Archived: Nelson Medical Practice

Updated 20 September 2017

In 2011, Nelson Medical Practice joined East Coast Community Healthcare Community Interest Company (ECCH), who are the provider for the practice. ECCH is a provider of over 30 community services, which includes four GP practices and has been established for six years.

Nelson Medical Practice provides services to approximately 6,400 patients in an urban area in Great Yarmouth. The practice has one male salaried GP. There is a practice manager on site. The practice employs two practice nurses and two advanced nurse practitioners. The practice also employs one health care assistant. East Coast Community Healthcare also provides a primary care practitioner and a pharmacist. Other staff include seven receptionists, one secretary, one reception manager, one prescribing administrator and a deputy practice manager. The practice holds an Alternative Provider of Medical Services contract with NHS England. Nelson Medical Practice is a training practice for student nurses and two of the nurses are trained for this role.

The practice is open between 8am and 6.30pm Monday to Friday. Extended hours appointments are available between 7.30am and 8am on Mondays and Fridays. Appointments can be booked up to four weeks in advance with the GP and nurses. Urgent appointments are available for people that need them, as well as telephone appointments. Online appointments are available to book up to one month in advance.

When the practice is closed patients are automatically diverted to the GP out of hour’s service provided by Integrated Care 24. Patients can also access advice via the NHS 111 service.

We reviewed the most recent data available to us from Public Health England which showed the practice has a smaller number of patients aged 70 to 89 years old compared with the national average. It has a larger number of patients aged 20 to 39 compared to the national average.

Income deprivation affecting children is 39%, which is higher than the CCG average of 26% and national average of 20%. Income deprivation affecting older people is 29%, which is higher than the CCG average of 17% and national average of 16%. Life expectancy for patients at the practice is 75 years for males and 81 years for females; this is comparable to the CCG and England expectancy which is 80 years and 83 years.

Updated 20 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Nelson Medical Practice on 27 July 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 at practice and provider level.
• The practice had some defined and embedded systems to minimise most risks to patient safety. However, the system to ensure patients had received their medicines needed to be improved as we found prescriptions that had not been collected since February 2017.
• The daily check list for emergency medicines was incomplete; however all medicines were in date.
• Exception reporting for the Quality and Outcomes Framework (QOF) was high compared to local and national averages and uptake for breast and bowel screening was low. The practice were aware of this and had a policy and plan in place to address this.
• Results from the GP patient survey, published in July 2017, below average for several aspects of care. 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.
• The practice had identified 240 patients as carers (3.8% of the practice list).
• 30% of the practice population did not have English as a first language. The practice had recognised this and provided documents in different languages.
• The practice had a ‘care connector’ who went to local meetings with voluntary groups and helped to sign post patients to relevant local services.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The infection prevention and control lead completed three monthly audits of room cleaning to ensure compliance.
• 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 and East Coast Community Healthcare (ECCH). The practice proactively sought feedback from staff and patients, which it acted on. However, the practice had recently lost a clinical lead and were being supported by ECCH until a new lead was appointed.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

We saw one area of outstanding practice:

• The practice held an information event in March 2017 to encourage fitness in patients registered at the practice. The practice had recognised that access to and involvement in exercise for their population group was limited. 60 patients attended the event and 58 signed up to the five week exercise plan. 38 patients had completed the 5 week plan and this enabled them to gain a free gym membership. This was an initiative of, and was funded by ECCH and had improved health outcomes for patients. ECCH hoped to run this event again.

The areas where the provider should make improvements are:

• Review the system for managing uncollected prescription scripts.

• Embed the policy and plan to reduce exception reporting ensuring that patients received appropriate follow ups.

• Review the system for the checking of emergency medicines.

• Continue to build on clinical leadership and active recruitment.

• Continue to monitor the effectiveness of actions taken in response to national GP Patient Survey, particularly in relation to patients’ access to the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 September 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, including respiratory complications and diabetes. Patients at risk of hospital admission were identified as a priority.

• The practice had an avoiding unplanned admissions register which was monitored and gave patients a range of options for access to the appropriate health care professional.

• Performance for diabetes related indicators was 92%, this was comparable to the CCG and national average of 90%. The exception reporting rate was 29%, which was higher than the CCG average of 17% and the national average rate of 12%. The prevalence of diabetes was 7% which was equal to the CCG average and 1% above the national average.

• 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 clinician 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. This included the district nurses and social services.

Updated 20 September 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 in line with national targets for all standard childhood immunisations. Children requiring immunisations had open access appointments, which meant they could be seen without pre-booking an appointment. The practice also phoned all patients who did not attend for 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. There were toys in the waiting room available for use.

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

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

• The practice also offered open access appointments to support urgent family planning issues.

Updated 20 September 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 offered weekly visits to local care homes. The practice also contacted the homes daily to establish if there were any concerns about patients and to help reduce unplanned admissions to hospital.

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. They involved older patients in planning and making decisions about their care, including their end of life care. The practice also held meetings with the MacMillan nurses to discuss these patients.

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

• Where older patients had complex needs, the practice shared summary care records with local care services. The practice also held regular meetings with a range of healthcare professionals, including district nurses.

• 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 20 September 2017

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

• 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 and text message reminders.

• The practice offered a full range of health promotion and screening that reflects the needs for this age group, including smoking cessation and alcohol advice.

• The practice held an information event in March 2017 to encourage fitness in patients registered at the practice. This enabled them to gain a free gym membership which improved health outcomes for the participants. This was an ECCH initiative and funded by ECCH.

Updated 20 September 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.

• 69% 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 clinical commissioning group average of 74% and the national average of 78%.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example, the practice had open access for vulnerable patients, including those with poor mental health.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs, but this needed improving. We found repeat prescriptions that had not been collected from February 2017. The practice had not reviewed these.

• The practice had 55 people on the mental health register, 38 of these had their care plans reviewed in the last year.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia. This involved close working with a local mental health team.

• 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 20 September 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 those with a learning disability. The practice had an open access system for vulnerable patients.

• 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 and those requiring translation services.

• The practice had 46 patients on the learning disability register and had reviewed 38 of these patients.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients, including social services and district nurses.

• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations, including domestic abuse.

• The practice had a member of staff trained in domestic abuse who could advise on local support groups and recognise the signs of domestic abuse. There was also a member of staff trained in sign language.

• The practice had a care connector, who liaised with local groups and charities and signposted patients where appropriate.

• Staff we spoke with 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. There were signs in all clinical rooms detailing contact numbers.