Archived: Meden Medical Services

Updated 28 September 2017

Meden Medical Services provides primary medical services to approximately 6,088 patients through a personal medical services (PMS) contract. The practice is located seven miles north of Mansfield in the village of Meden Vale. The practice has a branch surgery at Warsop Primary Care Centre which is a modern purpose built health centre located two miles away from the main surgery. We visited the branch surgery as part of this inspection. This area has historical links to the mining industry.

The practice is located within the area covered by NHS Mansfield and Ashfield Clinical Commissioning Group (CCG). It is registered with the Care Quality Commission to provide the regulated activities of; the treatment of disease, disorder and injury; diagnostic and screening procedures; family planning; maternity and midwifery services and surgical procedures.

The practice provides services to patients who reside in three care homes and one learning disability unit in Meden Vale and the surrounding areas.

The level of deprivation within the practice population is above the national average, but below the average for the clinical commissioning group (CCG). However, income deprivation affecting older people is below the national average. The patient population has a higher than average prevalence of chronic diseases

The clinical team comprises two GPs (one male and one female), the practice employs the services of three locum GPs, one nurse practitioner and one practice nurse, two healthcare assistants and tone phlebotomist. The clinical team is supported by a practice manager who is assisted by a reception supervisor and an administrative assistant. In addition, there are a team of reception staff and medical secretaries.

The practice is not a designated training practice; however the senior GP is a tutor and hosts first and second year medical students one morning a week during term time from the Nottingham University Medical School.

The Meden Vale surgery is open from 7am to 6.30pm on Mondays, from 7am to 7.30pm on Tuesdays, 7am until 12 noon on a Wednesday and Thursday and from 8am until 6.30pm on a Friday. The Warsop surgery is open from 8am until 6.30pm Monday to Friday with the exception of a Tuesday when the practice opens at 7am. Patients could access appointments at either surgery.

The practice has opted out of providing out-of-hours services for its own patients. This service is accessed by patients via NHS111 and is provided by Primary Care 24 located at Kings Mill Hospital, Nottingham which can be contacted via NHS111.

Updated 28 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Meden Medical Services on 16 December 2015. The practice was rated as requires improvement overall. The fully comprehensive report on the December 2015 inspection can be found by selecting the ‘all reports’ link for Meden Medical Services on our website at www.cqc.org.uk.

We carried out a further announced comprehensive inspection at Meden Medical Services on 27 June 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, there had been no significant events reported or reviewed since December 2016 for both the main and branch surgeries.

• Data showed patient outcomes were low compared to the national average.

• Data from the GP patient survey showed that patients rated the practice lower than average for several aspects of care. However, patients we spoke with said they were treated with compassion and respect and were involved in their care and decisions about their treatment. Feedback received from 18 CQC patient comment cards were all positive about their experience of the practice.

• Information about services and how to complain was available and easy to understand.

• The practice and branch surgery had good facilities and was well equipped to treat patients and meet their needs.

• The practice provided a range of services to meet the needs of its population. For example, the practice offered a minor injuries service.

• There was a leadership structure in place and staff told us they felt supported by management.

• The practice sought feedback from staff and patients, which it acted on. The practice had an active patient participation group (PPG) in place who met on a regular basic and carried out patient surveys in the patient waiting area.

The areas where the provider must make improvements are:

• Address the issues highlighted in the national GP survey in order to improve patient satisfaction, including appointment access and consultations with GPs and nurses.

• Ensure there is an effective system in place to manage and monitor processes to improve outcomes for patients.

• Review process in place to ensure blank prescription forms are tracked throughout the practice.

In addition the provider should:

• Continue to review the process for significant events on a regular basis to ensure any themes or trends are identified and learning has been embedded.

• Provide practice information to patients in particular in relation to the practice zero tolerance policy for patients.

• Ensure that safety updates from the MHRA received by the practice, are disseminated to relevant members of staff ensuring adequate records are held to evidence that relevant staff have received these alerts and actions taken as necessary.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 September 2017

The practice is rated as requires improvement for the care of people with long-term conditions. The service is rated as requires improvement for providing safe, effective, responsive and well led services and good for providing caring services. The evidence which led to these ratings applies to all population groups, including this one.

• Longer appointments and home visits were available when needed.

• Performance for diabetes related indicators was 76% which was lower than the CCG average of 85% and the national average of 90%.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The practice had a clinical prevalence of chronic obstructive pulmonary disease (COPD) which was significantly above the national average. (COPD is the name for a collection of lung diseases). However, performance for indicators to measure the management of COPD was below local and national averages. For example, performance for chronic obstructive pulmonary disease related indicators was 84% which was lower than the CCG average of 93% and the national average of 96%.

Updated 28 September 2017

The practice is rated as requires improvement for the care of families, children and young people. The service is rated as requires improvement for providing safe, effective, responsive and well led services and good for providing caring services. The evidence which led to these ratings applies to all population groups, including this one.

• 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.

• Childhood immunisations were carried out in line with the national childhood vaccination programme. Uptake rates for the vaccines given were comparable to CCG/national averages. For example, rates for the vaccines given to under two year olds ranged from 91% to 94% which was above the national expected standard of 90%.

• The practice’s uptake for the cervical screening programme was 81%, which was comparable with the CCG average of 84% and the national average of 81%.

• 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.

• 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 made efforts to engage with young people and had a noticeboard dedicated to under 16s.

Updated 28 September 2017

The practice is rated as requires improvement for the care of older people. The service is rated as requires improvement for providing safe, effective, responsive and well led services and good for providing caring services. The evidence which led to these ratings applies to all population groups, including this one.

• 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.

• 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 28 September 2017

The practice is rated as requires improvement for the care of working age people (including those recently retired and student). The service is rated as requires improvement for providing safe, effective, responsive and well led services and good for providing caring services. The evidence which led to these ratings applies to all population groups, including this one.

• 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 offered extended hours services three mornings per week from 7am and until 7.30pm one evening per week at one of its two sites.

• The practice offered online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 28 September 2017

The practice is rated as requires improvement for the care of people experiencing poor mental health. The service is rated as requires improvement for providing safe, effective, responsive and well led services and good for providing caring services. The evidence which led to these ratings applies to all population groups, including this one.

• In 2014-15, performance for mental health related indicators was 69.2% which was 21.9% below the CCG average and 23.6% below the national average. Data for 2015-16 demonstrated that the practice had made improvements however, performance was still below local and national averages in respect of mental health related indicators. For example, performance for mental health related indicators was 84% which was lower than the CCG average of 89% and the national average of 93%.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

Updated 28 September 2017

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. The service is rated as requires improvement for providing safe, effective, responsive and well led services and good for providing caring services. The evidence which led to these ratings applies to all population groups, including this one.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.

• The practice worked with multi-disciplinary teams in the case management of vulnerable people.

• The practice had information for 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.