St Peters Hill Surgery

Updated 8 November 2018

St Peters Hill Surgery is a GP practice which provides a range of primary medical services to around 15,750 patients from a surgery in the town centre of Grantham at an address of 15 St Peter’s Hill, Grantham, NG31 6QA.

The practices services are commissioned by West Lincolnshire Clinical Commissioning Group (CCG). The practice holds a General Medical Services (GMS) contract. The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities. The practice is registered with the Care Quality Commission (CQC) to provide 5 regulated activities; treatment of disease, disorder and injury, minor surgery, family planning, maternity and midwifery services and diagnostics and screening.

The service is provided by four GP partners (two male and two female), two salaried GPs (one male and one female), three practice nurses, one paramedic, four healthcare assistants, one practice care coordinator, one practice manager and one reception manager supported by a team of administrators and receptionists.

The practice website provides information about the healthcare services provided by the practice.

We reviewed information from the CCG and Public Health England which showed that the practice population had higher deprivation levels compared to the CCG average by lower than the average compared to other practices in England.

The practice is open between 8am and 6.30pm from Monday to Friday and between 8.30am and 12.30pm on Saturdays. Extended hours appointments are offered on Saturday mornings.

When the practice is closed patients are asked to contact NHS 11 for out-of-hours GP care. Appointments can be booked through 111 for extended hours via the K2 federation which the practice is part of.

Updated 8 November 2018

This practice is rated as Good overall. (Previous rating May 2018 – Good)

The key questions at this inspection are rated as:

Are services well-led? - Good

We carried out an announced focused inspection at St Peters Hill Surgery on 2nd October 2018. The practice had previously been rated as good overall in May 2018. However were rated as requires improvement in delivering well-led services. This inspection was to investigate whether the governance systems had been implemented to improve systems for complaints, infection control, staff training and monitoring of refrigerator temperatures.

At this inspection we found:

• The practice had reviewed and taken action on the report published in May 2018 and implemented systems and processes to improve the practice performance.
• The system for complaints and significant events ensured that incidents were investigated and reported on in a timely matter. We saw that staff members were involved with the process and the practice understood the duty of candour where appropriate.
• The practice had a system to manage infection prevention and control and had implemented a new cleaning schedule for all areas of the practice.
• The management of staff records and training was well managed and alerted staff when training was due to be completed.
• Refrigerators temperatures were monitored twice daily and secondary thermometers were in use.

The areas where the provider should make improvements are:

• The provider should hold an immunisation record for staff.
• Ensure that back up thermometers provide accurate information.
• Continue developing the meeting schedule within the practice and providing accurate meeting minutes.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Updated 4 May 2018

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

• Clinical staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met. Where patients had more than one condition, reviews were combined to avoid multiple appointments for patients.
• 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.
• Blood tests were available throughout the day as a staff member took samples to the hospital if it was after the pathology collection had taken place earlier in the day.
• Blood tests and long term condition reviews were available on Saturday mornings.
• The practice funded the loan of home blood pressure monitors to patients and had around 250 machines available.
• The community diabetic nursing team ran clinics from the practice.

Updated 4 May 2018

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

• From the examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances or had not been taken to hospital appointments.
• Immunisation rates were high for all standard childhood immunisations.
• Children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours.

The practice worked with midwives, health visitors and school nurses to support this population group.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.
• There were daily appointments available with specialist minor illness nurses for a variety of acute problems for children over the age of two years.

• Meetings took place between GPs and associated health care professionals to discuss children with a safeguarding concern.
• Asthma clinics were available after school or on Saturday mornings for school age children.
• Baby changing facilities were available.

Updated 4 May 2018

The practice is rated as good for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Care plans were in place for patients at high risk of hospital admission on the frailty register and these patients were proactively managed by the practice care coordinator to avoid hospital admissions.
• The practice care coordinator had held ‘family days’ at local nursing homes to provide information and assistance to relatives.
• The practice offered midweek morning flu clinics for elderly patients who did not want to attend on a Saturday or in an evening.
• Practice staff had delivered medication to patients on the frailty register on their way home, when pharmacy deliveries had finished for the day.

Updated 4 May 2018

The practice is rated as good for the care of working age people (including those recently retired and students).

The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours and telephone consultations. 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 undertook pre university and occupational vaccinations and reports as required.
• The practice were supportive of students when ‘back at home’ to enable them to access health care.
• The practice was open on Saturday mornings with both GP’s and nursing staff available.
• There were appointments available on a daily basis with minor illness nurses.
• Blood tests were available all day every day including during extended hours.
• As a result of patient feedback, more evening appointments were made available for smear tests and chronic disease reviews.

Updated 4 May 2018

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

• Patients were able to self-refer to the Improving Access to Psychological Therapies (IAPT) service without seeing a GP.
• 79% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was below the national average of 84%.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• Immediate access to a GP or nurse was available for patients with urgent mental health needs.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• A number of staff members had trained as ‘Dementia Friends’ to enable them to better support patients with dementia.
• Community psychiatric nurses were able to use a room at the practice to meet with patients who were more comfortable meeting there than elsewhere.

Updated 4 May 2018

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. Travellers regularly registered as temporary residents.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients with a learning disability and worked with a local care home for patients with a learning disability to ensure appointments were convenient to them and visited the home to carry out reviews where necessary.
• The practice regularly worked with other health care professionals and other agencies in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations and told us they had offered support to homeless or vulnerable patients in order to enable them to travel to a shelter or hospital.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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 was a food bank voucher distributor.