Barrack Lane Medical Centre

Updated 8 September 2016

Barrack Lane Medical Centre provides personal medical services to approximately 17,085 patients. There is a branch surgery located at Stoke Park. This provides alternative access to medical services for patients who cannot access central Ipswich. We did not attend the branch surgery during the inspection. According to information taken from Public Health England, the patient population has a higher than average number of patients aged 15-34 years, a lower than average number of patients aged 0-10 years and 20 – 35 years and a lower than average number of patients aged between 44-85+ years compared to the practice average across England.

The building provides good access with accessible toilets and car parking facilities. The practice provides treatment and consultation rooms on the ground floor with ramp access and automatic doors. The practice is an accredited training practice.

There is a team seven GPs. Five GPs are partners which mean they hold managerial and financial responsibility for the practice, and there is one salaried GP and a GP registrar. The practice nursing team consists of six nurse practitioners (all were qualified to prescribe medicines), this included the senior nurse/clinical lead, a visiting nurse practitioner who supported and undertook all care and nursing home visits, and six practice nurses, two who were qualified to prescribe and two health care assistants. The nursing team run a variety of appointments for long term conditions, minor illness and family health.

There is a practice manager who is supported by an assistant practice manager. In addition there is a team of non-clinical administrative, secretarial and reception staff who share a range of roles, some of whom are employed on flexible working arrangements.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are from 8am to 6.30pm daily with staggered appointments across all clinicians. The practice has extended hours appointments on Tuesday, Wednesday and Thursday mornings from 7am to 8am with GPs, nurses and healthcare assistants/phlebotomists. In addition to pre-bookable appointments that can be booked up to four weeks in advance, urgent appointments are also available for people that need them and the practice participated in the Suffolk Federation’s access pilot called ‘GP+’ where patients are able to make appointments outside core hours. The practice offers telephone consultations during the day to patients that might not be able to access the surgery during normal hours. Appointments can be booked in advance or on the same day. The practice is open Saturday mornings for patients to access the surgery for prescription collection or general enquiries.

The practice does not provide GP services to patients outside of normal working hours such as nights and weekends. During these times GP services are provided by GP+ and the NHS 111 service.

Updated 8 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Barrack Lane Medical Centre on 12 May 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 an effective system in place for reporting and recording significant events.
• 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.
• 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.
• 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 was aware of and complied with the requirements of the Duty of Candour.

We saw areas of outstanding practice:

• One GP and the practice manager had set up and continued to fund a website which provided a service to other GPs and junior doctors, making information more accessible to GPs, GP registrars and trainers. The website included a wide variety of guidance and support, for example it provided full guidance for the curriculum for the Royal College of General Practitioners, a resource designed to improve both quality and safety for patients. In addition to this, there was guidance on how to undertake Educational Supervision Reports (a workplace based assessment which builds up a picture of an individual’s performance and provides feedback on overall progress highlighting areas where more focused training may be required).
• The practice facilitated and participated in a specific project co-produced with the local Clinical Commissioning Group (CCG), NHS England, Health Outreach NHS and Barrack Lane Surgery to provide a full medical, psychological and social assessment for non-English speaking patients who were new to the NHS.
• The practice had developed a motivation tool for vulnerable patients who were of low mood or depressed. Where a patient was identified as requiring extra support the practice provided extended appointments to encourage recovery without the use of drugs and anti-depressants. Patients were encouraged to complete a goals list tool, developed by the practice to inspire and motivate the patient before their next review. These goals included personal, financial and career goals and encouraged patients to visualise their aims using all their senses. We were told this was a simple but powerful way to inspire patients to recover.

The areas where the provider should make improvement are:

• Ensure patients waiting for their appointments in all areas of the practice can be clearly seen by reception staff to ensure patients whose health might deteriorate can be seen by staff.
• Continue to develop methods used to proactively identify carers.
• Ensure patients with a learning disability are encouraged to attend for a review of their care plans.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 September 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.

• The practice used the information collected for the Quality and Outcomes Framework (QOF) and performance against national screening programmes to monitor outcomes for patients. QOF is a system intended to improve the quality of general practice and reward good practice. Data from 2014/2015 showed that the performance for asthma related indicators was 93% which was below the CCG average by 1% and the national average by 4%, with a 4% exception reporting which was in line with the CCG and national averages of 7%. Performance for diabetes related indicators was 82% which was below the CCG by 8% and the national average by 7%, with a 11% exception reporting which was in line with the CCG average of 9% and the national average of 11%.

• The practice had an annual recall system for patients with asthma and diabetes and the nurses set up more frequent recalls if the patients needed them. The practice offered longer appointments for patients with multiple conditions. Appointment lengths were tailored to patient and nurse need.
• Longer appointments and home visits were available to patients when needed.
• Duty GP were available each day to assist practice nurses with long term condition.
• 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 8 September 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.
• 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 75%, which was below the national average of 82%. There was a policy to offer telephone reminders for patients who did not attend for their cervical screening test. The practice demonstrated how they encouraged uptake of the screening programme by using information in different languages and for those with a learning disability and they ensured a female sample taker was available. There was a nominated administration member of staff who oversaw all non-attenders and ensured they were provided with sufficient information to make an informed choice.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice appointed an immunisation coordinator who acted as a liaison with child health and was a point of contact for patients. Childhood immunisation rates for the vaccinations given to under two year olds were comparable to CCG averages of 95% to 97% and 93% to 97%.
• We saw positive examples of joint working with midwives, health visitors and school nurses. The practice held joint monthly meetings with health visitors and there was an easy messaging system in place for ease of communication.

Updated 8 September 2016

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 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.
• There were dedicated nurse practitioners who undertook home visits for care homes ensuring continuity of care. In addition, GPs regularly undertook visits to care homes liaised with the home managers.
• The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, end of life care.
• 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.

• Flu vaccines were offered to patients over 65 years and flu days at the practice ensured other services were invited to attend such as the Red Cross and Suffolk Family Carers to offer patients information on guidance and support.

Updated 8 September 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 had extended hours appointments on Tuesday, Wednesday and Thursday mornings from 7am to 8am with GPs, nurses and healthcare assistants/phlebotomists. In addition to this, the practice participated in the Suffolk Federation’s access pilot called ‘GP+’ where patients could make appointments outside core hours. The practice offered telephone consultations during the day to patients that might not be able to access the surgery during normal hours. Appointments could be booked in advance or on the same day.
• The practice offered online appointments and prescriptions as well as a full range of health promotion and screening that reflected the needs for this age group.

• The practice encouraged its patients to attend national screening programmes for bowel and breast cancer screening. The practice uptake for patients aged 60-69 who were screened for bowel cancer in last 30 months was 55%; this was below the CCG average of 63% and the national average of 58%. The practice uptake for female patients screened for breast cancer in the last 36 months at 73% was in-line with the CCG average of 80% and national average of 72%.
• The practice was open Saturday mornings for patients to access the surgery for prescription collection or general enquiries.
• The practice offered minor surgery on site in addition to coil and contraception implants.

Updated 8 September 2016

The practice is rated as good for the safe, effective, caring and well led care of people experiencing poor mental health (including people with dementia), and outstanding for responsive care of people experiencing poor mental health (including people with dementia).

• The practice carried out advance care planning for patients with dementia. 74% of patients diagnosed with dementia had received a face to face care review April 2016. Overall performance for dementia indicators were above CCG and national average, with the practice achieving 94%, this was 2% above CCG average and 1% below national average. The rate of exception reporting was in line with both the CCG and national averages.
• The percentage of patients experiencing poor mental health who had a comprehensive, agreed care plan documented in their records, in the preceding 12 months (01/04/2014 to 31/03/2015) was 66%. This was 25 percentage points below CCG average and 27 percentage points below national average. The practice reported a large sudden increase in new patients registering at the practice during over the previous two years and felt this surge of new patients and read coding issues were responsible for the lower than CCG and national average percentages. The practice was able to demonstrate improved parameters and achievement across all QOF indicators for the year 2015 to 2016.
• 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.
• The practice had developed a motivation tool for vulnerable patients who were low or with a depression. Extra support was provided with extended appointments to encourage recovery without the use of drugs and anti-depressants. Patients were encouraged to complete a goals list tool, developed by the practice to inspire and motivate the patient before their next review. These goals included personal, financial and career goals and encouraged patients to visualise their aims using all of their senses.

Updated 8 September 2016

The practice is rated as good for the safe, effective, caring and well led care of people whose circumstances may make them vulnerable, and outstanding for responsive 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 had identified 68 patients with a learning disability on the practice register, 35% had received a health checks in the previous twelve months. However we were told the criteria for this register had changed recently which meant an increase in patients who met the criteria for the register to 86 patients. We were told an alert was placed on the clinical system for each patient on the learning disabilities register, the register was closely monitored and invitations were sent out to invite patients and their carers to attend for review. We were told that not many patients had responded therefore the practice adopted an opportunistic approach to review patients when they come to the surgery.

• 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 informed vulnerable patients about how to access various support groups and voluntary organisations.
• We were told patients with no fixed address or travellers often used a local resource centre as their point of contact, however the practice was open to appointments for all these patients and would offer the practice address if required as a point of contact.
• 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. Alerts on patients’ records notified staff if patients required longer appointments or had reduced vision or hearing. For example, if a patient was unable to see their name on the call screen and needed staff to alert them when their appointment was available.
• The practice facilitated and participated in a specific project co-produced with the local CCG, NHS England, Health Outreach NHS and Barrack Lane Surgery to provide a full medical, psychological and social assessment for non-English speaking patients who were new to the NHS. The liaison nurse gathered a full patient history including medication, immunisations history and itemised any health problems where GP intervention was required and liaised with health visitors regarding children and vaccination records. Advice was provided on contraception, smear tests and testicular examination. Breast examination, tooth care for children and where required dental and GP appointments were made for patients. All patients who were assessed were also given guidance in the use of; pharmacy services, how to make a GP appointments, 111 services, the criteria for using the ambulance services and A and E departments.