Leicester Terrace Health Care Centre

Updated 20 October 2016

Leicester Terrace Health Care Centre is located close to Northampton town centre. The practice has a small car park and is served by local public transport links. The practice site consists of two converted town houses. The practice holds records which show the original house was first used by a General Practitioner in 1897.

The practice is part of the NHS Nene Clinical Commissioning Group (CCG). Services are delivered under a General Medical Services (GMS) contract.

The practice staff team comprises of eight GP partners; four female and four male. As a teaching practice three GP registrars were also employed. The nursing team was made up of eight female practices nurses and three female health care assistants. Management and administration support is provided by a team of 20 staff, led by the practice manager, who is also a partner in the practice.

The practice has approximately 14,500 patients. The practice is open between the hours of 08.00 and 18.30 Monday to Friday, with appointments available during those times. Extended hours are available with appointments offered on Mondays until 19.30 and from 07.00 on Tuesdays. The practice is also open 08.00 until 10.00 on Saturday.

When the practice is closed patients are advised to contact the out of hours service offered locally by the provider Northamptonshire Out of Hours.

The services provided by Leicester Terrace Health Care Centre are delivered from one registered location, 7-9 Leicester Terrace, Northampton, NN2 6AL.

Updated 20 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Leicester Terrace Health Centre on 12 January 2016.

Overall the practice is rated as outstanding.

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 understood and fulfilled their responsibilities to raise concerns and report incidents or near misses. The practice logged all incidents and learning opportunities were maximised, with clear discussions and follow up action well documented. 
• 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. Improvements were made to the quality of care as a result of learning from complaints and concerns.
• Feedback from patients was consistently positive. Patients said they felt valued and were always treated with respect and dignity. Appointments with a named GP were readily available and there was continuity of care. On occasion patients noted a waiting time of longer than 15 minutes; however, the practice was aware of this feedback with regular surveys and monitoring of performance undertaken. The practice was seeking to address the situation with time management and appointment booking reviews. Urgent appointments and appointments for children were always available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs. The practice demonstrated a thorough awareness of the needs of its patient population and had implemented measures to improve outcomes for those most at risk.
• The practice delivered services to a higher than average proportion of younger patients and had forged good working relationships with a local county wide agency supporting parents with young children.
• Twice weekly visits to patients living in care homes served by the practice had reduced unplanned hospital admission and Accident and Emergency activity.
• The practice partners had created a flat and clear leadership structure. Staff felt supported by management. The practice proactively sought feedback from staff, external agencies and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw a number of areas of outstanding practice:

• The practice had built positive relationships with local organisations that were able to provide life skills, emotional support and advice for patients. For example, a link with a community law service had been accessed by patients seeking help with debt management and advice regarding applications for eligibility for government benefits. Additionally, links with the local branch of the Samaritans charity offered immediate support to patients whilst waiting for contact by the Improved Access to Psychological Therapies service (IAPT).
• The practice was forward looking and welcomed innovation. It supported staff in research projects and participated in local service development pilots, which had made demonstrable improvements to patients’ health and well-being.
• The practice had sustained measurable improvement in recognising and understanding the needs of carers. The number of patients recorded as carers had increased and services provided to carers had been improved. The practice had received external accreditation of their work.
• The practice demonstrated clear, strong and effective management. The partners had a vision for the practice, which had delivery of safe and high quality services to patients at its heart. The vision drove the ethos of the practice and formed a key plank of staff engagement and motivation.
• The vision was supported by a clear strategic plan, which was implemented using a regularly reviewed, costed and updated business plan. Partners held individual responsibility for service delivery areas and reported on progress of projects or developmental areas and future opportunities.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 20 October 2016

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

• Nursing staff had roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• 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. Multidisciplinary meetings were held on a weekly basis as required.

• The practice provided a foot examination to 94% of patients on the diabetes register within the preceding 12 months, compared to the CCG average of 89% and national average of 88%.

• Prescribing practice was actively monitored and managed. The practice uses and promotes the use of electronic prescribing.

• The practice undertakes the annual review of patients with long-term conditions by ‘birth months’.

• The practice has introduced ‘named’ or ‘usual’ GPs for all patients to maintain continuity of care wherever possible.

Updated 20 October 2016

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

• The practice held monthly safeguarding meetings with health visitor and midwife to identify children who may be at risk or those which have emerging needs or risks.

• 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 81%, which was in line with the CCG and national averages of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies. Longer appointments to offer combined post-natal and 6 week checks.

• We saw positive examples of joint working with midwives, health visitors and school nurses. The practice worked with a local charity, Northamptonshire Parents in Partnership (NorPIP), to provide clinics offering specialist therapeutic services to new parents and offered support with new or ongoing mental health issues.

• Sexual health and contraceptive services, available throughout the week and after school, with Chlamydia screening available to all patients under 25 years of age.

• Meningitis vaccination was offered to 6th Form and University students.

• The practice had produced a minor illness booklet aimed at the 'young child' cohort, which was also available on the practice website.

Updated 20 October 2016

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

• 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. Home visits by GPs are allocated by post-code area to ensure continuity of care for patients.
• The practice initiated and continued to provide twice weekly visits to the care homes to which it provided services. All residents had care plans in place. Practice involvement had resulted in reductions in non-elective admissions and visits to Accident and Emergency.
• A ground floor 'accessible' consulting room was created for patients who prefer to maintain their independence and not to use stair lifts and passenger lifts.
• The practice offered proactive, personalised care to meet the needs of the older people in its population. Monthly meeting with allocated Palliative Care Specialist Nurse attending Primary Health Care Team meetings and proactive working with the Collaborative Care Team.

Updated 20 October 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 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 was open from 08.00 – 18.30 every day and on 08.00 – 10.00 on Saturday mornings. Extended opening hours were available on Monday until 19.30 and early opening at 07.00 on Tuesday morning.

• Blood tests were available from 08.00 every day and throughout lunchtimes.

• GP and nurse routine appointments available for booking four weeks ahead. Telephone follow-up appointments offered to avoid patient visiting the surgery.

• The practice had positive links with local community organisations which provided specialist support to patients with financial and housing advice consultations in the surgery. The practice also worked in partnership with the Department of Work and Pensions in supporting people back to work.

• NHS Health checks for eligible patients.

Updated 20 October 2016

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

• 95% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is higher than both the CCG average 85% and the national average 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice invited learning disabled patients for annual health checks with a practice nurse. Accessible correspondence material was used to communicate with patients. Home visits are available for these reviews if patients are unable to attend the practice. Special attention is given to those patients who do not respond and appropriate intervention and checks will be made to ensure patients wellbeing.
• The practice carried out advance care planning for patients with dementia. Close links with patients who lived in care homes facilitated a systematic review of all patients who were residents. An early diagnosis of dementia ensured additional and correct support was provided.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. The practice had a proactive referral system with a local mental health charity to provide immediate support to patients while waiting for referral to IAPT services.

• The practice facilitated the provision of clinics at the surgery for parents of new born or young children by a local charity offering specialist therapeutic services to promote secure attachment between parent and baby and to alleviate ongoing mental health issues.
• The practice had supported research by its staff to facilitate early recognition and treatment of depression in carers and patients over the age of 65 years of age.
• 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. Clinicians had received Mental Capacity Act training.

• The practice provided longer appointment provided for patients with mental health problems and patients in crisis.

• The practice had created and maintained excellent, positive partnerships with the Mental Health team, with practice based clinics and specialist nurses offering dedicated support.

Updated 20 October 2016

The practice is rated as outstanding 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 regularly validated its register with the local authority social services to ensure it was accurate and up-to-date. The patient register was reviewed at weekly multidisciplinary meetings to determine appropriate support was being provided.

• The practice offered longer appointments for patients with a learning disability and home visits are available if the patient is unable to travel to the surgery. 

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. Advice for smoking cessation, sexual health and healthy lifestyle choices was available and routinely offered.

• The practice participated in an eight week programme to pilot an Acceptance and Commitment Therapy group, aimed at supporting patients with enduring weight gain problems. Ten patients from the practice took part, with results demonstrating all participants experienced a decrease in waist circumference and improvements in their general health.

• Although numbers of homeless or traveller patients was low, the practice held information to signpost patients to local support groups and voluntary organisations. The practice worked in cooperation with other town centre GP practices to support this group of patients.

• 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. Robust reporting and monitoring systems were in place to manage concerns identified.

• Patient information leaflets and ‘checking-in’ screen provided in different languages. Liaison with alcohol and diabetes groups had facilitated translation of leaflets and information has been tailored to meet patients’ needs.