Acle Medical Partnership Also known as Acle Medical Centre

Updated 10 January 2018

Acle Medical Centre is located in Acle, Norfolk. There is a branch surgery situated seven miles from the main practice at Reedham. We did not visit the branch surgery during this inspection. The practice holds a General Medical Service (GMS) contract to provide GP services to approximately 9,167 registered patients, which is commissioned by NHS England. A GMS contract is a nationally negotiated contract to provide care to patients.

The practice is run by four GP partners; one female and three male. The practice employs one female salaried GP and one male GP under the GP retainer scheme (this is a scheme which ensures qualified GPs who may be thinking of leaving practice or those who can only undertake a small amount of paid professional work can keep in touch with general practice and retain their skills).

The practice employs one female and one male nurse practitioner. There are five practice nurses, including a nurse manager, two health care assistants and a phlebotomist.

The clinical team is supported by a practice manager, a deputy practice manager, a practice administration manager, three IT administrators, a teaching co-ordinator, two medical secretaries, a reception team leader and a team of seven reception staff.

Acle Medical Centre is a dispensing practice and dispenses to approximately two thirds of its practice population. The dispensary is overseen by a senior dispenser and a team of six dispensers. The dispensary provides a free delivery service to patients for repeat and on occasion, urgent medicines.

The practice catchment area covers over 158 square kilometres and includes 32 villages. The practice also provides temporary services to holiday makers in the area often holidaying on boats on the canals. According to Public Health England information, the practice age profile has higher percentages of patients aged 40 to 85+ years compared to the practice average across England. It has lower percentages of patients aged 0 to 10 years and 15 to 40 years. Income deprivation affecting children and older people is below both the local area and national average.

The practice is open between 8:30am – 1pm and 2pm and 6:30pm Monday – Thursday and 8:30am to 6:30pm Friday. The branch surgery at Reedham is open from 8:30am to 12:30pm Monday, Tuesday and Friday. The branch surgery is closed Wednesday and Thursday.

The practice is open between 8.30am to 1pm and 2pm to 6.30pm Monday to Thursday and 8.30am to 6.30pm Friday. The branch surgery at Reedham is open from 8.30am to 12.30pm Monday, Tuesday and Friday. The branch surgery is closed Wednesday and Thursday. Out-of-hours care is provided by IC24 through the NHS111 service.

The practice does not offer an extended hours service, however we were told patients are seen when required with additional appointments made available each day. In addition to pre-bookable appointments that can be booked up to four weeks in advance, urgent appointments are also available for people that need them. The practice dispensary is open from 8.30am to 1pm and 2pm to 6pm Monday to Friday.

Updated 10 January 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Acle Medical Partnership on 6 December 2016. The overall rating for the practice was good, with requires improvement for providing effective services. The full comprehensive report on the 6 December 2016 inspection can be found by selecting the ‘all reports’ link for Acle Medical Partnership on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 18 December 2017 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 6 December 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good, and good for providing effective services.

Our key findings were as follows:

• The option to order prescriptions over the telephone was no longer available in the practice. The practice offered a prescription delivery service for patients requiring this. Due to the rural nature of the surrounding area this was a responsive change that saw deliveries sent to hard to reach locations.
• GPs were notified of uncollected medicines from the dispensary. These were reviewed on a weekly basis and where needed patients were contacted to clarify any reasons. We saw that a comprehensive log was kept.
• The practice had improved performance for their Quality and Outcomes Framework (QOF) but some further improvement was required.
• The practice had an effective audit programme in place which demonstrated improvements to quality of care.
• The practice was not yet providing extended hours’ appointments but had agreed to commence this from April 2018 onwards with their commissioners. From April 2018, the practice would be open on Mondays from 7am to 8pm and during lunchtimes the remained of the week. This was in addition to current opening hours. The most recent national GP Patient Survey data from July 2017 indicated that of the 120 patients that responded:
  • 80% were able to get an appointment to see or speak to someone the last time they tried compared to the local average of 89% and the national average of 84%.
  • 82% said the last appointment they got was convenient compared to the local average of 88% and the national average of 81%.
  • 62% were satisfied with the surgery’s opening hours compared to the local average of 79% and the national average of 76%.
• The practice had reviewed the coding processes and services available for carers. The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 161 patients as carers (nearly 2% of the practice list).
• Clinical leads had been appointed individual areas of responsibility when overseeing care delivery to patients.

There were two areas where the provider should make improvements:

• Continue to monitor and improve Quality and Outcomes Framework (QOF) performance.
• Continue to monitor and improve access to appointments.

We saw one element of outstanding practice:

• The practice had developed their approach to providing care to patients that lived in residential homes where the practice delivered care. The practice had developed a visit approach which combined advanced nurse practitioners and GPs skills and knowledge, including nutrition and multiple condition reviews. This had led to a 16% reduction in hospital admissions for these patients, meaning that the practice was the lowest performer for avoidable emergency hospital admissions within the CCG. This had led to a 64% reduction in cost between 2015/16 and 2016/17. Due to the success of this approach the practice had developed a national research project on which it was leading 300 practices to develop their approach.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 April 2017

The practice is rated as good for the safe, caring, responsive and well led care of people with long term conditions and requires improvement for effective care. The concerns which led to this rating apply to everyone using the practice including this group.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• 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). The most recent published results were 85% of the total number of points available with a 9% exception reporting rate which was two percentage points below the CCG average and one percentage point below the national average (exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects). We saw that exception reporting across all indicators was generally in line with local and national averages.
• Longer appointments and home visits were available when needed.
• 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 had administered flu vaccinations to 819 patients on the practice at risk register for the current 2016/2017 flu campaign at the time of the inspection. We were told the practice nurses provided flu vaccinations to 90% of housebound patients in the practice area, this included patients with long term conditions and carers.

Updated 6 April 2017

The practice is rated as good for the safe, caring, responsive and well led care of families, children and young people and requires improvement for effective care. The concerns which led to this rating apply to everyone using the practice including this 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. Childhood immunisation rates for the vaccinations given were in-line when compared to CCG/national averages. Childhood immunisation rates for the vaccinations given were comparable to CCG/national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 77% to 100% which was above the CCG average of 70% to 99% and five year olds from 71% to 97% which is comparable to the CCG average of 70% to 98%.

• 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’s uptake for the cervical screening programme was 95%, which was above the CCG average of 84% and the national average of 82%. There was a policy to offer telephone reminders for patients who did not attend for their cervical screening test.
• 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.

Updated 6 April 2017

The practice is rated as good for the safe, caring, responsive and well led care of older people and requires improvement for effective care. The concerns which led to this rating apply to everyone using the practice including this 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 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 and heart failure were above local and national averages.
• The practice looked after patients living in local nursing homes. GPs undertook regular visits and visited patients as and when required.
• The practice had administered flu vaccinations to 71% of patients aged over 65 years old for the current 2016/2017 flu campaign at the time of the inspection. We were told the practice nurses provided flu vaccinations to 90% of housebound patients in the practice area, this included patients with dementia and carers.
• The practice also facilitated health checks for older patients who were not reviewed as part of other chronic disease checks. We saw that as of 1 April 2015, 11% of the 1003 patients over 75 years had received a health review, with 89% of patients over 75 years seen by a GP within the previous year for other health checks and reviews.

Updated 6 April 2017

The practice is rated as good for the safe, caring, responsive and well led care of working age people (including those recently retired and students) and requires improvement for effective care. The concerns which led to this rating apply to everyone using the practice including this 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 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 bowel cancer screening rate for the past 30 months was 65% of the target population, which was in-line with the CCG average of 65% and above the national average of 58%. The breast cancer screening rate for the past 36 months was 80% of the target population, which was in-line with the CCG average of 80% and above the national average of 72%.
• Patients had access to appropriate health assessments and checks. These included health checks for new patients and NHS health checks for patients aged 40–74. The practice uptake for NHS health checks for 2015/2016 had been 4720 patients invited with 52% undergoing a health check.  Appropriate follow-ups for the outcomes of health assessments and checks were made, where abnormalities or risk factors were identified.  

Updated 6 April 2017

The practice is rated as good for the safe, caring, responsive and well led care of people experiencing poor mental health (including people with dementia) and requires improvement for effective care. The concerns which led to this rating apply to everyone using the practice including this group.

• The percentage of patients experiencing poor mental health who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015) was 64%, which was below the CCG average of 89% and the national average of 88%.

• The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months (01/04/2014 to 31/03/2015) was 76%, which was below the CCG average of 81% and the national average of 84%. The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. During the inspection we found that the practice had identified 78 patients with a diagnosis of dementia. Since 1 April 2016 the practice had undertaken a care plan review with 47%, with 75% having had a recent blood test. The practice referred patients to various support services as required.
• 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. Two members of the reception staff were registered dementia friends.

Updated 6 April 2017

The practice is rated as good for the safe, caring, responsive and well led care of people whose circumstances may make them vulnerable and requires improvement for effective care. The concerns which led to this rating apply to everyone using the practice including this group.

• The practice had identified 61 patients with a learning disability on the practice register, 70% of these patients had been invited for a health care review. Of these 41% had attended with other patients declining. The practice continued to encourage the remaining patients to attend for review and told us they would often review patients opportunistically.

• 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 out of hours.