Grimston Medical Centre

Updated 16 February 2017

Grimston Medical Centre is a purpose built practice situated in Grimston, King’s Lynn, Norfolk. The practice provides services for approximately 4,900 patients. It holds a General Medical Services contract with West Norfolk Clinical Commissioning Group.

According to information taken from Public Health England, the practice population has a larger percentage of adults aged over 45 years old in comparison to the national average for practices in England. The practice is in a rural area with a mixed level of deprivation.

The practice clinical team consists of three GPs, two practice nurses and two healthcare assistants. They are supported by a practice manager and reception, administration and secretarial staff. The practice is licensed to dispense medicines and employs six dispensers.

Grimston Medical Centre is open from Monday to Friday. It offers appointments from 9am to 12pm and 2pm to 5pm daily. The practice does not offer extended hours appointments. Out of hours care is provided via the NHS 111 service by Integrated Care 24.

Updated 16 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Grimston Medical Centre on 17 January 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• 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.
• Feedback from patients about their care was consistently positive. Patients said they were treated with compassion, dignity and respect and that they were involved in their care and decisions about their treatment. Data from the National GP Patient Survey published in July 2016 showed that patients rated the practice higher than others for all aspects of care. For example, 97% of patients said that the last GP they saw or spoke to was good at treating them with care and concern, in comparison to the local average of 89% and the national average of 85%.
• 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 GP and that there was continuity of care. Urgent appointments were available on the same day.
• 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 well 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.

However, the practice should make the following improvement:

• Undertake a review of the risk of legionella within the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 February 2017

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 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). Data from 2015/2016 showed that performance for diabetes related indicators was 100%, which was above the local average of 93% and the national average of 90%. Exception reporting for diabetes related indicators was 11%, which was in line with the local average of 14% and the national average of 12% (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).

• Longer appointments and home visits were available when needed.
• Patients with complex needs had a named GP and a structured annual review to check their health and medicines needs were being met. There was an effective recall system in place to ensure that patients were invited and attended annual reviews.
• 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 16 February 2017

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.
• Immunisation rates were in line with local and national averages for all standard childhood immunisations.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 83%, which was in line with the local average of 85% and the national average of 81%. Exception reporting for this QOF indicator was 1%, which was lower than the local average of 11% and national average of 7%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice offered a full range of contraception services and chlamydia screening.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 16 February 2017

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

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. All home visits were triaged by a clinician to prioritise visits and ensure appropriate and timely intervention.
• The practice contacted all patients after their discharge from hospital to address any concerns and assess if the patient needed GP involvement at that time.
• Weekly ‘bus slot’ clinics were held to facilitate patients who were only able to access the surgery via the West Norfolk door-to-door bus service.
• 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.
• 67% of patients aged over 65 had received an influenza vaccination in the previous 12 months.

Updated 16 February 2017

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 where possible.
• 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.
• Telephone appointments with a GP were available throughout the day.
• Practice staff carried out NHS health checks for patients between the ages of 40 and 74 years. The practice was able to refer patients to a health trainer to encourage lifestyle changes. 49 health checks had been completed in the previous four months.
• The practice offered many NHS services in house, reducing the need for outpatient referral and therefore improving patient convenience.

Updated 16 February 2017

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

• 90% of patients diagnosed with dementia had received a face to face care review in the last 12 months, which was above the local average of 81% and the national average of 84%. Exception reporting for this QOF indicator was 9%, which was in line with the local average of 8% and the national average of 7%.
• 95% of patients experiencing poor mental health had a comprehensive care plan, which was in line with the local average of 93% and the national average of 89%. Exception reporting for this QOF indicator was 7%, which was lower than the local average of 18% and the national average of 13%.
• 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 had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• The practice worked closely with a local care home for adults with mental health needs.

Updated 16 February 2017

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 travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability. 32 patients on the practice learning disability register had received an annual health check since April 2016.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients, and held regular multidisciplinary team meetings.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• The practice was engaged with the local carers support group, which provided guidance, support and respite for carers. Written information was available to direct carers to the various avenues of support available to them.
• 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 had recently organised domestic abuse awareness training for staff.