Greyfriars Surgery

Updated 13 January 2017

Greyfriars Surgery provides primary medical services to 11,479 patients from a single surgery situated in Boston town centre, Lincolnshire. The building is a purpose built surgery and was commissioned for use in 2004.The practice occupies the three floors of the building with patient consultations taking place on the ground and first floor. A passenger lift was available for patients and carers.

At the time of our inspection the practice consisted of two GP Partners two salaried GPs, two nurse practitioners, three practice nurses, a health care support worker and community health care support worker, an older adult rehabilitation technician and an older adult team clinical case manager. They are supported by a team of management, administration, reception and housekeeping staff.

The practice is located within the area covered by NHS Lincolnshire East Clinical Commissioning Group (CCG). A CCG is an organisation that brings together local GP’s and experienced health professionals to take on commissioning responsibilities for local health services.

The practice has a General Medical Services contract. (The GMS contract is a contract between general practices and NHS England for delivering primary care services to local

Communities). It is not a dispensing practice.

Boston and its surrounds has a population of 66,500 (2014) and has seen a 14.5% increase over the proceeding ten years, making it the fastest expanding population in Lincolnshire.

The practice has a higher than average percentage of patients aged between 25 and 35 years of age.

Boston and South Holland have some of the highest levels of migrant workers in England, they being predominantly form eastern Europe, in particular, Lithuania ,Poland and Latvia. Many of these patients are employed in agriculture, horticulture, food production , processing and manufacturing.

The surgery is open from 8am to 6.30pm Tuesday to Friday and from 8am to 8pm on Mondays.

The practice has opted out of providing out-of-hours services to their own patients. The out-of-hours service is provided by Lincolnshire Community Health Services NHS Trust and is accessed by NHS111.

Updated 13 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Greyfriars Surgery on 20 October 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.
• 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 was responsive to the needs of patients and tailored its services to meet those needs.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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 there was continuity of care, with urgent appointments available 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 supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• There was strong emphasis on learning and improvement.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• The provider should consider implementing a standard procedure to offer support to people in times of bereavement.

• Ensure that details on how to make a complaint is clearly displayed in the patient waiting area.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 January 2017

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

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

• Diabetes related clinical indicators showed the practice to be performing in line with CCG and national percentages.

• Longer appointments and home visits were available when needed.

• 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 13 January 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 generally higher for all standard childhood immunisations than both the CCG and national averages.

• 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.

• Rates for cervical screening were comparable to both CCG and national averages.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice provided a full range of immunisations for babies, children and young people which were clearly explained on the practice website.

• We saw positive examples of joint working with midwives, health visitors and district nurses. The joint working was promoted and enhanced by virtue of these other healthcare professionals holding their clinics at the surgery.

Updated 13 January 2017

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 participated in the older persons scheme which provided additional funding to enable the practice to meet the healthcare needs of his population group.

• GPs were assigned responsibility for the 15 nursing and residential homes where 90 patients of the practice lived.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Updated 13 January 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.

• 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.

• Extended opening hours were available on one evening a week.

• A full range of on-line services were available to meet the needs of this group of patients.

Updated 13 January 2017

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

• 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 identified 95 patients experiencing poor mental health and could provide them with information on how to access various support groups and voluntary organisations.

• All practice staff had taken part in dementia awareness training and had become ‘Dementia Friends’

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 13 January 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 those with a learning disability.

• It was the preferred practice for the women's refuge.

• Vulnerable patients such as those at risk of domestic violence had additional measures in place to ensure confidentiality.

• 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.