Billinghay Medical Practice

Updated 31 January 2017

Billinghay Medical Practice provides primary medical services to 4,789 patients from a single surgery situated in the village of Billinghay, Lincolnshire. The surgery was purpose built in 2007 and provides all clinical services on the ground floor.

The nearest 24 hour Accident and Emergency units are in Boston, 16 miles and Lincoln 17 miles distant. Public transport links are very poor and there are pockets of rural deprivation and isolation.

The practice has a higher number of older patients aged 65 to 85 than both the CCG and the national average.

At the time of our inspection the practice healthcare was provided by two GP Partners, one regular locum GP, two nurse practitioners (whole time equivalent WTE 1.77), three practice nurses (WTE 2.13) and two health care assistants (WTE 1.2). There is also a part time Care Co-ordinator who is a registered general nurse and is responsible for the management of older adults service. They are supported by a team of dispensers, management, administration, reception and housekeeping staff.

The practice is located within the area covered by NHS South West Lincolnshire Clinical Commissioning Group (CCG). A CCG is an organisation that brings together local GP’s and experienced health professionals to take on commissioning responsibilities for local health services.

The practice has a General Medical Services contract. (The GMS contract is a contract between general practices and NHS England for delivering primary care services to local

Communities). It is a dispensing practice.

The surgery is open from 8am to 6.30pm Monday to Friday with extended hours until 7.45pm every Wednesday.

The practice has opted out of providing out-of-hours services to their own patients. The out-of-hours service is provided by Lincolnshire Community Health Services NHS Trust and is accessed by NHS111.

We had not previously inspected this practice.

Updated 31 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Billinghay Medical Practice on 29 November 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.
• 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.
• The practice was responsive to the needs of patients and tailored its services to meet those needs.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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 there was continuity of care, with quick and easy access to GPs and nurses.
• 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.

The areas where the provider should make improvement are:

• Review procedures to ensure prescriptions are signed before drugs are dispensed to patients.

• Should obtain written consent for certain procedures such as joint injections and not rely on verbal consent recorded in patients’ medical records.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 31 January 2017

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

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

• Data from the Quality and Outcomes framework showed that the clinical indicators for diabetes care were 97%, which was 5% above the CCG and 7% above the national average.

• Home visits to patients with long term conditions who were unable to attend the surgery were undertaken by a nurse practitioner or a GP if more appropriate. All palliative care home visits were carried out by GPs.

• 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 31 January 2017

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

• The practice held regular safeguarding meetings with health visitors.

• The practice offered a full range of long-acting reversible contraception and sexual health advice.

• Children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• Rates of cervical screening at 76% were in line with both CCG and national figures.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice provided a full range of immunisations for babies, children and young people. Immunisation rates were relatively high for all standard childhood immunisations.

• The practice hosted weekly mid-wife clinics.

Updated 31 January 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.

• All patients had a named, accountable GP.

• The practice employed a part time care co-ordinator, an experienced community nurse, whose role was to meet the healthcare needs of those primarily older patients who had been identified as being at the highest at risk of unplanned admission to hospital. This was part of the enhanced unplanned admissions service.

• The care-coordinator played a pivotal role in reviewing and formulating care plans with patients who had recently been discharged from secondary care.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice provided a dedicated telephone line for residential and care homes and the ambulance service in support of the unplanned admissions enhanced service.

Updated 31 January 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 reflected the needs for this age group.

• The practice offered extended hours appointments on one evening a week to help meet the needs of patients in this group.

• The practice promoted on-line services including ordering of prescriptions and booking of appointments.

Updated 31 January 2017

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

• Data from the Quality and Outcomes framework showed that the clinical indicators for dementia care were 100%, which was 5% above the CCG and 3% above the national average.

• 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 identified 31 patients experiencing poor mental health and told them how to access various support groups and voluntary organisations.

• There was a good understanding of how to support patients with mental health needs and dementia.

Updated 31 January 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 those with a learning disability.

• The practice had 44 patients on its learning disability register and offered longer appointments for patients in this group.

• 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.