Longfield Medical Centre

Updated 10 July 2017

This practice is based in the Longfield Medical Centre in Maldon, Essex. It is a dispensing practice which means it is able to offer dispensing services to those patients on the practice list who live more than one mile (1.6km) from their nearest pharmacy.

The current list size is around 14544 patients and the practice is open to new patients. There is five female GPs and four male GPs offering five sessions a week. There are six female practice nurses. The practice holds a general medical service contract (GMS).

The practice is open between 8am and 6.30pm Monday to Friday. Appointments were available from 8am until 6pm. GPs completed home visits in addition to these consultation sessions. Extended hours are offered Tuesdays, Thursdays and Fridays 7am to 8am and Wednesdays 6.30pm to 7.30pm. Out of hour’s cover is provided by Primecare. The dispensary is open Monday to Friday 8.30am to 6.30pm and Saturdays 9am to 1pm.

The practice area demographic comprises of mainly white British, with smaller numbers of other nationalities including Polish and Bangladeshi. Levels of income deprivation affecting children and older people are in line with the averages for the CCG and nationally.

Updated 10 July 2017

Letter from the Chief Inspector of General Practice

This inspection of Longfield Medical Centre practice carried out on 21 June 2017 was to check improvements had been made since our last inspection on 18 February 2016. Following our February 2016 inspection the practice was rated as requires improvement overall. Specifically they were rated as requires improvement for safe and well-led, and good for caring, effective and responsive. The full comprehensive report on the inspection can be found by selecting the ‘all reports’ link for Longfield Medical Centre on our website at www.cqc.org.uk.

As a result of our findings at the inspection in February 2016 we took regulatory action against the provider and issued them with requirement notices for improvement.

Following the inspection on 18 February 2016 the practice sent us an action plan that explained what actions they would take to meet the regulations in relation to the breaches of regulations.

At this inspection we found that the majority of the improvements had been made and progress had been made across all areas of concern. Overall the practice is now rated as good.

Our key findings were as follows:

• Significant events were fully investigated, patients received support, honest explanations and apologies. The learning was shared with appropriate staff.
• There was a clear recruitment process in place for permanent and locum staff, including an induction process.
• There were disclosure and barring service checks in place for all staff.
• Staff performing chaperone duties had received appropriate training for this role.
• There were systems in place to ensure safe medicines management both within the practice and the dispensary.
• There was a system in place to deal with any medicines alerts.
• Prescription paper was monitored and stored securely.
• Infection control audits were completed and action taken to resolve any issues.
• Policies and procedures were up to date and staff were aware of where to find them and their contents.
• A range of audits and re audits had been completed to improve the quality of service provision.
• Clinical outcomes for patients with diabetes were lower than Clinical Commissioning Group (CCG) and national averages for patients for the year 2015 to 2016 however we saw data from 2016 to 2017 which demonstrated improved outcomes for those patients.
• The practice had a clear system for identifying and supporting the carers on their register, although the numbers of carers identified were low.
• The complaints policy was clearly visible to patients. Complaints were fully investigated and there was a clear audit trail of actions taken by the practice.
• There was a process in place to gather and act on patient feedback.
• Staff had worked as a team and felt confident anything they raised as either an issue or suggestion for improvement would be followed up.
• Changes to senior nursing hours meant the team lacked direct leadership and cohesion.

However there were areas of practice where the provider needs to make improvements

The provider should:

• Review patient group directives (PGDs) to make sure that nursing staff are only using ones that contain the correct authorisations.
• Check that cleaning is being completed as per cleaning schedules.
• Check that small equipment used, such as, airways forceps, are either single use and packaged in sterile containers or appropriately sterilised.
• Review the nursing structure to provide more leadership.
• Review staff understanding of the components of the Mental Capacity Act.
• Improve the identification of patients who are carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 July 2017

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

• GP partners and nursing staff had lead roles in long-term disease management.
• Nationally reported data from 2015 to 2016 showed that outcomes for patients for long-term conditions were either in line with or lower than compared to other practices locally and nationally. For example, numbers of patients with diabetes receiving appropriate reviews were lower than the local and national average for some indicators and similar for others. The practice showed us unpublished data from 2016 to 2017 which evidenced improvements.
• There was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 10 July 2017

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

• 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.
• Immunisation rates were high for all standard childhood immunisations.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• GPs had an understanding of consent, Gillick competence and Fraser guidelines.
• The practice worked with midwives, health visitors and school nurses to support this population group.  

Updated 10 July 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 patients in its population. Patients were involved in decision making about their care and treatment.

• The practice completed regular ward rounds for those patients living in a care home.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs. Longer appointments and telephone consultations were also available.
• 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 10 July 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of this population group had been identified and the practice had adjusted the services it offered to ensure these were accessible and flexible, for example, extended opening hours.
• 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 practice offered as a full range of health promotion and screening that reflects the needs for this age group. These included, well woman and well man checks.
• Nationally reported data showed that outcomes for patients for uptake of cervical smears were in line with other practices locally and nationally.
• The practice offered a range of online service such as online booking and repeat prescription ordering.

Updated 10 July 2017

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

• 83% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was in line with the CCG and national average.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• 95% of patients with schizophrenia, bipolar affective disorder and other psychoses, had a care plan in their notes, which was higher than the CCG and national average.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Nursing staffs’ understanding of elements of the mental capacity act and consent required improvement.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

Updated 10 July 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 homeless people and those with a learning disability.
• 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff had training in how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies.