Middleton Lodge Practice

Updated 25 February 2016

Middleton Lodge Practice provides primary medical services to approximately 12376 patients through a general medical services contract (GMS). The practice serves a semi-rural area and is located in New Ollerton.

The level of deprivation within the practice population is above the national average. However, income deprivation affecting children and older people is below the national average.

The clinical team comprises five GPs (male and female), three practice nurses and three healthcare assistants/phlebotomists. The practice also employs a diabetes nurse. In addition the practice has recently recruited a new practice nurse who is due to start in March.

The clinical team is supported by a practice manager, an office manager and 12 secretarial, reception and administration staff.

The practice opens from 8.30am to 6pm Monday to Friday. Telephone lines are open from 8am. General appointments are offered each morning from 8.30am to 11.20am and each afternoon from 2pm to 5.20pm. Appointments with a duty doctor are available daily from 8.30am to 6pm. The practice does not provide extended hours surgeries.

The practice has opted out of providing out-of-hours services to its own patients. This service is provided by Central Nottinghamshire Clinical Services (CNCS).

Updated 25 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Middleton Lodge Practice on 21 January 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.
• Most risks to patients were assessed and well managed; however there were areas where systems needed to be strengthened to ensure all risks were mitigated.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients told us 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 told us they found it easy to make urgent appointments on the same day but that could sometimes be a wait to access non-urgent appointments.
• There was an ongoing programme of improvement in place to upgrade facilities within the practice.
• The practice had a wide range of policies and procedures to govern activity and support staff.
• 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.

However we identified areas where the provider should make improvements. The provider should:

• Ensure blank computer prescriptions are handled in line with guidance

• Ensure all measures to control the risk of legionella are implemented.

• Improve mechanisms to communicate with all staffing groups including reception and administrative staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 February 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 employed a specialist diabetic nurse to help meet the needs of this population group.

• Indicators to measure the management of diabetes were higher than local and national averages. For example, the percentage of patients on the practice register for diabetes with a record of being referred to a structured education programme within nine months of entry onto the register was 94.7%. This was above the local and national averages.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 25 February 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.

• 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.

• The premises were suitable for children and babies. Urgent appointments were always available on the day.

• The practice offered dedicated weekly child health care clinics with flexible appointment times.

Updated 25 February 2016

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

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

• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice worked effectively with the multi-disciplinary teams to identify patients at risk of admission to hospital and to ensure their needs were met.

• The percentage of people aged 65 or over who received a seasonal flu vaccination was which was marginally above the national average of 73.2%.

Updated 25 February 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. This included access to appointments including telephone consultations where this was appropriate.

• The practice was proactive in offering online services and all GP appointments were offered through the online booking system

• Health promotion and screening was provided that reflected the needs for this age group.

Updated 25 February 2016

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

• 93.8% of patients with a mental health condition had a comprehensive care plan documented in their records in the previous 12 months which was above the CCG average of 81%.

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

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• It 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 people with mental health needs and dementia.

Updated 25 February 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 those with a learning disability.

• It offered longer appointments for people with a learning disability in addition to offering other reasonable adjustments.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• Information was available for vulnerable patients about how to access various support groups and voluntary organisations.

• The practice had a range of information in pictorial format to support the understanding of patients with a learning disability.

• Staff knew how to recognise signs of abuse in vulnerable adults. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns.