patients who are also carers to help ensure that all patients on the practice list who are carers are offered relevant support if appropriate.
• Continue to work to their action plan to address identified concerns with infection prevention and control practice.
• Ensure the medicines refrigerator contents are stored securely.
• Take steps to improve patient satisfaction.
• Continue to work to improve patient outcomes in terms of the Quality and Outcomes Framework (QOF)

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 October 2017

The practice was rated as requires improvement for safe, effective and responsive. The issues identified affected all patients including this population group.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• 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.
• Performance for diabetes related indicators was lower than the CCG and national averages. (Practice rate is 32% compared to the CCG average of 88% and the national average of 90%). This data is for the period 1st April 2015 – 31st March 2016 however the provider provided evidence of QOF data for 2016/2017 which had not been published yet which showed similar performance.
• 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 2 October 2017

The practice was rated as requires improvement for safe, effective and responsive. The issues identified affected all patients including this population group.

• 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. However not all staff were aware of the Gillick competency test and the Fraser guidelines.
• The practice provided support for premature babies and their families following discharge from hospital.

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

Updated 2 October 2017

The practice was rated as requires improvement for safe, effective and responsive. The issues identified affected all patients including this population group.

• 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 2 October 2017

The practice was rated as requires improvement for safe, effective and responsive. The issues identified affected all patients including this population group.

• 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.
• 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 2 October 2017

The practice was rated as requires improvement for safe, effective and responsive. The issues identified affected all patients including this population group.

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

• 50% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months which was lower than the CCG average of 90% and the national average of 84%.
• 36% of patients with schizophrenia and other psychoses had a comprehensive, agreed care plan documented in preceding 12 months which was lower than the CCG average of 92% and the national average of 89%.
• The practice did not have a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• 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 2 October 2017

The practice was rated as requires improvement for safe, effective and responsive. The issues identified affected all patients including this population group. The practice held a register of patients living in vulnerable circumstances including asylum seekers, refugees 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.