Staploe Medical Centre

Updated 6 September 2016

Staploe medical centre provides general medical services to approximately 20,600 patients. The practice was formed in 1970 through the amalgamation of three single handed GP practices in Soham and Isleham. The practice grew over the years; with the village of Soham and local villages seeing a more rapid growth over the last five years. The practice moved to the current health centre location in 1990 with extensions to the site in 2001 following the growth of the practice patient list size. The building provides good access with accessible toilets and car parking facilities. The practice provides treatment and consultation rooms on the ground floor with ramp access and automatic doors. The practice is an accredited eastern region clinical research network practice and an accredited training practice. The practice provides services to a diverse population age group, is in a semi-rural location and is a dispensing practice, dispensing to approximately 8000 patients. A dispensing practice is where GPs dispense the medicines they prescribe for patients who live more than 1 mile (1.6km) from a community pharmacy.

There is a team of 58 clinical and non-clinical staff including 12 GPs. Six GPs are partners which means they hold managerial and financial responsibility for the practice and there are six salaried GPs. The practice nursing team consists of the senior nurse/clinical manager, a lead nurse, one nurse practitioner, six practice nurses and five health care assistants (one of whom was currently undertaking training to become a nurse). The nursing team of nine run a variety of appointments for long term conditions, minor illness and family health.

There is a practice manager who is supported by a managerial assistant. In addition there is a team of dispensers and a team of non-clinical administrative, secretarial and reception staff who share a range of roles, some of whom are employed on flexible working arrangements.

The practice is open between 8.30am and 6pm Monday to Friday. Appointments are from 8.40am to 10.30am every morning and 3.30pm to 5.30pm daily. Extended hours appointments are offered from 6.30pm to 9pm Monday evenings and from 8.30am to 10.30 am every Saturday for pre-booked appointments. In addition to pre-bookable appointments that can be booked up to three months in advance, urgent appointments are also available for people that need them. We were told GPs see their own patients where possible to provide continuity of care and all patients with urgent problems are seen on the same day, however not necessarily by their own GP. The practice runs a ‘duty team’ system each day. Where patients request an appointment on the day, contact details are transferred to the duty team consisting of a GP and a practice nurse. The patient is contacted within the hour and where required an appointment or home visit or telephone consultation is allocated with the most appropriate clinician.

The practice does not provide GP services to patients outside of normal working hours such as nights and weekends. During these times GP services are provided by Urgent Care Cambridge via the NHS 111 service.

Updated 6 September 2016

Letter from the Chief Inspector of General Practice

Our key findings across all the areas we inspected were as follows:

We carried out an announced comprehensive inspection at Staploe Medical Centre on 28 April 2016. 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.
• Risks to patients were assessed and well managed.
• 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.
• 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Patients said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments 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 on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw the following areas of outstanding practice;

• The Practice ran a GP team or ‘squadron’ system. GPs were grouped into permanent squadrons to maximise continuity during annual or sick leave. During leave all issues and results for a patient were handled by the same group of GPs with two or more GPs from the same squadron never on leave at the same time, thus maximising continuity of care for patients. The duty GP oversaw the daily triaging of calls, home visits, the agenda for the clinicians morning coffee break meeting and peer review of referrals. The duty team reviewed all out of hours contacts first thing to ensure an early review or visit and where required an early admission to secondary care.
• The practice research team had been recognised as an ‘exemplary medical research team in primary care’ by the National Institute for Health Research (NIHR) and as a consequence had secured two years of awards (research capability funding). The practice acted as a hub for other practices encouraging the Royal College of General Practitioners (RCGP) research ready model and used funds raised by the research team to improve clinical resources and education throughout the practice teams.

The areas where the provider should make improvement are:

• Assess the suitability of the drop-off locations for the safe and appropriate storage of medicines.
• Improve the management of blank prescription forms and to ensure that an audit trail of usage was maintained.
• Ensure that all waiting areas of the practice can be clearly seen by reception staff to ensure the safety and security of vulnerable patients.

  We carried out an announced comprehensive inspection at Staploe Medical Centre on 28 April 2016. Overall the practice is rated as good.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 September 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• 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 2014/2015 showed that performance for diabetes related indicators was 100%, which was above the CCG and the national averages by 11percentage points.
• Longer appointments and home visits were available when needed.
• All these 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.

Updated 6 September 2016

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 A&E attendances.
• Childhood immunisation rates for the vaccinations given were comparable to CCG/national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 72% to 98% and five year olds from 92% to 96%.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses. 

Updated 6 September 2016

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

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure were above local and national averages.
• The practice ensured it prioritised care for their older patients and offered proactive, personalised care to meet the needs of older people. Care plans were in place for older patients with complex needs. All patients had a named GP.
• The practice had administered flu vaccination to 72% of patients who were on the practice register for over 65 years. Shingles and pneumococcal immunisations were also provided.
• The practice oversaw the care of patients in one nursing home and residential homes. There was a lead GP for the nursing home and another GP for the residential homes. The practice ensured there was weekly protected time for these GPs to provide support to these homes.

Updated 6 September 2016

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 offered a ‘Commuter’s Clinic’ from 6.30pm to 9pm Monday evenings and from 8.30am to 10.30 am every Saturday for pre-booked appointments.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs of this age group.
• The practice also encouraged its patients to attend national screening programmes for bowel and breast cancer screening. The bowel cancer screening rate for the past 30 months was 59% of the target population, which was in-line with the CCG average of 59% and the national average of 58%.The breast cancer screening rate for the past 36 months was 62% of the target population, which was below the CCG average of 72% and above the national average of 72%.
• The practice offered NHS health checks for patients aged 40–74. The practice had undertaken in excess of 2,700 of these checks over the last four years.

Updated 6 September 2016

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

• The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months (01/04/2014 to 31/03/2015) was 82% compared to the national average of 84%. Overall performance for dementia indicators were above CCG and national average with the practice achieving 100%. The rate of exception reporting was in line with both the CCG and national averages.
• The percentage of patients experiencing poor mental health who had a comprehensive, agreed care plan documented in their records, in the preceding 12 months (01/04/2014 to 31/03/2015) was 98% compared to the national average of 88%. Overall performance for mental health indicators were also above CCG and national average with the practice achieving 100%. The rate of exception reporting was in line with both the CCG and national averages.
• The practice regularly worked with multi-disciplinary teams in the case management of patients 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. Leaflets were available in the waiting area on a range of services available for patients and carers.
• 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 all undergone mental capacity act training and had a very good understanding of how to support patients with additional mental health needs and dementia.

Updated 6 September 2016

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 had identified 49 patients with a learning disability on the practice register, 42 had received a health checks in the previous twelve months. All these patients had supporting care plans.
• 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.