The Trinity Medical Practice

Updated 28 April 2017

The Trinity Medical Practice covers the entire Dengie Peninsula east of Chelmsford in Essex. The practice is a dispensing practice providing medical services to about 3500 patients.

The premises have been adapted from a single story building in the centre of the village. There are four clinical rooms, a spacious reception area with wellbeing promoting posters and leaflets.

The practice has one GP (female), a regular locum, two practice nurses and two healthcare assistants. The clinical team are supported by a practice manager, dispensary staff, administration and office team.

The practice is open between 8am to 6.30pm and is closed for lunch from 1pm to2pm on Monday to Friday. Appointments can be booked on the day if requested before 10am on a wait to be seen basis Monday to Friday 8am to 11am. Emergency slots 12-12.30 for patients that have difficulties sitting in the reception area. Telephone consultations and home visits were booked in after emergency surgery.

The practice opted out of providing GP out of hour’s services. Unscheduled out-of-hours care is provided by Primecare services and patients who contact the surgery outside of opening hours are provided with information on how to contact the service. This information is also available on the NHS choices website.

The practice provides the following directed enhanced services:

• Dispensing medicines.
• Childhood immunisations and vaccinations.
• Dementia screening.
• Flu vaccinations.
• Unplanned hospital admissions avoidance.
• Improving on-line access.

Learning disabilities health checks.

Updated 28 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Trinity Medical Practice on 1 September 2016. Overall the practice is rated as outstanding.

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

• There was an open and transparent approach to safety within the practice. Effective systems were in place to report, record and learn from significant events. Learning was shared with staff and external stakeholders where appropriate.

• Feedback from patients about their care was consistently positive and was significantly above the local and national averages.

• There were established and embedded processes in place for managing medicines.

• Effective standards of cleanliness and hygiene were maintained throughout the practice.

• The practice had a system in place to ensure enough staff with the right skill mix were on duty to ensure safe care delivery.

• Bookable 10-minute appointments for patients who found it stressful to wait in a busy surgery were available from 12pm to 1pm daily and reserved for identified patients.

• Staff had received appropriate training to undertake their roles and responsibilities.

• The practice was approved for postgraduate medical education at Anglia Ruskin University, offering mentorship and supervision for those undertaking the medical prescribing course.

• The practice recognised the importance of the continuing development of staff skills, competence and knowledge to ensure high-quality care.

• The practice provided a highly responsive service to meet the needs of their patients across all population groups and tailored them accordingly.

• The practice held several different meetings with health care professionals to share and coordinate services for patients.

• Staff understood the relevant consent and decision-making requirements of legislation and guidance.

• The practice proactively offered residents and people holidaying in local caravan parks, the opportunity to register at the practice to receive care and treatment when required.

• Staff used every contact as an opportunity to identify potential risks to patients health and signposted them to support to live healthier lives.

• There was a strong, visible, person-centred culture within the practice. Staff were highly motivated to offer care that was kind and promoted patient’s dignity.

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

• The practice had a clear vision and a set of values, with patient’s wellbeing as a priority.

• There was a clear leadership structure and staff felt supported by management.

• The practice actively sought the views from a wide range of stakeholders, including patients, staff, visiting professionals and commissioners about their experience of and quality of care and treatment delivered.

We saw several areas of outstanding practice:

• The practice recognised the risk to patients suffering from poor mental health, who did not collect their prescriptions. They had put a system in place to issue prescriptions on a weekly basis only for early detection of crisis. The practice had promoted itself as a place of safety for any person who felt vulnerable or in need. They advertised through the community press outlining its purpose, and a logo was displayed in the practice front window.
• The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 4.5% of the practice list as carers. There were processes in place that alerted the GP if a carer had been admitted to hospital. There were plans in place to ensure the frail patient left at home would receive support. For these cases there was close liaison with the carer and the family of the patient so that alternative arrangements could be made to ensure there was continuity of care for the patient concerned.
• The practice had built a close liaison with the local school. They offered a minor injuries service where an injured child could attend the surgery for immediate triage and assessment. This resulted in a reduced A&E attendances and was less stressful for parent and child as they were seen in a familiar environment. The local school has a number of children identified with special educational needs; these children often have complex medical needs also. The GP liaises with the school to attend joint review meeting to establish timely interventions and resolution of issues.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 April 2017

The practice is rated as outstanding 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 achieved above the local and national averages for their performance with a 99% achievement for clinical indicators.

• The practice employed the services of a local pharmacist who attended the practice weekly to offer in depth medicine reviews for all patients including those on polypharmacy and high risk medicines.

• The practice had a bespoke palliative care services; the GP provided out of hours care to patients identified as being in the last 12 months of their life and those with complex medical needs, so they could access health care from the GP directly 24hours a day.

• The practice held health related fundraising events each year a ‘flu-a-thon’, where patients would be invited to attend the practice receive their immunisation have a mini health check and enjoy some activities for example food stalls, live music and pony rides.

• Longer appointments and home visits were available when needed.

• Patients told us they felt that their long term condition care provided was of a high standard. This was supported by the high QOF performance. For example, the percentage of patients with diabetes whose blood sugar levels were managed within acceptable limits was 85% compared to the CCG average of 73% and national average of 77%.

• All patients with a long-term condition received a structured annual review to check their health and medicines needs were being appropriately met.

• For those patients with the most complex needs and associated risk of hospital admission, the practice team worked closely with the local community health providers including the community matron and respiratory team to deliver a multidisciplinary package of care.

Updated 28 April 2017

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

• The practice promotes itself as a place of safety for any person who feels vulnerable or in need. So far, it has been used on a number of occasions, including domestic violence.

• The GP provided out of hours care to patients with complex medical needs, so they could access health care from the GP directly 24hours a day.

• The practice had built a close liaison with the local school and offered a minor injuries service and collaborated care for children with special needs.

• 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.

• The practice held quarterly meetings with the health visitor, and reviewed any children on a child protection plan at their own monthly clinical meeting.

• The practice provided neonatal checks, six week post-natal checks for new mothers and eight week baby checks.

Updated 28 April 2017

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs in order to deliver care more effectively. Monthly meetings with wider members of the healthcare team were held to review more complex and vulnerable patients.

• There were processes in place that alerted the GP if a carer had been admitted to hospital. There were plans in place to ensure the frail patient left at home would receive support.

• The practice held health related fundraising events each year a ‘flu-a-thon’, where patients would be invited to attend the practice receive their immunisation have a mini health check and enjoy some activities for example food stalls, live music and pony rides.

Updated 28 April 2017

The practice is rated as outstanding 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 access to the GPs was provided on a Wednesday evening from 7pm to 9.30pm -through the use of skype and telephone consultations, this was to improve access for workers and commuters, and those in education, but was not restricted to these groups.

• Feedback from patients was consistently positive. They told us they could get an appointment quickly and at a time that was convenient to them. For example, the July 2016 national GP patient survey indicated that 86% of patients were able to get an appointment to see or speak to someone the last time they tried compared to a CCG average of 74% and a national average of 76%.

• The practice actively promoted health-screening programmes to promote wellbeing.

• The practice provided new patient health assessment checks and NHS health checks.

• 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.

Updated 28 April 2017

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

• The Practice employed the services of a local pharmacist who attended the practice weekly to offer in depth medication reviews for all patients including those on polypharmacy and high risk medicines.

• The practice had processes in place for monitoring prescriptions that had not been collected. Patients suffering with poor mental health received weekly prescriptions so uncollected prescriptions could be recognised at an early stage and to check on the welfare of the patient.

• A dementia specialist nurse held a monthly clinic; appointments were over an hour long and were for patients, their family, or carers.

• The practice introduced special patient booked appointment slots between 12pm and 1pm. these were booked by reception and included patients with mental health issues who would not cope with waiting in an open surgery.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia whom they carried out advance care planning for.

• Patients with a learning disability and those with dementia were supported to make decisions through the use of care plans, which they and their carers were involved in and agreed with.

• QOF data showed 93% of patients with schizophrenia, bipolar affective disorder and other psychoses that had a comprehensive, agreed care plan documented in the record, in the preceding 12 months were higher than CCG and national average of 89%.

• 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.

• The practice had processes in place for monitoring prescriptions that were not collected from the dispensary, particularly where patients had been identified as experiencing poor mental health.

• For patients with dementia, written consent for relatives to share in medical information and treatment planning was encouraged and well documented.

• The practice told patients experiencing poor mental health and patients with dementia and their carers about how to access services including talking therapies and various support groups and voluntary organisations. Information was available for patients in the waiting area.

Updated 28 April 2017

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

• The practice promoted itself as a place of safety for any person who felt vulnerable or in need. It had been used on a number of occasions, including by lost and frightened patients, and those seeking shelter.

• The practice introduced special patient booked appointment slots between 12pm and 1pm for patients with a learning disability and those suffering with autism who might have found it stressful waiting in a bust surgery waiting room.

• The practice allows residents of caravan parks to use the surgery as their postal address for healthcare appointments.

• The practice offered a free loan service for medical equipment for patients, particularly after discharge from hospital.

• There were processes in place that alerted the GP if a carer had been admitted to hospital. There were plans in place to ensure that those patients they were caring for received continuity of care while the carer was hospitalised.

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

• The practice offered longer appointments for patients with a learning disability.

• The practice worked with multi-disciplinary teams in the case management of vulnerable people and informed patients how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adults. 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 provided bespoke care and support for end of life patients. Patients were kept under constant review by the practice in conjunction with the wider multi-disciplinary team.