St George's Medical Centre

Updated 1 June 2016

St George’s Medical Centre is situated in Littleport, Ely, Cambridgeshire. The practice provides services for approximately 10,600 patients. It holds a General Medical Services contract.

The practice has two male GP partners, and three salaried GPs (one male, two female). The team also includes four female nurse practitioners, three of whom can prescribe, three female practice nurses, two female health care assistants, one female phlebotomist and three female dispensary staff. They also employ a practice manager, an assistant practice manager, a finance manager and a team of reception/administration/secretarial staff.

The practice regularly trains medical students and one GP at the practice will qualify as a GP registrar trainer later this year. The practice is a dispensing practice and dispenses medications to approximately 1800 patients. There is also as separate pharmacy on site. The practice is 25 miles from the nearest general hospital.

The practice’s opening times are from 8am until 6pm Monday to Friday, with extended hours on Tuesdays, Wednesdays and Thursdays from 6.30pm until 7.30pm. The practice has opted out of providing GP services to patients outside of normal working hours such as nights and weekends. During these times GP services are provided by Urgent Care Cambridgeshire via the 111 service.

We reviewed the most recent data available to us from Public Health England which showed that the practice had an average practice population in line with the national England average. The deprivation score was also comparable to the average across England.

Updated 1 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St George’s Medical Centre on 24 March 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 an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• The practice hosted various services on site to ease access issues for patients and local people in their area and sourced various equipment using the funds raised by a charity group.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Urgent appointments with a GP were available on the same day.
• The GP Patient survey results were in line with the local and national averages.
• Information about services and how to complain was available and easy to understand.
• 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 practice was aware of and complied with the requirements of the Duty of Candour.

Areas of outstanding practice are;

• In 2008 the practice initiated an in house outpatient clinic including surgical procedures for a local general hospital who used the room rent free. The partners funded the room specification changes needed, to meet the required standards to have an operating room within the practice.The practice charged the hospital an administration charge for the up keep of the services provided which included rates/ cleaning/ management/ etc.The services provided included; ophthalmology (conditions relating to the eye), urology (conditions relating to the urinary system), gynaecology fertility service (conditions relating to the female reproductive system) and general surgery. The hospital provided the staff to the clinic.The clinics and operations were Consultant led.Patient response to the ongoing service has been positive.
• The practice housed an oncology outreach programme for the local hospital in Cambridge for the past two years. The practice recognised that patients found it difficult to attend the local hospital for chemotherapy treatment and gained permission to set up the unit. The practice sourced the funds to set up the unit privately and offered the room to the hospital for a charge of £10 per day and the remainder of the annual running costs were funded by a charity group called patients and users lenders of special equipment (PULSE). The practice received a large donation from a local business to set up the cancer suite. The unit benefitted the nine other practices in the locality and worked jointly with the specialist oncology nurses. In the past two years approximately 1200-1400 patients had attended the outreach programme. The hospital provided the staff for the outreach programme.
• The practice had sourced a bladder scanner (a device to identify the residual amount of urine in the bladder) from the PULSE. The practice explained that it saved time, money, hospital admissions and referrals for patients to the continence clinic.

The areas where the provider should make improvements are;

• Review the information displayed in the waiting room.
• Fire procedure training should be undertaken by all staff.
• Consider strengthening the records maintained to show what training staff have received and what is still required.
• Take more proactive steps to improve breast and bowel screening rates and to review exception reporting for some clinical indicators.
• Ensure the practice is proactive in identifying carers.

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 lead roles in chronic disease management and patients at risk of hospital admission were identified. The practice used the information collected for the Quality and Outcomes Framework (QOF) and performance against national screening programmes to monitor outcomes for patients. QOF is a system intended to improve the quality of general practice and reward good practice. Data from 2014/2015 showed that performance for diabetes related indicators was 94%; which was better than the CCG average by 5% and the England average by 5% with an10.5% exception reporting which was below the CCG exception reporting average of 12.9%.
• Longer appointments and home visits were available to patients when needed.
• The practice offered health checks for patients who needed long tem condition management.
• 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 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 people who had a high number of A&E attendances. Children and young people’s safeguarding meetings were held every eight weeks with health visitors and safeguarding was a standing agenda for the weekly GPs’ meetings. GPs and nurses were safeguarding level three trained (safeguarding children and young people).
• Immunisation rates were above average for the 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 practice had extended their appointment times to incorporate both a baby check and a mother’s postnatal check together at the same time to save the family having to come into the practice twice.
• The practice had a private room available for mothers who were breast feeding.

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 responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice offered health checks for patients aged over 75.
• The practice offered an anti-coagulation (monitoring the clotting of blood) service.
• GPs regularly visited patients in three residential and two nursing homes and liaised with the home managers. The GPs completed medication reviews at the homes every six months.
• The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, end of life care. The practice had 50 patients on their palliative care (end of life) register.
• The practice had sourced a bladder scanner from the charity group called patients and users lenders of special equipment (PULSE). The practice explained that it saved time, money, hospital admissions and referrals for patients to the continence clinic.

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, 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. They operated extended hours on a Tuesday, Wednesday and Thursday evening from 6.30pm until 7.30pm. They offered telephone consultations during the day to patients that might not be able to access the surgery during normal hours. Appointments could be booked 2-3 weeks in advance.
• The practice offered online appointments and prescriptions 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 above the CCG and England average by 2%.

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 carried out advance care planning for patients with dementia.
• 93% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was above the CCG and the England average by 9% with a 2.7% exception reporting which was 8% below the CCG and 6% below the England exception reporting averages.
• Patients with mental health concerns were offered annual health checks.
• The practice regularly worked with multi-disciplinary teams in the case management of people 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.
• The practice had a system in place to follow up patients who had attended accident and emergency where they might have been experiencing poor mental health including patients seen during out of hours. The practice and the out of hours service used the same clinical computer system and could access information about patients when needed.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

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 homeless people, travellers and those with a learning disability. They had identified 66 patients with a learning disability and all had received an extensive health check in the previous 12 months. The practice referred patients to various support services and had regular liaisons with the local learning disability nurses.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• 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 hosted various services on site to ease access issues for patients and local people in their area for example; an oncology programme, outpatients clinics, anti-coagulation service and sourced various equipment using the funds raised by a charity group.