Long Bennington Medical Centre Also known as Dr Lawrenson & Partners

Updated 20 July 2016

Long Bennington Medical Centre provides primary medical services to approximately 5,804 patients in Long Bennington and its surrounding villages. The practice dispenses medicines to 96% who are registered with the surgeries. The practice over 23 villages in the local area.

At the time of our inspection the practice employed four GP partner (two male and two female), and one locum GP (female) ,a Practice Manager, one deputy practice manager, one finance manager, three practice nurses, one health care assistant, one dispensary manager, four dispensers and 10 reception and administration staff.

The practice has a General Medical Services Contract (GMS). The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities.

The practice has one location registered with the Care Quality Commission (CQC) which is Long Bennington Medical Centre, 10 Valley Lane, Long Bennington,Newark,Notts NG23 5FR

The practice currently has two branch surgeries:-

Allington Village Hall, 3 The Hawthorns, Allington Gardens, Grantham NG32 2FS

Hougham and Marston Village Hall, Main Street, Marston, Lincolnshire NG32 2HH

Long Bennington Medical Centre is open from 8am to 6.30pm Monday to Friday with emergency access to a doctor available between 8.00am and 8.30am, and 6.00pm and 6.30pm Monday to Friday. The practice have open surgery (sit and wait) every morning where patients can attend the practice and are guaranteed an appointment to be seen by a GP. GP appointments are available from 9-12 noon and 3.30pm to 5.30pm Monday to Friday. A variety of nurse and health care assistant appointments were also available very day. Patients can book appointments by phone, online or in person. Appointments could be booked up to four weeks in advance.

The practice also have branch surgeries at Allington and Marston where patients can be seen by a GP. Long Bennington Medical Centre have put in an application to NHS England to close both of the branch surgeries and on the day of the inspection no final decision had been made.

The practice provide extended hours surgeries on Monday and Thursday evenings between 6.30pm and 8.00pm. These appointments were particularly useful to patients with work commitments.

The dispensary is open Monday to Friday 8.30am to 6pm. They offer a dispensary service to patients who are registered with the practice

The practice is located within the area covered by NHS SouthWest Lincolnshire Clinical Commissioning Group (SWLCCG). The CCG is responsible for commissioning services from the practice. A CCG is an organisation that brings together local GP’s and experience health professionals to take on commissioning responsibilities for local health services.

The practice had a website which we found had an easy layout for patients to use. It enabled patients to find out a wealth of information about the healthcare services provided by the practice. Information on the website could be translated by changing the language options. This enabled patients where English is not their first language to read the information provided by the practice.

We inspected the following location where regulated activities are provided: -

Long Bennington Medical Centre, 10 Valley Lane, Long Bennington,Newark,Notts NG23 5FR

We also visited the branch surgery at Allington Village Hall, 3 The Hawthorns, Allington Gardens, Grantham NG32 2FS

Long Bennington Medical Centre had opted out of providing out-of-hours services (OOH) to their own patients. The OOH service is provided by Lincolnshire Community Health Services NHS Trust. There were arrangements in place for services to be provided when the practice is closed and these are displayed on the practice website.

The practice were registered with the Care Quality Commission but the registration certificate had not been updated since a new GP partner had joined the practice in July 2015. We spoke with the management team who told us that they were in contact with CQC in order to progress a new registration certificate.

Updated 20 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Long Bennington Medical Centre on 24 May 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. However themes and trends were not reviewed to ensure actions were taken in a timely manner.
• Risks to patients were assessed and well managed.
• The practice assessed needs and delivered care in line with relevant and current evidence based guidance and standards, including National Institute for Health and Care Excellence (NICE) best practice guidelines. 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 complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• Processes were in place for handling repeat prescriptions which included the review of high risk medicines.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Review themes and trends from significant events to ensure actions were undertaken in a timely manner.

• Ensure the safeguarding registeris current and up to date

• Ensure that all necessary emergency medicines are available for use at all times.

• Embed a system for the identification of carers.

• Put a system in place to monitor QOF in relation to exception reporting to ensure actions are taken where required.

• Put a process in place to check medicines in the dispensary are within their expiry date and suitable for use.

• Embed a system to review standard operating procedures (SOP) and processes and monitor their use.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 July 2016

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

• GPs and the practice nurse 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, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less was 92.7% which was 0.4% above the CCG average and 1.3% above the national average. Exception reporting was 1.9% which was 3.3% below CCG average and 3.3% below national average.

• The practice encouraged its patients to attend national screening programmes. For example, 85.3% of patient with diabetes attended for eye screening. This was above the CCG average of 83.3% and national average of 80%.

• The practice told us 24.4% of patients who were on four medicines or more had received a medicine review in the last 12 months which is below CCG and national average.

• 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.

Updated 20 July 2016

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

• 17% of patients registered with the practice are under 16 years of age.

• 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 comparable to CCG and national average for all standard childhood immunisations.

• 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 and health visitors.

• Six week baby checks and 8 week old childhood immunisations are carried out at the practice.

• The practice offers a full range of emergency and continuous contraceptive service. For example, chlamydia screening packs and contraception advice.

• The practice’s uptake for the cervical screening programme was 88.2%, which was above the CCG average of 80.9% and the national average of 80%. The practice also encouraged its patients to attend national screening programmes for bowel and breast cancer screening. The practice uptake for bowel screening was 68% which was above the CCG average of 60.8% and national average of 60%. The practice uptake for breast screening was 73.7% which was slightly below the CCG average of 75.8% but above the national average of 70%.

Updated 20 July 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.

• 30% of patient registered with the practice are 65 years of age and over.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Staff had completed care plans for 2.53% of patients who had been assessed as being at risk which was above the national average of 2%.

• The practice signpost to various organisations including Age UK and the staff liaise closely with the District Nurses.

Updated 20 July 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 encouraged its patients to attend national screening programmes for bowel and breast cancer screening. The practice uptake for bowel screening was 68% which was above the CCG average of 60.8% and national average of 60%. The practice uptake for breast screening was 73.7% which was slightly below the CCG average of 75.8% but above the national average of 70%.

• 51% of working age patients had their blood pressure checked in the last year.

• The practice maintained their website and offered information to patients via a newsletter. They also had a Twitter account to notify patients with information about the practice and general health promotion advice.

Updated 20 July 2016

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

• 84.2% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months.

• 87.5% of patients with depression had their care reviewed in a face to face meeting in the last 12 months.

• Only 66.6% of people experiencing poor mental health had received an annual physical health check in the last 12 months.

• 100% of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in their record in the last 12 months was higher than the CCG average of 94% and national average of 88%.

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

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. For example, Mood juice.

• The practice refer patients to the Single Point of Access (SPA) and Improving Access to Psychological Therapies (IAPT)

• The practice offered dementia screening to patients aged 65 and over. They also completed a memory and mood assessment using the Cantab cognitive tool for patients aged 50 to 90 years of age.

• Staff had a good understanding of how to support patients with mental health needs and dementia. We saw that the practice had a dementia awareness update at a recent practice learning day attended by all staff.

Updated 20 July 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 homeless people, travellers and those with a learning disability.

• 90.9% of patients with a learning disability had received a review in the last 12 months.

• 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. For example, St Barnabas Lincolnshire Hospice and Cruse Bereavement Care.

• 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.

• The practice offered support to carers and to those who were bereaved.

• The practice look after patients registered with the practice who stay in the Hospice in a Hospital in Grantham.