Heathgate Medical Practice

Updated 20 February 2017

Heathgate Medical Practice is situated in Poringland, Norfolk with a branch surgery in Rockland St Mary. The practice provides services for approximately 8,800 patients in approximately 80 square miles. The practice has seen a 7.5% increase in patient numbers in the past 10 years. It holds a General Medical Services (GMS) contract. A GMS contract is a nationally negotiated contract to provide care to patients. In addition, the practice also offers a range of enhanced services commissioned by their local CCG: facilitating timely diagnosis and support for people with dementia and extended hours access.

Heathgate Medical Practice has been an approved training practice for over 20 years. This means that doctors who wish to work in General Practice have to spend time training in a surgery environment to gain the experience and qualifications they need to become a GP. The practice has two qualified GP trainers and two associate trainers who mentor and support the education of the doctors in training. The practice also host medical students.

The practice has three male and two female GP partners and a managing partner. The team also includes a female nurse practitioner, two female practice nurses, one female health care assistant, one female phlebotomist and four dispensers. They also employ a team of secretarial, administration and reception staff.

The surgery in Poringland is open between 8am and 6pm Monday to Friday with extended hours on a Wednesday between 6.30pm and 7.30pm and on a Friday morning between 7am and 8am. Additional weekend appointments are available on a selection of Saturday mornings. The surgery in Rockland St Mary is open on Mondays between 8.30am and 12pm and 2.30pm and 5.30pm, Tuesdays and Thursdays between 8.30am to 12pm, Wednesdays between 2.30pm to 5.30pm and Fridays between 8.30am to 12pm and 2,30pm to 5pm. The branch surgery is closed on the weekends. When the surgery is closed, patients have full access to healthcare services through the Poringland surgery. During out-of-hours GP services are provided by Integrated Care 24 (IC24) via the 111 service.

We reviewed the most recent data available to us from Public Health England which showed that the practice had a lower than average practice population under age 45 and higher than average over 45 to 85+ compared to the national England average. The deprivation score was significantly lower than the average across England.

Updated 20 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Heathgate Medical Practice on 11 January 2017. 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 the practice had systems in place for reporting and recording significant events. All opportunities for learning from internal and external incidents were maximised.
• Risks to patients who used services were assessed and well managed.
• The practice was proactive and responsive to patients’ needs.
• Patient safety alerts were logged, shared and initial searches were completed and the changes effected.
• 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.
• The practice had undertaken 411 NHS health checks last year.
• Results from the national GP patient survey showed patients responded positively to all questions in the survey. All results were above the local and national averages. For example; 95% of patients said they could get through easily to the practice by phone compared to the CCG average of 70% and the national average of 73%.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice gathered feedback from patients and it had a very engaged and proactive patient reference group (PRG), who liaised closely with staff and influenced practice development. Changes were made to the way it delivered services as a consequence of feedback from patients and the PRG.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs. For example; the practice had a room available which included a baby weighing facility for parents to use.
• There was a clear strong 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 area where the provider should make an improvement was:

• Develop a system to proactively identify carers.

We saw areas of outstanding practice including:

• The practice had encouraged the Clinical Commissioning group (CCG) to look at commissioning a local enhanced service with Practices across the CCG to engage in the monitoring of patients with eating disorders, based on monitoring submitted by the practice. A new local enhanced service was commissioned and two partners at the practice formalised a practice protocol for the process. The adoption of the monitoring principles were outlined in a guide prepared by Kings College London.
• The practice offered an “options” letter and questionnaire for patients due an asthma review. The letter gave four options of how to book their review and ensured patients were involved and included in decisions about their care. All responses were overseen by the respiratory lead.
• The practice used a “passport to health” which gave patients information and reminders of ongoing and new conditions and what treatments or regular tests were needed.
• The practice created a pull up banner to promote ‘lost clinical time’ due to patients who did not attend for clinical appointments in the practice. We saw evidence of the Norfolk CCG’s support campaigns which followed and the practice’s banner and poster designs were made available to other practices within the CCGs. The banner included lost hours and appointment data for the practice each month. The practice provided data which showed the amount of patients who had missed an appointment each month, excluding the flu vaccination clinics, had declined immediately following the campaign.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 February 2017

The practice is rated as outstanding for the care of people with long-term conditions.  The practice was rated as outstanding for responsive and well led services. These ratings apply to everyone using the practice, including this population group.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. The practice completed joint reviews for patients who had two or more long term conditions to ensure patients did not have to attend the practice on multiple occasions.
• Data from 2015/16 QOF showed that performance for diabetes related indicators was 96%, which was 4% above the CCG average and 6% above the England averages with an exception reporting of 15% which was the same as the CCG average of 15% and higher than the England average of 12%.
• Longer appointments and home visits were available when needed which included for long term condition reviews.
• 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.
• The practice hosted the hospital diabetes eye screening clinic annually.
• Nursing staff had completed the Warwick certificate in diabetes care (CIDC) course.
• The practice used a “passport to health” which gave patients information and reminders of ongoing and new conditions and what treatments or regular tests were needed.
• The practice offered an “options” letter and questionnaire for patients due an asthma review. The letter gave four options of how to book their review and ensured patients were involved and included in decisions about their care. All responses were overseen by the respiratory lead.
• The practice offered three anticoagulation clinics per week.

Updated 20 February 2017

The practice is rated as outstanding for the care of families, children and young people. The practice was rated as outstanding for responsive and well led services. These ratings apply to everyone using the practice, including this population group.

• 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 the averages for 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 positive examples of joint working with midwives, health visitors and school nurses. The health visitors used a room at the practice and undertook joint visits with the practice clinical staff to patients where necessary. The midwives ran a weekly clinic from the practice. The practice provided glucose tolerance testing for pregnant women which meant they did not need to visit the hospital for the tests.
• The practice had a room available which included a baby weighing facility for parents to use. It included baby weighing scales, equipment cleaning wipes, a check list for cleaning by both patients after use and the practice and various information regarding child protection guidance, adult safeguarding and vaccinations.
• The practice had a baby changing area and encouraged breast feeding within the practice.
• The practice supported the local secondary schools with materials for lessons regarding sexual health.
• Text messaging was used to confirm appointments.

Updated 20 February 2017

The practice is rated as outstanding for the care of older people. The practice was rated as outstanding for responsive and well led services. These ratings apply to everyone using the practice, including this population group.

• 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.
• The practice had a palliative care register and the practice worked closely with the multi-disciplinary team, out-of-hours and the nursing team to ensure proactive palliative care planning.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis, dementia and heart failure were generally in line with the local and national averages.
• The practice looked after patients living in two local care homes. The GPs visited patients weekly and met with the home managers to discuss specific care needs.
• Patients were directed to the Good Neighbour Scheme which supports older people in their daily living.
• The practice offered flu, shingles and pneumococcal vaccinations to this population group.

Updated 20 February 2017

The practice is rated as outstanding for the care of working-age people (including those recently retired and students). The practice was rated as outstanding for responsive and well led services. These ratings apply to everyone using the practice, including this population group.

• 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 offered pre-bookable appointments with GPs and nurses on a selection of Saturday mornings and extended hours on a Friday morning between 7am and 8am and in the evening on a Wednesday between 6.30pm and 7.30pm. Appointments could be booked up to six weeks in advance.
• The practice was proactive in offering online services, telephone clinics, as well as a full range of health promotion and screening that reflected the needs for this age group.
• The practice’s uptake for the cervical screening programme was 84% which was the same as the CCG average and higher than the England average by 3%. The practice exception reporting for the clinical domain was 2% which was better than the CCG average of 8% and the England average of 7%.
• The practice offered catch up vaccinations for students studying away at university.
• The practice participated in the C-Card scheme which offered discreet Chlamydia screening and contraception for patients aged 13-24.
• The practice had extended hours phlebotomy services.
• In October 2016 the practice made 22 additional routine appointments available per week for patients to ease the winter pressures. In January 2017 the practice made a further 16 routine appointments available per week due to an NHS England scheme for winter pressures.

Updated 20 February 2017

The practice is rated as outstanding for the care of people experiencing poor mental health (including people with dementia). The practice was rated as outstanding for responsive and well led services. These ratings apply to everyone using the practice, including this population group.

• The practice regularly worked with 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 offered library prescriptions and lent out mindfulness books.
• 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 completed a dementia harmonisation programme in 2016 to ensure patients with the condition were supported and continued to screen patients using the appropriate cognitive test.
• The practice was a dementia friendly practice. The practice manager had devised an action plan which included 30 minute appointments for dementia reviews.
• The practice hosted a member of the local Wellbeing service and advertised the service in their newsletter.
• The practice patient reference group held a dementia awareness event in 2016 with local support groups in attendance which included the Alzheimer Association.
• 86% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which similar to CCG average by and above the England average by 2% with a 14% exception reporting which was higher than the CCG average of 11% and the England average of 7%. The practice had 25% of their practice population aged 65 and above.
• The practice achieved 93% for mental health related indicators in QOF, which was below the CCG average by 3% and the same as the England average with an exception reporting of 13% which was below the CCG average of 14% and above the England average of 11%.

Updated 20 February 2017

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable. The practice was rated as outstanding for responsive and well led services. These ratings apply to everyone using the practice, including this population group.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. The practice had 27 patients on the learning disabilities register and all patients had been invited to attend a care 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.
• 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 during out-of-hours.
• The practice staff had completed deaf awareness training.
• The practice had encouraged the Clinical Commissioning group (CCG) to look at commissioning a local enhanced service with Practices across the CCG to engage in the monitoring of patients with eating disorders, based on monitoring submitted by the practice. A new local enhanced service was commissioned and two partners at the practice formalised a practice protocol for the process. The adoption of the monitoring principles were outlined in a guide prepared by Kings College London.