Ormesby Village Surgery Also known as Coastal Villages Practice

Updated 6 April 2018

Ormesby Village Surgery provides services to approximately 17,500 patients in Ormesby, Great Yarmouth. There are three branch sites in the villages of Martham, Caister and Hemsby. We visited all branch sites as part of this inspection. The practice 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 from the Hemsby and Caister branches. The practice also has a delivery driver who can deliver medicines to housebound patients.

The practice has six male GP partners and four female salaried GPs. There is a practice manager and business and quality managers based at another site managed by the provider and lead staff at the other three sites. There are weekly management meetings which are rotated between the sites. There are 12 practice nurses, one nurse practitioner, two pharmacists and seven healthcare assistants. The dispensary has six dispensers across both dispensaries. There is a large team of administration, secretarial and reception staff across all sites. The practice holds a General Medical Services contract with Great Yarmouth and Waveney Commissioning Group (CCG).

Appointments can be booked up to four weeks in advance with GPs and nurses. Urgent appointments are available for people that need them, as well as telephone appointments. Online appointments are available to book up to one month in advance. Patients can be seen at any practice site.

• Ormesby is open between 8.30am and 5.30pm Monday and Friday, 8.30 to 1pm Tuesday and Wednesday and 8.30am to 6.30pm on Thursdays. The practice closes from 1pm to 2pm Monday, Thursday and Friday.

• Martham is open 8.00am to 5.30pm Monday to Friday. The practice closes at 6.30pm on a Wednesday.

• Caister is open 8.30am to 5.30pm Monday and Wednesday, 8.30am to 6.30pm Friday and 8.30am to 1pm Tuesday and Thursday. The practice closes 1pm to 2pm Monday, Wednesday and Friday.

• Hemsby is open 8.30am to 5.30pm Monday and Friday, 8.30am to 6.30pm Tuesday and 8.30am to 1pm Wednesday and Thursday. The practice closes 1pm to 1.30pm Monday, Tuesday and Friday. When practices close, patients may attend the other practices that are open.

When the practices are closed patients are able to use the out of hour’s service provided by Integrated Care 24. Patients can also access advice via the NHS 111 service.

We reviewed the most recent data available to us from Public Health England which showed the practice has a smaller number of patients aged 0 to 44 years old compared with the national average. It has a larger number of patients aged 60 to 84 compared to the national average. Income deprivation affecting children is 14%, which is lower than the CCG average of 25% and the national average of 20%. Income deprivation affecting older people is 15%, which is lower than the CCG average of 17% and national average of 16%. Life expectancy for patients at the practice is 80 years for males and 83 years for females; this is similar to the national expectancy which is 79 years and 83 years respectively.

Updated 6 April 2018

We carried out an announced comprehensive inspection at the Ormesby Village Surgery on 18 September 2017. The practice was rated as good for providing effective, caring, responsive and well led services and requires improvement for providing safe services. Overall the practice was rated as good. The full comprehensive report following the inspection on 18 September 2017 can be found by selecting the ‘all reports’ link for Ormesby Village Surgery on our website at www.cqc.org.uk.

We undertook a follow up focused inspection of Ormesby Village Surgery on 14 March 2018. This inspection was carried out to review in detail the actions taken by the practice to improve the quality of care and to confirm that the practice was now meeting legal requirements and also additional improvements made since our last inspection.

Overall the practice is still rated as good, and now good for providing safe services.

Our key findings were as follows:

• The practice no longer used fabric curtains. All curtains were disposable and there was a clear policy outlining how often these needed to be changed and how to dispose of them correctly.

• The practice had access to the hepatitis B immunity of the cleaning staff employed by an external company.

• All staff that worked in the dispensary had undertaken a competency assessment.

• The practice had reviewed the standard operating procedures for the dispensary for both sites. These were practice specific and had been reviewed and signed by all staff.

• The security of the dispensary at the practice’s branch location in Caister had been reviewed and improved.

• The practice had implemented a new policy for the checking of equipment and medicines in clinical rooms. Medicines and equipment we checked in clinical rooms were in date.

• The practice kept logs of expiry date checks in the dispensary.

• There was evidence that near misses were appropriately recorded for both dispensaries.

• The practice had reviewed the GP patient survey results relating to access and had highlighted the areas of lower than average performance. They had implemented an action plan which included:

  • Liaising with the clinical commissioning group to be part of a pilot to provide extended hours as part of a hub with three other local practices, due to launch in July 2018, to offer weekend and evening appointments. The practice would provide GPs and nurses in conjunction with the other practices.

  • Providing additional nursing appointments.

  • All receptionists planned to complete a care navigator course to improve patient access to local support groups.

  • Adapt the appointments system to be more flexible to meet demand. For example, the practice had put on extra clinics for chest complaints and minor illnesses during the winter period.

  • Liaison with the patient participation group (PPG). They had devised a patient survey to gain feedback about the changes they had implemented. The PPG were reviewing the survey questions and amending them prior to conducting the survey in April 2018.

The area where the provider should make improvements:

• Update the policy relating to the process for monitoring expiry dates on equipment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 October 2017

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

• Nursing staff had lead roles in long-term disease management, such as respiratory conditions and diabetes. Patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators was 98%, this was 8% above the CCG and England average. The exception reporting rate was 18%, which was higher than the CCG average of 17% and the national average rate of 12%. The prevalence of diabetes was 9% which was higher than the CCG average of 8% and the national average of 6%.

• The practice had reviewed and improved their recall system to improve monitoring of patients with long term conditions.

• The practice had been a part of a feasibility study relating to asthma which also upskilled nurses in the management of asthma.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• All these patients had a named GP and 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 named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 24 October 2017

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

• From the sample of documented examples we reviewed we found 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 relatively high for all standard childhood immunisations.

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

• The practice was above average for cervical screening rates.

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

• The practice worked with midwives and health visitors on a regular basis.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

• The practice held a monthly contraceptive coil fitting clinic. The practice had completed a patient satisfaction survey on this clinic and found all 52 responses were positive in relation to the staff attitude and information given about and prior to the procedure.

• One GP was trained in supporting women to breastfeed and promoted and supported patients to breast feed their babies whenever possible. Support was given to parents who could not feed their child this way.

Updated 24 October 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

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

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs. The practice had weekly visits to local care homes. The practice employed two pharmacists who managed all the medicines for patients living in care homes. This ensured the care homes received continuity of prescribing in a timely manner and reduced polypharmacy (prescriptions for multiple medicines).

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care. The practice held monthly meetings to discuss patients at the end of life.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Where older patients had complex needs, the practice shared summary care records with local care services such as district nurses.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible such as weight management and smoking cessation.

• The practice offered a medicines delivery service to housebound patients.

Updated 24 October 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, flexible and offered continuity of care, for example, extended opening hours and Saturday appointments were provided.

• 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 telephone consultations where appropriate for those who could not make it to the surgery.

• The practice was proactive in offering NHS health checks and had seen an increase from 431 provided in 2016/17 to 554 health checks being provided so far in 2017/18 (April 1st to 18th September 2017).

• The practice regularly referred patients to the local well-being service.

Updated 24 October 2017

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

• The practice carried out advance care planning for patients living with dementia.

• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is higher than the national average of 84%.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia. The practice held a local ‘memory joggers’ group who helped to support people with dementia.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• Performance for mental health related indicators was 95%. This was 5% above the CCG average and 2% above the England average. The exception reporting rate was 7%, which was lower than the CCG average of 19% and England average of 11%. The prevalence of patients with recorded mental health conditions in the practice was 1%, which was equal to the CCG and national averages.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations, including local wellbeing services.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff interviewed had a good understanding of how to support patients with mental health needs and had all received training in dementia.

Updated 24 October 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 completed 26 health checks out of 92 so far for 2017/18 for patients with learning disabilities. The practice recognised the need to complete more health checks for this group. There was an improvement so far from last year which saw the practice complete 18 health checks. The practice had improved recall.

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

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable. The practice held regular end of life care meetings with the Macmillan nurses.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients such as district nurses.

• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations including carers groups.

• Staff interviewed knew 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 in normal working hours and out of hours. Staff had also completed training relating to female genital mutilation and ‘prevent’ (a government approved anti-terrorism training course).