Greater Peterborough Network (Extended Hours Service)

Updated 10 August 2017

Greater Peterborough Network (GPN) was set up in 2015 by local GPs, and the service is commissioned by NHS England to deliver seven day extended hours access to routine primary care, the service is provided at Boroughbury Medical Centre in the city centre. Local practices that join as members of GPN are able to book appointments for their patients directly into this service or patients can be allocated appointments via NHS 111. The service does not take direct bookings from patients. Services offered include GP and nursing appointments, long term condition reviews, wound clinics, cervical screening, health promotion and phlebotomy. Annual health checks are available for patients with a learning disability. The service provides primary care to patients registered with 28 local practices who cover the city of Peterborough and surrounding area.

The service was commissioned to provide 130 hours per week of access in extended hours. Appointments can be booked up to 14 days in advance and they offer same day appointments.

The extended hours service operates from 6.30pm to 8.30pm on weekdays, and from 9am to 5pm on weekends and bank holidays. To access the service during these hours, patients phone their own GP practice or NHS 111. They are given an appointment to attend the GP Hub at Boroughbury Medical Centre. The GP hub has good access by train or bus as well as free parking facilities. The service did not provide a GP out-of-hours service.

All of the GPs who work in the extended hours service are from the member practices, are self-employed, and work on a sessional basis. In addition to GPs the provider uses the services of employed and sessional nurses, and health care assistants.

Updated 10 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Boroughbury Medical Centre (Extended Hours Service) on 29 June 2017. Overall the service 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 recording, reporting and learning from significant events.
• Risks to patients were assessed and well managed.
• Patients’ care needs were assessed and delivered in a timely way according to need.
• 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. We noted that some staff employed on a sub-contractor basis were overdue refresher training.
• There was a system in place that enabled staff to access and add information to the patient records.
• The service managed patients’ care and treatment in a timely way.
• Patients said they were treated with compassion, dignity, and respect and they were involved in their care and decisions about their treatment.
• Information about service 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.
• The service had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and most staff felt supported by management. However, some staff we spoke with did not always feel engaged with the senior management team. The service proactively sought feedback from staff and patients, which it acted on.
• The service was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• The system in place should ensure that all staff have received all training that is appropriate to their role in a timely manner.

• Effective communication and engagement should be in place to ensure all staff are engaged with the senior management team.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 August 2017

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

• Nurses and GPs with specialist skills were employed to undertake the management of long term conditions.

• GP practices were able to book appointments with the service for patients in the evening and weekends, making it more convenient for patients who could not attend their GP practice during the day.

• Appointments were available through the patients GP practice or through the national NHS 111 system, this service ensured that emergency processes were in place for patients with long-term conditions who experienced a sudden deterioration in health.

• The service used the same electronic medical records system as the GP practices. This ensured that consistent and standardised recording for services such as annual health checks was used and that information was easily accessible to the patient’s own GP.

Updated 10 August 2017

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

• We found there were systems to identify children living in disadvantaged circumstances and who were at risk. For example, children and young people who had been identified through the GP practice and whose records were flagged.

• 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. Furthermore, through the opportunity to book appointments via the national NHS 111 service the extended hours service offered young people the opportunity to see GPs or nurses outside of school hours.

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

Updated 10 August 2017

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

• GP practices were able to pre-bookable appointments into the extended hours service that were convenient to the patient, their family, or carers.

• The service offered complex wound dressing during the evenings and weekends. This ensured patient’s dressings were changed in a timely manner.

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

• The service used the same electronic medical records system as the GP practices. This ensured that consistent and standardised recording for services such as annual health checks was used and that information was easily accessible to the patient’s own GP. This ensured that continuity of care was maintained.

Updated 10 August 2017

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

• The needs of this population group had been identified and the extended hours service ensured these were accessible, flexible and offered continuity of care. For example, GP practices were able to pre book appointments for routine health care such as cervical screening, annual reviews of long term conditions, smoking cessation and healthy lifestyle advice.
• GP appointments could be booked on the day for patients who required medical advice; these appointments were available from 6.30pm to 8.30pm Monday to Friday.
• Routine appointments for GP and nurses were available at the weekends.

• NHS health checks were available at times convenient to the patient.

• The service used the same electronic medical records system as the GP practices. This ensured that consistent and standardised recording for services such as annual health checks was used and that information was easily accessible to the patient’s own GP.

Updated 10 August 2017

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

• The service had systems and process in place to ensure patients who required urgent mental health support were referred appropriately and in a timely manner to the appropriate mental health service.

• The service had a system for restricting prescribing for patients. Staff we spoke with told us that they would only supply a limited amount of medicines to a patient and inform the patient they would need to contact their own GP for a further review.

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

• Staff, including nurses and non-clinical staff, had received training and had a good understanding of how to support patients with mental health needs and dementia.

Updated 10 August 2017

The service is rated as good for the care of people whose circumstances may make them vulnerable.

• The service had easy access to identify vulnerable patients and ensured appropriate communication between the service and the GP practice.

• The service offered longer appointments for patients with a learning disability. For those patients attending for an annual review the service used a template to record the finding that was consistent with that used in the practices.

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

• 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 during normal out of hours.

• A hearing loop was available for those patients that wished to use it.

• Clinical staff undertook chaperone duties. We saw posters and information advising patients of this service in the waiting areas and consultation rooms.