The Parks Medical Practice Also known as Grange Park Surgery

Updated 12 October 2017

The Parks Medical Practice provides a range of primary medical services and is formed from three village surgeries dating back to 1937 from its current premises located at the following four sites at Grange Park Surgery, Wilks Walk, Northampton and Blisworth Surgery, Stoke Road, Northampton and Roade Medical Centre, London Road, Northampton and Hanslope Surgery, Western Drive, Hanslope, Milton Keynes.

The practice premises are leased from NHS Property Services, and are provided under a General Medical Services (GMS) contract which is a nationally agreed contract with NHS England.

The practice serves a population of approximately 20,200 patients. The practice offers dispensary services to patients from both the Blisworth and Hanslope Surgeries. The area served is less deprived compared to England as a whole. The practice population is mostly white British with approximately 6% of mixed ethnicity. The practice serves a slightly above average population of those aged from 5 to 14 years and 40 to 54 years. There is a lower than average population of those aged from 15 to 34 years. Approximately 1,400 registered patients were aged 75 years and over.

The practice is a training practice and currently delivers training to business and administration apprentices, student nurses, medical students, foundation doctors and GP Registrars (GP trainees).

The clinical team consists of seven GP partners; four male and three female, five salaried GPs; four female and one male, one independent nurse prescriber, eight practice nurses and three health care assistants (all female). There is also a team of 21 dispensary staff working across the two dispensary sites. The team is supported by five managers; a lead practice manager, a deputy practice manager and additional surgery managers located at each of the four sites along with a team of 15 other non clinical administration and reception staff.

Grange Park Surgery is open daily from 8am to 6.30pm, whilst the other sites namely Blisworth, Hanslope and Roade Surgeries are open daily from 8.00am to 12.30pmand between 2.30pm and 6.30pm (the surgery is closed between 12:30pm and 2:30pm for lunch).

The practice offers extended hours at Grange Park Surgery on alternate Tuesdays from 6.30pm to 8.30pm, and every Tuesday and Thursday at one of the other branch surgeries.

Morning surgeries are also available on alternative Saturdays from 8.30am to 10.30am.

When the practice is closed services are provided by the Out of Hours Centre based at Northampton General Hospital and can be accessed via the 111 service.

Updated 12 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Parks Medical Practice on 20 January 2017. The overall rating for the practice was Good however breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us and submitted an action plan outlining the actions they would take to meet legal requirements in relation to:

Regulation 12 (RA) Regulations 2014, safe care and treatment.

The full comprehensive report from the inspection on 20 January 2017 can be found by selecting the ‘all reports’ link for Parks Medical Practice on our website at www.cqc.org.uk

This inspection was a focused follow up inspection carried out on 7 September 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulation that we identified on our previous inspection on 20 January 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as ‘Good’.

From the inspection on 20 January 2017, the practice was told they must:

• Improve measures related to fire safety so that actions identified in a recent fire risk assessment were implemented.
• Ensure risk assessments are undertaken where no DBS checks for non clinical staff carrying out the role of the chaperone.
• Meet the requirements of the Health and Safety at Work Act 1974 so that all eligible clinical staff had received the appropriate vaccinations, for example Hepatitis B.

We also told the practice that they should make improvements to the follows areas:

• Consider offering health checks to patients aged 75 years and over.
• Implement a systematic approach to the management of infection prevention and control, for example through annual audits.
• Ensure further identification of significant events including incidents and near misses logged by the dispensaries and consider these through the incident reporting process.
• Consider recording verbal complaints to ensure lessons learnt from these formed part of the annual trend analysis.
• Continue to encourage attendance at safeguarding meetings from external agencies.
• Ensure all staff were supported by providing appropriate supervision and appraisal.
• Implement a systematic approach to the management of exception reporting for QOF to ensure practice wide quality improvements.

Our key findings were as follows:

• Actions identified in a recent fire risk assessment had been implemented to ensure fire safety.
• Systems were in place for identifying, assessing and mitigating risk in relation to non-clinical staff undertaking chaperone duties. Non clinical staff that undertook chaperone duties had been risk assessed for the need of a Disclosure and Barring Service (DBS) check with appropriate safeguards and were trained for this role.
• We were sent confirmation that all eligible clinical staff had received the vaccinations as appropriate.
• The practice confirmed that there were alternate arrangements for eligible patients in the 75 years and over age group to receive an annual check with a GP. For example through medication reviews and long term conditions reviews.
• A six monthly infection control audit schedule was now in place at each branch with the first audit cycle completed during July 2017.
• Significant events including incidents and near misses logged by the dispensaries were now included at local team meetings, quarterly branch meetings and quarterly department meetings and were part of the annual significant event analysis and learning.
• A form was available to enable staff to record verbal complaints and comments which was discussed during practice meetings and part of the annual significant event analysis and learning.
• The practice had escalated the non-attendance of staff from external agencies in safeguarding meetings to the locality manager and agreements were in place to improve attendance.
• The practice confirmed that appraisals that were outstanding had been completed in February 2017.
• The practice confirmed that there was an effective process for exception reporting including a central reminder system operated by a dedicated QOF staff member. This included a referral system to a GP highlighting non-attendance to ensure appropriate decision making which included prompting patients to attend for the relevant monitoring and checks.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 31 March 2017

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 percentage of patients with diabetes with a HbA1c (haemoglobin levels in the blood) less than 64mmol/mol recorded in the last 12 months was 64%, compared to the local CCG average of 69% and the national average of 68%.
• 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.
• A system was in place to monitor patients effectively, medication reviews took place routinely every six months.
• For those patients with more complex needs, the named GP worked closely with relevant health care professionals to deliver a multidisciplinary package of care. For example, patients with palliative care needs were well supported and the practice worked closely with specialist assistance from local Hospices.

Updated 31 March 2017

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 84%, which was comparable to the CCG average of 76% and the national average of 76%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice provided a variety of health promotion information leaflets and resources for this population group. For example, smoking cessation, sexual health immunisations and obesity where patients could have access to dedicated programmes through third party services.
• We saw examples of joint working with midwives, health visitors.
• The GPs attended safeguarding meetings and always provided reports where necessary for other agencies. Although we found that meetings were not always attended by external agencies.
• The practice offered a range of contraceptive services including oral contraception pills, injections and intrauterine devices (IUDs or contraceptive coils).
• Practice nurses delivered baby and child immunisation clinics, reception staff telephoned parents to remind them of the appointments which were directly booked by external child health.

Updated 31 March 2017

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

• All older people had a named GP. The appointment system allowed pre-booking for patients who wished to see their named GP and flexibility if patients needed to book longer appointments.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice offered proactive, personalised care to meet the needs of the older people in its population. However, health checks were not offered to patients aged 75 years and over.
• Trained nurses offer additional services, for example a leg ulcer clinic and a micro suction clinic for ear irrigation (removal of ear wax).
• Community based flu clinics supplement those offered across all four sites. The practice also carried out vaccinations for housebound patients in their own homes.
• The practice delivered care and treatment to three local care homes providing a weekly ward round plus adhoc visits and telephone access to a GP.
• The practice offered domcillary phlebotomy services for patients unable to travel to hospital.
• There was a home flu vaccination service during the flu vaccination season.

Updated 31 March 2017

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.
• The practice encouraged its patients to attend national screening programmes for bowel and breast cancer screening. For example 66% of patients attended for bowel screening within six months of invitation compared to the local CCG average of 60% and the national average of 58%.
• The practice provided a ring back service by a duty GP or a nurse at the patient’s request where appropriate.
• The practice had enrolled in the Electronic Prescribing Service (EPS). This service enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.
• The practice offered extended hours at Grange Park Surgery on alternate Tuesdays between 6.30pm and 8.30pm, this enabled access to routine appointments for working patients who could not attend during normal opening hours.
• Morning surgeries were also available on alternative Saturdays between 8.30am and 10.30am.

Updated 31 March 2017

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

• The percentage of patients with a dementia care plan reviewed in last 12 months was 89%, compared to the local CCG average of 81% and the national average of 78%.
• 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 support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended A&E 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 work closely with a local nursing home caring for patients with severe dementia. All patients had detailed care plans in place and special patient notes in place as appropriate. We were told that the responsible GP regularly visited outside normal hours and delivered urgent medications.

Updated 31 March 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 homeless people and those with a learning disability.
• The practice has a total of 56 patients on the learning disability register, 20 of these patients had received a health check between 2015 and 2016.
• 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 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.
• Staff had received additional training in domestic abuse.
• The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 288 patients as carers (approximately 1.5% of the total practice list). They have worked closely with Northamptonshire Carers to establish monthly carers meetings.
• Veterans were recorded on the practice computer system to ensure support to ex Armed Forces