Gayton Road Health and Surgical Centre Also known as Vida Healthcare

Updated 11 April 2017

Gayton Road Health Centre is part of Vida Healthcare Group, which is made up of six GP practices in Norfolk. The Vida Group has a senior management team which comprises of clinicians and support executives. The senior management team maintain an overall responsibility for the management of the practices, but delegate some decision making to a local management team. Gayton Road Health Centre is a practice situated in King’s Lynn, Norfolk and serves approximately 16,000 registered patients.

The practice clinical team consists of 14 GPs (of which five regularly work at other Vida Healthcare practices), a team of 12 nurses and nurse practitioners (some nurses offer specialist services such as; diabetes, well-woman, dietary, cardiovascular and respiratory services and work both at

the practice and across other Vida general practice locations), one operating department practitioner, one emergency care practitioner and seven healthcare assistants (of which three are senior). They are supported by a secretarial team, a scanning and attachment team, an IT team, a summarising team, a practice manager and a senior management team.

The population of King’s Lynn has an age profile generally similar to Norfolk as a whole, but with a relatively low proportion of adults aged 20-34 and slightly above average proportions of people aged 60 and over. The practice is in an urban area and around 11,300 King’s Lynn & West Norfolk people live in LSOAs (Lower layer Super Output Areas - a geographic hierarchy designed to improve the reporting of small area statistics in England and Wales) in the most deprived ten per cent in England, representing around eight per cent of the Borough’s population.

The practice is open from 7.30am to 7pm, Monday to Friday. Out-of-hours care is provided by Integrated Care 24 (IC24) via the NHS 111 service. The practice makes use of a triage team existing of advanced nurse practitioners and urgent care practitioners. There was also a triage doctor allocated daily.

Updated 11 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Gayton Road Health Centre on 17 January 2017. Overall the practice is rated as good.Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• 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.
• Feedback from patients about their care was positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Data from the National GP Patient Survey published in July 2016 showed that patients rated the practice in line with others for most aspects of care.
• 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.
• 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 well 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 provider was recognised as “An Investor In People” (the Investing In People Standard explores practices and outcomes within an organisation under three performance headings: leading, supporting and improving).
• Although the provider maintained performance data and information for the organisation, a breakdown of individual practice’s Quality Outcome Framework performance was not available and could not be provided by the practice.
• An incident occurred several days prior to the inspection where a car had driven through the walls of the practice building causing significant damage to the premises back office area. Despite the considerable damage and need for amending the day to day operations the practice was able to operate as per usual and facilitate our inspection.

We saw several elements of outstanding practice:

• The practice made use of a ‘customer service charter’, which aimed to support all of the practice staff in delivering excellent customer service by following an agreed set of standards on timeliness, accuracy and appropriateness. There were four champions active at the practice and they met with champions from five other practices that the provider managed on a monthly basis to discuss complaints and commendations.
• The practice had developed the “ABC team”, which staff described as the connection between the practice and its elderly and less able patients. This team of nursing staff travelled to patients’ homes to assist patients in maintaining independence and to ensure that they had the physical and mental capacity to look after themselves.
• The practice had developed the “My Practice Passport” for patients with dementia and had been rolled out to other patient groups, for example patients with a visual impairment. The passport was a document that was kept on the patient and contained information about the patient stating “things you must know about me”, “things that are important to me” and “things I like and dislike”.

The area where the provider should make an improvement is:

• Improve the recording of meeting minutes and actions to provide evidence of decision making processes.
• Ensure policies and protocols are reviewed in a timely manner.
• Ensure recorded supervision of nurse practitioners by GPs takes place effectively.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 April 2017

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 Vida group 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 2015/2016 showed that performance for diabetes related indicators was 99%, which was 6% above the local average and 10% above the national average. Exception reporting for diabetes related indicators was slightly higher than the local and national averages (exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).

• Longer appointments and home visits were available when needed.
• Patients with complex needs had a named GP and a structured annual review to check their health and medicines needs were being met. There was a robust recall system in place to ensure that patients were invited and attended annual reviews.
• 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 11 April 2017

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.
• Immunisation rates were in line with local and national averages for all standard childhood immunisations.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• The Vida group used the information collected for the QOF and performance against national screening programmes to monitor outcomes for patients. QOF data indicated that the percentage of women aged 25 or over and who have not attained the age of 65 whose notes record that a cervical screening test has been performed in the preceding 5 years was 88%, which was 3% above the local average and 6% above the national average. Exception reporting for this indicator was 15% which was 4% above the local average and 9% above the national average.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• All staff were trained to child safeguarding level three.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 11 April 2017

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.
• The practice contacted patients after their discharge from hospital to address any concerns and assess if the patient needed GP involvement at that time.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure, were consistently above local and national averages during 2015/16.
• The practice provided care to patients in ten local care and nursing homes. The practice undertook reviews of patients’ medicines in care homes with a pharmacist from the local CCG.

Updated 11 April 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 reflects the needs for this age group.
• Practice staff carried out NHS health checks for patients between the ages of 40 and 74 years. During 2015-16 the practice had undertaken 279 checks and since April 2016 140 health checks were undertaken.
• The practice provided minor surgery on site.

Updated 11 April 2017

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

• The practice had 173 registered patients with dementia, of which 122 had received an annual review since April 2016. The practice continued to invite the remaining patients as well as undertake opportunistic screening.
• The practice had 89 registered patients experiencing poor mental health, of which 53 had received an annual review since April 2016. The practice continued to invite the remaining patients as well as undertake opportunistic screening.
• 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.
• 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 a good understanding of how to support patients with mental health needs and dementia. All practice staff had undergone training by a dementia charity as to how best to interact with people with dementia.
• The practice had developed the “My Practice Passport” for patients with dementia and had been rolled out to other patient groups, for example patients with a visual impairment. The passport was a document that was kept on the patient and contained information about the patient stating “things you must know about me”, “things that are important to me” and “things I like and dislike”. The leaflet not also informed about the patient but had also proven useful as a development tool for staff who had to increase their understanding of specific patient groups who this passport was designed for. The passport was developed in cooperation with the local hospital where a similar patient tool was used. Information was also electronically recorded.

Updated 11 April 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 119 registered patients with a learning disability, of which 70 had received a review since April 2016 and 37 had declined. The practice informed us that invites were continued to be sent to the remaining nine and that they liaised with the local learning disabilities services if they had any specific concerns.
• 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.
• Patients who were identified as carers were signposted to local carers’ groups. The practice had 163 (1%) patients registered as carers. A bespoke carers leaflet was available in the practice.
• 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.
• The practice had developed the “ABC team”, which staff described as the connection between the practice and its elderly and less able patients. This team of nursing staff travelled to patients’ homes to assist patients in maintaining independence and to ensure that they had the physical and mental capacity to look after themselves. Staff explained that the people they visited were not always aware what they needed to do or who to contact to get the help or support they need. Visits were arranged in response to requests from GPs, nurses, family or friends.