The Lakenham Surgery

Updated 5 April 2018

The practice is situated in Norwich, Norfolk. The practice offers health care services to approximately 8,400 patients in Norwich and surrounding area. The practice holds a General Medical Service (GMS) contract with the Norwich clinical commissioning group. The premises are purpose built with all treatment and consultation rooms on ground level. Parking is available beside the surgery.

There are four GP partners (one female, three male) who are supported by two salaried GPs (both female). There are two practice nurses and two healthcare assistants. A team of 11 administration and reception staff support the practice manager and reception manager.

The practice provides a range of clinics and services, which are detailed in this report, and operates generally between the hours of 8.30am and 6.00pm, Monday to Friday. Selected Saturday morning appointments are available with GPs, nurses and healthcare assistants. The dates of these are made available for patients to ensure they are able to book these appointments in advance. The practice provides sit and wait appointments each evening from Monday to Friday 5pm to 6pm in response to population dynamics. Out of hours services are provided by Integrated Care 24.

The practice has a lower number of patients aged 0 to 18 years and a higher number of patients aged 65 or over compared to the local and national average. The deprivation score is below the England average with the practice being in the fourth more deprived decile. Income deprivation affecting children is 26% compared to the national average of 20%. Income deprivation affecting older people is 23% compared to the national average 20%. Male and female life expectancy in this area is in line with the England average at 79 years for men and 83 years for women.

Updated 5 April 2018

This practice is rated as Good overall. (Previous inspection October 2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Lakenham Surgery on 22 February 2018.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When they did happen, the practice learned from them and improved their processes. The practice shared outcomes of significant events with staff and other local GP practices.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment were delivered according to evidence based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Staff were consistent and proactive in helping patients to live healthier lives.
• The facilities and premises were appropriate for the services delivered.
• QOF performance for 2016/17 for diabetes related indicators was 85%; this was below the CCG average of 93% and below the England average of 91%.
• Annual health assessments for people with a learning disability were undertaken but required improvement. The practice had 79 patients on the learning disabilities register, of which only 3 had received a health review in 2017/18 at the time of inspection.
• There was a system for receiving and acting on safety alerts. For example, Medicines and Healthcare Products Regulatory Agency (MHRA) alerts were reviewed by the practice management team and GPs. Actions as a result were recorded but there was no log kept of historical responses. The practice informed us they would commence this immediately.
• Staff had the skills, knowledge and experience to carry out their roles and there was a strong focus on continuous learning and improvement at all levels of the organisation.
• The practice performed consistently above average for its satisfaction scores in the national GP patient survey. Patients responded positively to questions about their involvement in planning and making decisions about their care and treatment and felt they were treated with compassion, dignity and respect.
• Staff we spoke with told us they were able to raise concerns and were encouraged to do so. They had confidence that these concerns would be addressed.
• The practice had a clear vision and credible strategy to deliver high quality care and promote good outcomes for patients.

The areas where the provider should make improvements are:

• Ensure QOF performance for diabetes and asthma achieves a good standard.
• Ensure annual health assessments for patients with learning disabilities are undertaken.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Updated 1 October 2015

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. 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 medication 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. However we saw that patients with learning disabilities had not received annual health checks.

Updated 1 October 2015

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. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives and health visitors.

Updated 1 October 2015

The practice is rated good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older patients. The practice offered proactive, personalised care to meet the needs of the older people in its population and offered home visits, if necessary, as well as on the day access appointments for those with complex needs for example, in dementia and end of life care. The practice had daily contact with district nurses and participated in monthly meetings with other healthcare professionals to discuss any concerns.

Updated 1 October 2015

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. Selected alternate Saturday morning appointments were available for patients unable to access the practice during the week. In addition sit and wait appointments were available Monday to Friday afternoons. The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 1 October 2015

The practice proactively identified patients who may be at risk of developing dementia. The practice were aware of the number of patients they had registered who were suffering from dementia and additional support was offered. This included those with caring responsibilities. A register of dementia patients was being maintained and their condition regularly reviewed through the use of care plans. Patients were referred to specialists and on-going monitoring of their condition took place when they were discharged back to their GP. Annual health checks took place with extended appointment times if required. Patients were signposted to support organisations such as Improving Access to Psychological Therapies and the community psychiatric nurse for provision of counselling and support. Staff had a clear understanding of the 2005 Mental Capacity Act and their role in implementing the Act. The practice had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

Updated 1 October 2015

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, travellers and those with a learning disability. Longer appointments were offered for patients with a learning disability; however patients with a learning disability had not received an annual health check.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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 out of hours.