The Market Surgery

Updated 1 June 2016

The Market Surgery provides a range of medical services to approximately 8900 patients; the practice catchment area covers the town of Aylsham and extends to a radius of approximately eight miles. The practice has access to a suitable room within a sheltered housing unit and offers limited services, for all patients, in the village of Cawston on Friday mornings.

The practice holds a General Medical Services (GMS) contract to provide GP services, is a research and training practice. There are currently two trainee GPs working in the practice and the practice takes medical students throughout the year. A training practice has trainee GP’s working in the practice; a trainee GP is a qualified doctor who is undertaking further training to become a GP. A trainer is a GP who is qualified to teach, support, and assess trainee GPs.The practice has a dispensary and this was included in this inspection.

Data from Public Health England shows the practice serves an area where income deprivation affecting children and older people is lower than the England average. People living in more deprived areas tend to have a greater need for health care services. The practice has a higher number of patients aged 60 years and over than national average.

The practice provides medical services to patients living in eight care homes for older people. In addition, they serve three care homes for patients of any age with severe learning disabilities; there is also a secure unit for those patients with severe learning disabilities. They look after the health and wellbeing of young people who are experiencing poor mental health and have been admitted to a local secure unit. These secure units are for patients who maybe held under the Mental Health Act.

The practice has a team of six GPs meeting patients’ needs. Four GPs (three male and one female) are partners and they hold managerial and financial responsibility for the practice. There are two female salaried GPs and a nurse practitioner. In addition there are four practice nurses and two healthcare assistants/phlebotomists. One nurse acts as the nurse manager.

An assistant practice manager, accounts, and operations managers support the practice manager. A team of 11 receptionist and administrators support the management team. A team of nine dispensers and assistant dispensers support the dispensary manager. A housekeeper, who is responsible for the cleaning is also employed.

Patients using the practice have access to a range of services and visiting healthcare professionals. These include health visitors, midwives, and community staff including smoking cessation advisors. In addition the practice holds additional contracts with the CCG such as D-dimer testing. D-dimer tests are used to help rule out the presence of any blood clot that may harm the patient.

The practice is open from Monday to Thursday 7.30am to 6.30pm and Friday 8am to 6.30pm. The practice opens a limited service on Friday mornings in the nearby village of Cawston.

Outside of practice opening hours Integrated Care 24 (IC24) provides urgent health services. Details of how to access emergency and non-emergency treatment and advice is available within the practice and on its website.

Updated 1 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Market Surgery on 15 April 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised. The practice was proactive in ensuring that all staff had the opportunity to join meetings and had ownership of changes that resulted.

• Feedback from patients about their care was consistently positive. Patient feedback scores from the NHS GP Survey, the Friends, and Family Test (FFT) and from our own comments cards was extremely positive about the practice. Patients expressed high satisfaction levels with the service citing attentive and caring staff. 95% of patients using the FFT would recommend the practice.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. For example, the practice provided care to several local residential and nursing home. Some of these homes were for specific groups of patients, (for patients with learning disabilities or who were experiencing poor mental health), the practice was proactive when working with the staff, and carers to ensure those patients’ needs were met.

• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result.

• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw an area of outstanding practice including:

• The practice team worked in a well-co-ordinated manner to enable end-of-life care to take place at home. This was evidenced by the fact that 27% of the practice's patients died in hospital compared to a national average of 50%. Involvement in end-of-life care had provided very valuable training for all the GPs including the trainee GPs and had enabled them to gain confidence in managing complex cases.

However there was an area of practice where the provider could and should make an improvement:

• Request that the patient or their representative sign for the collection of controlled drugs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 June 2016

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

Nursing staff had roles in chronic disease management; data showed that patient outcomes were in line when compared with other practices in the locality. Patients that had attended appointments had a structured annual review to check that their health and medication needs were being met. The practice held weekly meetings attended by GP, nurse and administration staff to ensure that patients received appropriate re-calls and follow up.

Home visits were available to those patients who could not attend the surgery.

Longer appointments were available if required. Practice staff followed up patients who did not attend their appointments by telephone.

Patients taking long term medicines were routinely followed up to ensure safe prescribing and compliance.

Updated 1 June 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 patients who had a high number of A&E attendances. Immunisation rates were in line with local averages for all standard childhood immunisations. Young children were given priority appointments for urgent needs.

The practice was part of the C-Card scheme; this scheme enabled young patients to access free condoms. Any children identified by the school nurse were given priority appointments. All staff were aware and applied appropriate use of the Gillick competency framework.

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

Young patients being care for in specialist units were given personalised care if they attended the practice. Joint working with the staff ensured that medical records were shared for example; medicines and care plans.

Updated 1 June 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 proactive in care planning, not only for those patients that were on the vulnerable registers. To ensure that patients were cared for in the place they wished to remain, the practice was proactive in identifying and recording this information. We saw evidence that the practice had worked to the Gold Standards Framework for those patients with end of life care needs.

Continuity of care was maintained for older people through a stable GP workforce and personalised patient centred care. The practice provided visits to local care homes.

The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. A GP was available throughout the day to visit those patients that needed it. A GP held a weekly clinic in a nearby village to accommodate those patients that had difficulty with transport.

There was a delivery service for patients who were unable to collect their medicines from the pharmacy or dispensary.

Updated 1 June 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, including 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 reflected the needs for this age group.

The practice did not restrict patients to certain appointment times to attend for their annual reviews; patients who worked were able to book at times that were convenient to them. Telephone consultations were available for those patients who wished to seek advice from a GP.

NHS health checks were available.

Updated 1 June 2016

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

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

The practice looked after a large number of patients living in care homes; all of these patients received an annual review undertaken by a GP.

Staff told us that all patients with dementia had received advance care planning and had received an appropriate review. The patients that lived in care homes had advance care planning and had regular reviews with GPs as well as an annual review. All patients with dementia had a named GP and continuity of care was prioritised for them.

Same day appointments and telephone triage with a GP was offered to ensure that any health needs were quickly assessed for this group of patients.

The practice told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Staff had knowledge on how to care for patients with mental health needs and dementia.

The practice supported a local initiative which ensured the town of Aylsham was dementia friendly and several staff members were dementia friends. The practice had advised on a dementia friendly leaflet, this leaflet was circulated to all shops in Aylsham. The practice had received advice from a dementia specialist on appropriate signage for the practice. All staff at the practice had received training in dementia awareness.

Updated 1 June 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 and carried out annual health checks.

The practice had 96 patients on the register of patients with learning disabilities, living both in their own home and residential care, all of these patients had received a review.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. We saw the practice provided vulnerable patients with information about how to access various support groups and voluntary organisations.

Staff knew how to recognise signs of abuse or neglect 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.

Practice staff were intuitive to the needs of this group of patients and demonstrated that they had a personalised approach to helping them.