Blofield Surgery

Updated 29 November 2016

Blofield Surgery is located in Blofield, a rural village seven miles east of Norwich, Norfolk. The practice is run by a partnership of two male GPs. The practice employs three salaried GPs, a nurse practitioner and a nurse prescriber, a practice nurse lead and a practice nurse and a health care assistant. The clinical team is supported by a practice manager, a dispensary manager, a deputy practice manager, a practice administrator and two administration officers. There are teams of dispensers, administrative and reception staff, medical secretaries, cleaning staff and an apprentice. The practice dispenses to over 91% of its patients.

The registered practice population of 6,208 are predominantly of white British background, and the practice deprivation score is low compared with the rest of the country. According to Public Health England information, the practice age profile has higher percentages of patients from 5 to 19 years and over 40 to 85+ years compared to the practice average across England. It has lower percentages of patients between the ages of 0 – 5 years and 20 to 39 years.

The practice is open between 8am and 6.30pm Monday to Friday. GP appointments are from 8.30am to 10.30am every morning and 3.30pm to 5.20pm daily. Nurse appointments are from 9am to 1pm every morning and 2pm to 5.15pm daily, with phlebotomy appointments daily from 8.10 am to 10.40am. Extended hours appointments are offered in the form of telephone appointments between 7.30am and 8 am Monday, Tuesday, Thursday and Friday. These telephone appointments are provided by the two GP partners and can be booked via reception. Once an appointment is made the GP will call the patient at an allotted time between 7.30am or 7.45am.

GPs also conduct telephone consultations from 11.30am daily to discuss urgent medical matters. In addition to pre-bookable appointments that can be booked up to eight weeks in advance, urgent appointments are also available for people that need them. The practice operates a system where there are same day appointments available with the nurse practitioner and the nurse prescriber with other appointments available with the practice nurse and health care assistant for emergencies. The dispensary is open from 8am to 1pm and 2.30pm to 6.30pm Monday to Friday. Prescription requests can be made on-line, by post, at the dispensary front desk or by using the dispensary post box.

The practice holds a General Medical Services (GMS) contract to provide GP services which is commissioned by NHS England. A GMS contract is a nationally negotiated contract to provide care to patients. The practice offers a range of enhanced services commissioned by their local CCG: including improving patient on-line access, extended hours access and support for people with dementia. Out of hours care is provided via the NHS 111 service.

Updated 29 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Blofield Surgery on 29 September 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 a system was in place for reporting and recording significant events and complaints. However, we noted that the learning extracted from the events was not comprehensive and therefore opportunities to minimise risks to patients were missed.
• 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.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it relatively easy to make an appointment with a named 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 practice used a range of assessments to manage the risks to patients.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• The practice should put systems in place to record the movement of medicines stock throughout the practice and dispensary to ensure an audit trail for all medicines.
• The practice should ensure there are effective systems in place to identify trends and training needs from significant events and complaints
• Ensure there is a regular programme of two cycle audits undertaken by clinicians.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 November 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. There was a dedicated member of staff who oversaw all recalls for patients with long term conditions and liaised with the nursing team to ensure patients were reviewed.
• Performance for diabetes related indicators was better in comparison to both the CCG average of 93% and the national average of 89% with the practice achieving 96%, with an 11% exception reporting. This was in line with the CCG average of 12% and the England average of 11%.
• 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 29 November 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.The practice undertook quarterly safeguarding meetings with the practice GP lead and deputy, management and the administration officer.  A did not attend policy had been developed for children who missed appointments to ensure the practice had oversight of their care and treatment.  Monthly meetings were held between the GP safeguarding lead and health visitors. 
• Childhood immunisation rates were comparable to CCG/national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 63% to 99%, which was comparable to the CCG range of 70% to 99% and five year olds from 67% to 100%, which is comparable to the CCG range of 70% to 98%.
• 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.
• The practice’s uptake for the cervical screening programme was 85%, which was above the CCG average of 77% and the national average of 74%. There was a policy to offer telephone reminders for patients who did not attend for their cervical screening test. 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 29 November 2016

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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. All home visits were triaged by a clinician to prioritise visits and ensure appropriate clinical intervention.
• The practice would contact all patients after their discharge from hospital to address any concerns and assess if the patient needed GP involvement at that time.
• The practice offered health checks for patients aged over 75.
• 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.

Updated 29 November 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 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.
• Appointments were available before and after usual working hours as well as during the day. Telephone appointments were available in addition to on-line appointments and repeat prescription requests, on-line prescription enquiries and emails.
• The practice 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 70% of the target population, which was above the CCG average of 65% and the national average of 58%.The breast cancer screening rate for the past 36 months was 83% of the target population, which was above the CCG average of 80% and the national average of 72%.

Updated 29 November 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 had been reviewed in a face-to-face review in the preceding 12 months (01/04/2014 to 31/03/2015) was 80%. This was comparable to the CCG average of 82% and the national average of 84%. At the time of our inspection the practice had invited 55 patients identified as having dementia for a health check, of these 37 had undergone a review since April 2016, others were scheduled with an appointment or had declined. The practice referred patients to various support services as required.
• Performance for mental health related indicators was better in comparison to both the CCG average of 96% and the national average of 92%, with the practice achieving 98%. However, the practice had an exception reporting rate of 42% for this indicator, which was higher than the CCG average of 20% and the national average of 11%.
• 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 patient participation group (PPG) had organised a talk for patients and carers by the director of the Norfolk and Suffolk Dementia Alliance about the incidence and contributing causes of dementia.
• 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.

Updated 29 November 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 offered longer appointments for patients with a learning disability. The practice had identified 40 patients with a learning disability on the practice register, 30 of these patients where a health check was appropriate. 21 of these patients had received a health check with invitations sent to the remaining patients
• The practice regularly worked with other health care professionals in the case management of vulnerable patients. The practice undertook quarterly meetings to discuss vulnerable adults and met monthly with the health visitor to review vulnerable children and families.
• 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.