Market Cross Surgery

Updated 23 December 2016

Market Cross Surgery is situated in Mildenhall, Suffolk. The practice provides services for approximately 11000 patients within 50 square miles. It holds a General Medical Services contract and is a dispensing practice. The practice is a member of the West Suffolk CCG (Clinical Commissioning Group). The practice has two female and four male GP partners and three female salaried GPs which equates to six whole time equivalent GPs as some work part time. The team also includes five female practice nurses, one female health care assistant and five dispensers. They also employ a practice manager, an assistant practice manager and a team of secretarial, administration and reception staff. The practice started teaching medical students in 1993 and became a training practice for doctors becoming GPs in 2000. The practice employs 32 members of staff and has the 5th highest clinical staffing level out of the 21 practices in their CCG.

The practice is open between 8am and 6.30pm Monday to Friday with extended hours on Monday and Tuesday evenings from 18:30 to 20:30 and Wednesday morning from 7am to 8am. During out-of-hours GP services are provided by Care UK via the 111 service.

We reviewed the most recent data available to us from Public Health England which showed that the practice had an average practice population aged between 0-59 and a slightly higher than average practice population between 60-85+ compared with the national England average. The deprivation score was lower than the average across England.

Updated 23 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Market Cross Surgery on 10 November 2016. Overall the practice is rated as outstanding. The practice is rated as good for providing safe, effective and well led services and outstanding for providing caring and responsive services.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and the practice had systems in place for reporting and recording significant events.
• The practice was proactive and responsive to patient’s needs.
• Data from the national GP patient survey showed patients rated the practice higher than the CCG and national averages for several aspects of care.
• The practice had identified 216 patients as carers (2% of the practice list).
• Patient safety alerts were logged, shared and searches were completed to ensure reviews of patient care took place where necessary.
• 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. However some e-learning training was overdue.
• 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. 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 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.
• Due circumstances beyond their control and to IT problems during a change to their computer system, the practice performance in some areas of the quality and outcome framework were below the CCG and national averages.

The areas where the provider should make improvements are:

• Monitor printer prescription form logs to ensure they are tracked throughout the practice and improve the measures for the security of controlled drugs.
• Monitor the fridge temperature logs to ensure that dispensary staff have understood the cold chain training given to them.
• Ensure the practice has an up to date fire risk assessment and any identified actions are completed.
• Review staff training ensuring all staff are up to date with training appropriate to their role and needs.

Outstanding elements;

• A young people’s guide to the Market Cross surgery was written and available to patients which included advice on managing stress, healthy weight, contraception, smoking cessation, sexual health and travel advice. It included links to websites and various schemes, the guide was written in a clear colourful leaflet. The leaflet also included information on confidentiality to help young people to have confidence to speak with clinicians at the practice.
• The practice recognised that they served a hard to reach population of patients who may be marginalised. They engaged with the local travelling community and had achieved positive outcomes. They recognised that this group of patients often respond better to verbal and pictorial information and with the community helped develop a health education DVD, including health promotion subjects. The practice were proactive in undertaking data searches for this group of patients to identify gaps in public health measures, such as childhood immunisation and men’s health. Furthermore, to increase engagement with health outcomes for men and women of all ages of the travelling community, there was a plan in place to house an on-site fixed cabin where outreach services could be supplied. A member of the patient participation group who was from the travelling community supported this.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 December 2016

The practice is rated as good for the care of people with long-term conditions. We found the practice to be outstanding for caring for this population group.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The practice completed co-ordinated long term conditions clinics so that patients did not have to attend for multiple reviews for different conditions.
• The practice had a joint diabetes clinic with the secondary specialist care nurse.
• Longer appointments and home visits were available when needed.
• 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.
• The practice 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). Due circumstances beyond their control and to IT problems during a change to their computer system, the practice performance in some areas of the quality and outcome framework were below the CCG and national averages. Data from 2015/2016 showed that performance for diabetes related indicators was 73%, which was 22% below the CCG average and 16% below the England average. The practice exception reporting was significantly better than the CCG and England averages in all 11 indicators for diabetes.

Updated 23 December 2016

The practice is rated as outstanding for the care of families, children and young people. We found the practice to be outstanding for caring and responsive and good for safe, effective and well led in this population group.

• 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 relatively high 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, and we saw evidence to confirm this.
• 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.
• The practice ran asthma clinics specifically for children outside of school hours.
• The practice and the PPG had compiled a young people’s guide to the Market Cross surgery which was available to patients and included advice on stress, weight, contraception, smoking cessation, sexual health and travel advice. It included links to websites and various schemes all written in a clear colourful leaflet. The leaflet also included information on confidentiality to help with the fear young people may have of speaking to clinicians at the practice
• The practice worked closely with the CAMHS primary care link-worker service (child and adolescent mental health services (CAMHS) are for children aged 0-18 and their families who are experiencing mental health problems).
• Three GPs ran a long-acting reversible contraceptives (LARC) clinic. Appointments were available within school hours making access more convenient for patients with children.

Updated 23 December 2016

The practice is rated as good for the care of older people. We found the practice to be outstanding for caring for this population group.

• 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.
• The practice had 48 patients on their palliative care register and the practice worked closely with the multi-disciplinary team, out-of-hours and the nursing team to ensure proactive palliative care planning. The practice was awarded the Royal College of General Practitioners Gold Standard Framework Quality Hallmark Award (for end of life care) in 2012 and was one of only three practices to be reaccredited with it when assessed in 2015.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including hypertension, dementia and heart failure were above or in line with the local and national averages.
• The practice looked after patients living in two local care homes. Named GPs were allocated to each care home and the GP visited patients as and when required.
• The practice had regular engagement with the community geriatrician.

Updated 23 December 2016

The practice is rated as good for the care of working-age people (including those recently retired and students). We found the practice to be outstanding for caring for this population group.

• 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.
• The practice’s uptake for the cervical screening programme was 81% which compared to the CCG and England average of 82% with an exception reporting of 3% which was better than the CCG average by 2% and the England average of 3%.
• Three GPs ran a long-acting reversible contraceptives (LARC) clinic, this enable patients who could not attend during business hours to access appointments at a time that suited them.

Updated 23 December 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). We found the practice to be outstanding for caring for this population group.

• The practice had an in-house psychiatric clinic where patients could see a consultant or a link-worker.
• The practice had an in-house counselling sessions supplied by the Well Being Suffolk Service.
• The practice worked closely with the CAMHS primary care link-worker service (child and adolescent mental health services (CAMHS) are for children aged 0-18 and their families who are experiencing mental health problems).
• 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 completed in-house mental capacity education including the Mental Capacity Act.

Due circumstances beyond their control and to IT problems during a change to their computer system the practice performance in some areas of the quality and outcome framework were below the CCG and national averages. The practice achieved 62% for mental health related indicators in QOF, which was below the CCG and England averages by 31%. The rate of exception reporting for these indicators was significantly better than the CCG and England averages in six out of seven indicators in mental health and one indicator showed similar exception reporting. 74% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was below than the CCG average by 11% and the England average by 10% with a 7% exception reporting which was the same as the CCG and England averages of 7%.

Updated 23 December 2016

We found the practice to be outstanding for effective, caring, responsive and well led and good for safe in this population group.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. The practice had 62 patients on the learning disabilities register and had invited all of them in for a review. 45 patients had attended. The practice offered longer appointments for patients with a learning disability.
• The practice had a lead GP for learning disability patients.
• The practice looked after patients living in a learning disability assisted living accommodation and two National Autistic Society homes.
• The practice engaged with the PPG regarding the traveller community and had input into a health education information DVD.
• 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.
• 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 during out-of-hours. The practice had adult and child safeguarding leads and all members of staff we spoke with knew who to speak with and were able to demonstrate that appropriate measures would be taken.