Archived: Plowright Medical Centre

Updated 3 November 2017

Plowright Medical Centre provides primary care services to approximately 6,000 patients. The main surgery opened in 2005 and in 2008 won the national sustainability award for energy efficiency and beat 210 new NHS health centres in minimal carbon dioxide omissions.

The surgery is located at Jack Boddy Way, Swaffham, PE37 7HJ. The branch surgery at Necton, opened in 1995, and is located at North Pickenham Road, Necton PE37 8EF.

The practice has one male GP and is supported by one salaried male GP with a further GP due to start in October 2017. Four regular locum GPs (three female, one male) also provide sessions at the practice offering continuity of care to the patients. There are four practice nurses, four health care assistants, twelve administrative staff, a practice manager, and nine dispensary staff.

The practice was able to offer dispensing services to those patients on the practice list who lived more than one mile (1.6km) from their nearest pharmacy. Both sites have a dispensary and we visited both sites as part of this inspection.

Plowright Surgery Swaffham is open Monday to Friday from 8.30am to 6.30pm and closed from 1pm to 2pm on Tuesdays.

Necton Surgery is open Monday to Friday from 8.30am to 12pmand 2pm to 5pm and on Thursdays the surgery is closed from 12pm.

Out of hours care is provided by Integrated Care 24 through the 111 non-emergency services.

The practice had a higher number of patients on their register aged 60 years and over compared to the national average, with over 1200 patients over the age of 70 (22%).

Figures showed that 66% of patients had a long-standing health condition compared to the national average of 54%.

Updated 3 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Plowright Medical Centre on 27 September 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 an effective system in place for reporting and recording significant events. The practice were able to evidence significant events were recorded and discussed at practice meetings.
• Risks to patients were assessed and well managed. Comprehensive risk registers were held and gave clear management oversight.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge, and experience to deliver effective care and treatment.
• Results from the GP patient survey showed patients rated the practice in line with or below others for several aspects of care.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they did not always find it easy to make an appointment with a named GP, but that urgent appointments were 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 upon.
• The provider was aware of and complied with the requirements of the duty of candour.
• Clinical and non-clinical audits were carried out.
• The practice had implemented a system to email patients regarding flu vaccinations once consent had been received. The practice told us that this had contributed to the increased number of flu vaccinations they had performed to date. The number of vaccines given up to the day of the inspection already exceeded the total given in the whole full season last year.

We saw areas of outstanding practice:

• The practice provided accommodation for two wellbeing counsellors and the service was available for all patients in the community. The practice provided and paid for the services of three additional counsellors for three sessions a week, with different areas of expertise including child adolescent and psychotherapy, mental health, post-natal depression, hypnotherapy, cognitive behavioural therapy, eating disorders, post-traumatic stress, phobias and depression. Clinics slots were for one hour and a quiet room with settees had been made available to help make patients feel relaxed and comfortable. Since January 2017, they have provided 430 appointments to over 80 patients whose ages have ranged from under 16 to over 90 years old. We reviewed comments from the patient feedback which were all positive about the help they had received and the positive impact on their lives.

• The practice employed a member of staff as a single point of contact for safeguarding (SPOC). This staff member was trained to safeguarding level two and worked with the GP safeguarding leads and with other agencies and health professionals such as health visitors and community nurses. All safeguarding information received was directed to this staff member and they held discussions and meetings with any relevant agencies and professionals to prepare the reports for the practice safeguarding lead and other professionals to use when attending any case conferences. We reviewed three examples where this had been beneficial to professional’s involved and ensured safer management of the person(s) concern.

The areas where the provider should make improvement are:

• Continue to monitor patient satisfaction as highlighted in the national GP patient survey and the impact of changes made in response to patient feedback.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 November 2017

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

• Nursing staff had lead roles in chronic disease management including asthma and diabetes. The practice nurses had received specific training in diabetes, asthma, and chronic obstructive pulmonary disease, to support the GPs’ management of long term condition patients.
• The practice provided facilities for the diabetic retinopathy (eye screening) service to see patients on site.
• Longer appointments and home visits were available when needed.
• All patients had a named GP and 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. Bi-monthly multi-disciplinary meetings took place to discuss palliative care and reviews.
• The practice had significantly improved on the delivery of flu vaccinations for patients at risk. On the day of the inspection they had already exceeded their performance for 2016 and had further Saturday clinics planned.
• Home visits were available for patients whose condition made it difficult for them to attend the surgery.
• Same day appointments were offered if needed.
• The care home matron monitored patients in care homes and reported to the senior partner if intervention was required.

Updated 3 November 2017

The practice is rated as good overall for the care of families, children, and young people. The practice is rated as outstanding for providing safe services to families, children and young people.

• Children were prioritised and fast tracked with regards to same day appointments.
• Appointments were staggered throughout the day making it easier for patients to book appointments for children before or after school.
• The practice employed a member of staff as a single point of contact for safeguarding (SPOC). This staff member worked with the GP safeguarding leads and with other agencies such as health visitors and community nurses. All safeguarding information received or required was directed to the SPOC. The SPOC was able to gather all information to give an overview of all safeguarding concerns. We reviewed three examples where this had been beneficial to professional’s involved and ensured safer management of the person(s) concern.
• The practice had set up a social media website page to keep people up-to-date with changes or information about the services provided. Information included the introduction of a patient self-check in screen and a link to join the friends of Plowright Medical Centre Swaffham.
• Saturday flu clinics were available for patients unable to attend during the week.
• 82% of female patients aged 25-64, attended for cervical screening within the target period compared to the CCG average of 84% and the national average of 82%.
• Travel vaccines were available, by appointment, during normal clinic times.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• School readiness health checks were offered at which additional support was offered for children preparing to start school, including communication, physical exercise and dental health.
• The practice had employed the services of a counsellor with specific skills in child psychotherapy and eating disorders and post natal depression.

Updated 3 November 2017

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

• The practice offered proactive, personalised care to meet the needs of the 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.
• A medicines delivery service was offered to vulnerable patients and those with long-term conditions and frailty who could not attend the surgery.
• The practice had significantly improved the uptake of flu vaccinations and the practice nurse attended housebound patients to ensure.
• The practice provides facilities for other agencies such as Age UK, West Norfolk befrienders and West Norfolk Carers to provide a monthly drop in clinic.
• Monthly hearing aid clinics are hosted to ensure that patients are able to access support and new batteries easily and closer to home.

Updated 3 November 2017

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

• 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 reflects the needs for this age group.
• Telephone consultations were available for patients unable to attend the surgery.
• The practice had an internet social media page which gave useful health information and information on the services provided at the surgery.

Updated 3 November 2017

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

• 82% of patients with dementia or poor mental health were telephoned prior to their appointment as a reminder that the appointment was due, and to check if the patient had any concerns or worries.
• 100% of patients diagnosed with mental health issues had a comprehensive care plan documented in their records in the preceding 12 months which was 7% above the CCG average and 2% above the national average.Exception reporting was 2% compared to the CCG and national average of 11%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• The practice had recently signed up to be a dementia friendly practice; they had dementia friendly posters in the waiting rooms. The practice had considered and planned the design of the recently built restrooms to ensure these were reflective of dementia patient’s needs. They had incorporated different coloured seating and signs on the doors to make these areas dementia friendly and promote independence for these patients
• The practice employed counsellors to work at the practice. The practice had considered the population and employed three counsellors with special interests in child, adolescent and adult mental health to ensure they met the needs of the whole population. This service had proved popular with patients and was reflected in the CQC comment cards.

Updated 3 November 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.
• 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 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, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

• The practice employed a member of staff as a single point of contact for safeguarding (SPOC). This staff member was trained to safeguarding level two and worked with the GP safeguarding leads and with other agencies and health professionals such as health visitors and community nurses. All safeguarding information received was directed to this staff member and they held discussions and meetings with any relevant agencies and professionals to prepare the reports for the practice safeguarding lead and other professionals to use when attending any case conferences. We reviewed three examples where this had been beneficial to professional’s involved and ensured safer management of the person(s) concern.