Reepham & Aylsham Medical Practice

Updated 23 January 2018

Reepham and Aylsham Medical Practice is a well-established GP practice that has operated in the area for many years. It serves approximately 9,000 registered patients and has a general medical services contract with NHS North Norfolk CCG.

The service is located at two sites in villages North West of Norwich, Norfolk, one in Reepham and the other in Aylsham. The two practices are approximately seven miles apart and offer very similar services including a dispensing service at both sites. We visited both sites as part of this inspection visit. According to information taken from Public Health England, the patient population for this service has a higher than average number of patients aged over 55 years, a lower than average number of patients aged 20-44 years, and less than 4 years compared to the practice average across England.

The practice team consisted of four GPs (three male, one female), two nurse practitioners, a minor injuries nurse, three practice nurses, two healthcare assistants and a phlebotomist. A team of dispensing, reception and administrative staff support them along with a practice manager and assistant practice manager.

The opening times for the main surgery are Monday to Fridays from 8.30am to 6pm. Extended hours appointments are available from 7am to 8am and 6.30 to 7.30pm on Mondays. An out of hour’s service is provided locally by Integrated Care 24 through the NHS 111 service.

The practice is a training practice involved with the training of GP registrars (doctors studying to become GPs) and offers student nurse placements.

Updated 23 January 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Reepham and Aylsham Medical Practice on 19 September 2016. The practice was rated as good for providing effective and caring services, requires improvement for providing responsive and well led services and inadequate for providing safe services. Overall the practice was rated as requires improvement.

We undertook a comprehensive inspection of Reepham and Aylsham Medical Practice on 06 July 2017 under Section 60 of the Health and Social Care Act 2008 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 19 September 2016. The practice was rated as good overall and requires improvement for providing safe services. The full comprehensive report following the inspection on 19 September 2016 and 06 July 2017 can be found by selecting the ‘all reports’ link for Reepham and Aylsham Medical Practice on our website at www.cqc.org.uk.

We undertook a follow up focused inspection of Reepham and Aylsham Medical Practice on 16 January 2018. This inspection was carried out to review in detail the actions taken by the practice to improve the quality of care and to confirm that the practice was now meeting legal requirements.

Overall the practice is still rated as good, and has been rated as good for providing safe services.

Our key findings were as follows:

• All equipment in the emergency bag was in date. There was a comprehensive policy and log in place to support the new checking system.

• There was a system in place to monitor the use of blank prescription stationary which was in line with relevant guidance.

• There was a system in place to record, learn from and discuss incidents such as near misses in the dispensary.

• There were two dispensaries and the system for managing uncollected scripts was uniform across both dispensaries and ensured GPs were informed when medicines were not collected.

• At the inspection on 06 July 2017, we found that exception reporting for 2015/16 for ‘the percentage of patients with cancer, diagnosed within the preceding 15 months, who had a patient review recorded as occurring within six months of the date of diagnosis’ was significantly higher than the local and national averages. (Exception reporting is the removal of patients from the Quality and Outcomes Framework calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects). The practice had run an audit and data from 2016/17 showed this exception reporting had reduced and was comparable to the local and national averages.

• The practice had implemented an audit calendar which ensured second audit cycles were completed in a timely manner. The practice had also implemented a system whereby each member of staff completed a yearly audit for professional development. Some of these audits included prescribing for urinary tract infections, prescribing blood thinning medicines, appointments and an audit of the practice website. The practice also completed audits on population groups to ensure audits were relevant to their practice. For example, the practice had completed an audit to ensure they had appropriately identified all patients approaching the end of life. Systems and processes were implemented and this resulted in increased staff awareness of the patient’s condition.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 August 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 practice employed a respiratory and diabetic nurse specialist to improve services available for patients with respiratory illness and/or diabetes, reducing the need to travel to hospital.
• 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). Performance for diabetes related indicators was higher compared to the CCG and national average. The practice achieved 100%, this was 7% above the CCG average and 10% above the national average.
• Longer appointments and home visits were available when needed.
• 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.

Updated 14 August 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.
• Immunisation rates were in line with or above the local averages for most 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 practice had a comprehensive cervical screening programme. The practice’s percentage of patients receiving the intervention according to 2015-2016 data was 78%, which was in line with the local average of 78% and above the England average of 73%. Patients that had not attended for a screening appointment were followed up with letters and telephone calls.
• 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 provided twice monthly sexual health clinics, one at Reepham and one at Aylsham.
• A member of the nursing team had worked with a local school to develop detailed lesson plans for delivering education on sexual health and other medical matters. This member of staff was also actively involved in delivering the lessons and visited local schools to discuss sexual health matters with pupils.

Updated 14 August 2017

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.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure, were above local and national averages.
• The practice had held an educational event for the local Rotary Club, advising and informing the attendees of various health matters such as men’s health.

Updated 14 August 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.
• Extended hours appointments were available from 7am to 8am and between 7pm and 8pm on Mondays, these included appointments with clinicians and phlebotomy services.

Updated 14 August 2017

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

• The practice had 57 registered patients with dementia, of which 54 had received an annual review in the last 12 months.
• The practice had 73 registered patients experiencing poor mental health, all of which had received a timely annual review.
• The practice regularly worked with a integrated care coordinator and 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 had an effective system in place to support and safeguard patients that did not attend for their appointments.

Updated 14 August 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 those with a learning disability. The practice had 79 registered patients with a learning disability, all of which had received a timely annual review.
• 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. There was an integrated care coordinator active in area with whom the practice worked closely when managing these patients.
• Patients who were carers were proactively identified and signposted to local carers’ groups. The practice had 151 patients registered as carers.
• 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 out of hours.