Two Rivers Medical Centre

Updated 2 March 2018

The practice area covers the town of Ipswich and extends into the outlying villages. The practice offers health care services to approximately 24,700 patients. The practice was formed as a result of a merger of two GP practices in April 2015. Since the merger, they have also managed the building of and relocation to a new, purpose built health centre in July 2016. The centre has consultation space for GPs and nurses, midwives and mental health link workers. The centre also accommodates the community glaucoma service, hearing service and specialist physiotherapy service. The practice holds a Primary Medical Service (PMS) contract with the local CCG.

• There are three GP Partners at the practice (two female and one male), nine associate (salaried) GPs (four female and five male), five nurse practitioners, all of whom are independent nurse prescribers, seven practice nurses, three practice paramedics, four health care assistants and two practice pharmacists.
• A team of administration, reception, medical secretaries and information technology staff support the management team. The business manager is support by a practice operations manager, a deputy practice operations manager, a reception manager and an information technology manager.
• The practice is open between 8am and 6.30pm Monday to Friday. Extended hours are available from 7.30am Monday to Friday and until 7.30pm on Tuesday. Patients are able to book evening and weekend appointments with a GP through Suffolk GP+ (Suffolk GP+ is for patients who urgently need a doctor’s appointment, or are not able to attend their usual GP practice on a weekday.)
• When the practice is closed, Care UK provide the out of hours service; patients are asked to call the NHS 111 service to access this service, or to dial 999 in the event of a life threatening emergency.
• The practice demography is similar to the Clinical Commissioning Group (CCG) and national average, with slightly more male patients aged between 35 to 39 and 45 to 49. Income deprivation affecting older people is higher than the CCG average and similar to the national average.
• Male and female life expectancy in this area is in line with the England average at 81 years for men and 85 years for women.

Updated 2 March 2018

We carried out an announced comprehensive inspection at Two Rivers Medical Centre on 15 August 2017. The practice was rated as requires improvement for providing safe services and good for providing effective, caring, responsive and well led services. Overall the practice was rated as good. The full comprehensive reports on the 15 August 2017 inspection can be found by selecting the ‘all reports’ link for Two Rivers Medical Centre on our website at www.cqc.org.uk.

We carried out an announced focused inspection at Two Rivers Medical Centre on 19 February 2018. This was to check they had followed their action plan and to confirm they now met legal requirements in relation to the breaches identified in our previous inspection on 15 August 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good, and good for providing safe services.

Our key findings from this inspection were as follows:

• The practice had effective systems in place to ensure that Disclosure and Barring Service (DBS) checks were completed for all staff who worked unsupervised with patients.
• Significant events were investigated, reviewed and all learning had been identified and outcomes were monitored to completion.
• Emergency medicines were stored appropriately and room temperatures were recorded to ensure these medicines were stored within the recommended range.
• Portable electrical appliance testing had been undertaken in September 2017.
• The practice had five nurse practitioners, all of whom had qualified as Independent Prescribers and could therefore prescribe medicines for specific clinical conditions. They received support from GPs for this extended role; however there was no formal review of their work.
• The practice had a carers’ champion and a dedicated carers’ information board in the reception area. Work had been undertaken to ensure that patients identified as carers had been coded appropriately. The practice had identified 549 patients as carers, which was just over 2% of the practice list.

The areas where the provider should make improvements are:

• Consider the need to formally review the work undertaken by the nurse practitioners to obtain assurance of the quality of their work.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 September 2017

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

• The practice used the information collected for the Quality and Outcomes Framework (QOF) to monitor outcomes for patients (QOF is a system intended to improve the quality of general practice and reward good practice). Data from 2015/2016 showed that performance for diabetes related indicators was 83%, which was below the local average of 93% and national average of 90%. Unverified data from 2016/2017 (which excluded any exceptions) showed the practice had improved performance in this area.
• GPs and nursing staff had lead roles in chronic disease management. The practice offered annual checks to ensure patients’ health and medicine needs were being met. These were scheduled in line with the patient’s month of birth to ensure more effective coordination. The practice pharmacist undertook regular medicine reviews for patients with long term conditions.
• Patients were involved in their own care with management plans being in place for patients with chronic obstructive pulmonary disease (COPD), asthma and diabetes.

• Longer appointments and extended hours appointments were available. Reviews for housebound patients with long term conditions were undertaken by paramedics employed by the practice.
• 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 21 September 2017

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

• There were systems in place 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 attendances.
• Immunisation rates were in line with the CCG and national averages for all standard childhood immunisations.
• We saw evidence that children and young people were treated in an age-appropriate way and were recognised as individuals.
• The practice offered a full range of contraception services and chlamydia screening.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice offered baby changing facilities and a breastfeeding room to allow privacy to nursing mothers.
• Midwives were based in the health centre. We saw positive examples of joint working with health visitors and social care.
• The practice provided primary care services to patients, parents and carers during their stay at a local children’s hospice.

Updated 21 September 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.
• GPs, paramedics and nursing staff provided home visits to patients living in the 13 nursing and residential homes covered by the practice.
• Frail patients have been identified using a computer based tool and coded accordingly. These patients were reviewed to ensure they were not unnecessarily prescribed medicines which may cause confusion or falls.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis, dementia and heart failure were above the local and national averages.
• The practice patient participation group held a health education awareness event for older people in May 2017. Patients were signposted to organisations who specialised in services for older people.

Updated 21 September 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.

• Extended hours appointments were available from 7.30am Monday to Friday and until 7.30pm on Tuesday. Patients were able to book evening and weekend appointments with a GP through Suffolk GP+ (Suffolk GP+ is for patients who urgently need a doctor’s appointment, or are not able to attend their usual GP practice on a weekday.)
• 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.
• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 83%, which was in line with the local and national average of 82%.

Updated 21 September 2017

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

• 84% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was the same as the CCG and England average.
• 71% of patients experiencing poor mental health had a comprehensive care plan, which was below the CCG and the national average of 89%. 2016/2017 unverified data from the practice (which excluded any exceptions) showed the practice had improved performance in this area to 96%.
• The practice worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice worked with two mental health link workers who held four clinics per week for patients. The link workers were based in the practice.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia. 22 members of staff had received dementia awareness training. The practice were in the process of becoming a dementia friendly GP practice.

Updated 21 September 2017

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

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. This included patients with drug and alcohol misuse, some of whom the practice supported through a shared care agreement.
• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
• There were 100 patients on the learning disability register. 78 of these patients had received an annual health check in the last 12 months.
• Longer appointments were offered for patients whose circumstances may make them vulnerable.
• Vulnerable patients were informed about how to access various support groups and voluntary organisations.
• Staff had received deaf awareness training.
• 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’s computer system alerted GPs if a patient was also a carer. The practice had identified 155 patients as carers (0.6% of the practice list). However the practice felt there may be a coding issue where some carers had an alert rather than a code, which would not be counted when searches were undertaken.