Caythorpe & Ancaster Medical Practice

Updated 21 June 2016

Caythorpe and Ancaster Medical Practice is a semi-rural training and teaching practice working from two sites and provides primary medical services to approximately 8,900 patients. The surgeries are based at Ancaster and Caythorpe and cover a further 40 small villages. The practice dispenses medicines to 97.2% of patients who were registered with the surgeries.

At the time of our inspection the practice employed four GP partner (male), two salaried GPs (one male and one female), three GP registrars, a Practice Manager, four practice nurses, four health care assistants, one dispensary manager, one care co-ordinator, one accounts manager, one office manager, two delivery drivers, three house keepers, two reception supervisors, ten dispensers and 19 reception and administration staff.

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

The practice is a GP training practice. GP Registrars are fully qualified doctors who already have experience of hospital medicine and gain valuable experience by being based within the practice. The practice participate in the apprenticeship scheme and also provide training to medical students, student nurses and nurse practitioners undertaking further training to become prescribers.

The practice has one location registered with the Care Quality Commission (CQC) which is Caythorpe and Ancaster Medical Practice, Ancaster Surgery, 12 Ermine Street,

Ancaster, Grantham, Lincs, NG32 3PP. The practice also has a branch - Caythorpe Surgery, 52High Street, Caythorpe, Grantham, Lincs, NG32 3DN.

Ancaster Surgery is open from Monday 8am to 6.30pm Monday to Friday. Patients can book appointments by phone, online or in person. GP appointments were available from 9-12noon and 3.30pm to 5pm Monday to Friday. Nurse Appointments were available from 9.10am to 12.30 and 3.30pm to 5pm. There was also a ‘sit and wait’ clinic which started after morning surgery if an urgent appointment was required on the day. Appointments could be booked up to four weeks in advance.

The practice offered extended access evening appointments from 6.30 until 8.30pm on Mondays at Caythorpe Surgery and Tuesdays at Ancaster Surgery. These appointments were particularly useful to patients with work commitments.

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

The practice had a website which we found had an easy layout for patients to use. It enabled patients to find out a wealth of information about the healthcare services provided by the practice. Information on the website could be translated by changing the language options. This enabled patients where English is not their first language to read the information provided by the practice.

We inspected the following location where regulated activities are provided: -

Caythorpe and Ancaster Medical Practice, Ancaster Surgery, 12 Ermine Street,

Ancaster, Grantham, Lincs NG32 3PP and the branch surgery Caythorpe Surgery, 52High Street, Caythorpe, Grantham, Lincs. NG32 3DN

Caythorpe and Ancaster Medical Practice had opted out of providing out-of-hours services (OOH) to their own patients. The OOH service is provided by Lincolnshire Community Health Services NHS Trust. There were arrangements in place for services to be provided when the practice is closed and these are displayed on the practice website.

Updated 21 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Caythorpe & Ancaster Medical Practice on 21 April 2016. Overall the practice is rated as outstanding.

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

• At the inspection we found that patients were protected by a strong comprehensive safety system and a focus on openness, transparency and learning when things go wrong. The practice had comprehensive systems in place to keep people safe which took into account current best practice.

• There was an open and transparent approach to safety and an effective system in place for the reporting, recording, investigating and monitoring of significant events.

• Information about safety was highly valued and was used to promote learning and improvement. Risk management was comprehensive and well embedded.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, the practice employed a qualified nurse as a care co-ordinator who liaised with other agencies in the care of older people.
• Feedback from people who use the service and stakeholders was consistently and strongly positive.93 patients expressed high levels of satisfaction about all aspects of the care and treatment they received. The feedback from comments cards we reviewed said they are treated with care, compassion, dignity and respect. Staff went the extra mile.
• Data from the January 2016 national GP survey was also consistently high.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, a Neighbourhood team. The team identified those most at risk of health and social care problems and decided how best to manage their needs.

• Services were tailored to meet the needs of the patients and were delivered in a way to ensure flexibility, choice and continuity of care. The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group

• The practice had good facilities at both sites and was well equipped to treat patients and meet their needs.

• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw a number of areas of outstanding practice including:

• The practice ensured that the patients were protected by a strong comprehensive safety system with a focus on openness, transparency and learning when things went wrong. The level and quality of incident reporting demonstrated that all staff were open and fully committed to reporting incidents and near misses.

• A GP partner, with the support of Lincolnshire County Council, introduced a “Bicycles for exercise programme” The practice purchased 13 electric bicycles and these were loaned to identified“at-risk” patients, for example, those with cardiovascular disease, to encourage them to become more physically active. The practice used their medicine delivery service to deliver these to patients. The feedback from this project was very favourable and encouraged patients to go on to continue to cycle and become physically fitter.

• A GP partner, with support from local agencies, had helped to develop local walking groups.These were initially surgery based but had now become autonomous and self-sustaining under the “Walk for Life” scheme. They now had active weekly walking groups based in both Caythorpe and Ancaster surgeries. Independent research by Sheffield Hallam University (The value of walking – an ethnographic study of a Walking for Health group, Gordon Grant April 2015) had validated the success of this programme. These groups were promoted through the practice website, information in the waiting rooms and through Patient Group newsletters.

The areas where the provider should make improvement are:

• Ensure the safeguarding register is current and up to date

• Have a system to record safeguarding and gold standard framework palliative care meetings.

• Ensure that guidance received within the practice is checked and interpreted correctly to ensure patient safety. For example, in relation to repeat prescriptions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 June 2016

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

• A GP partner was the practice champion of care of long-term conditions

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

• 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.

• National reported Quality and Outcomes Framework (QOF) data to 2014/15 showed that the practice had performed well in relation to providing care and treatment for the clinical conditions commonly associated with this population group. The most recent published results for 2014/2015 showed that the practiced had achieved 99.8% of the total number of points available, with 9.1% exception reporting.

• GP or nurses carried out home visits and medication reviews were arranged for patients who found it difficult to leave their homes.

• The practice had protocols for the management of hypertension (high blood pressure) and had diagnostic equipment to enable patients to be monitored by the practice instead of having to travel to the local hospital. As part of the service to patients they provided a home delivery service for the BP monitors to ensure better monitoring and treatment.

• The practice maintained registers of patients with COPD and asthma. NICE guidance was followed in diagnosing such patients e.g. by using spirometry. A GP partner took the lead on the interpretation of spirometry results to ensure the approach was consistent and robust.

Updated 21 June 2016

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

• A GP partner was the practice champion of care of families, children and young people.

• 16% of the practice population was under 14 years of age.

• 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 comparable to national averages for most immunisations. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 71% to 94% and five year olds from 77% to 94%.

• The practice’s uptake for the cervical screening programme was 82%, which was comparable to the national average of 82%.

• In response to patient feedback and demand the practice had a “sit and wait” clinic at the end of the booked morning surgeries so that if anyone had a problem they felt needed urgent assessment they were guaranteed to be seen on the same day.

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

• The practice provides a full range of contraceptive services, from oral contraceptives, emergency contraception, to long-acting contraceptives including implants and intrauterine devices.

• We saw positive examples of joint working with midwives and health visitors.

Updated 21 June 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population. They offered home visits and urgent appointments for those with enhanced needs.

• Staff were highly committed to meeting the needs of the patients.

• A GP partner was the practice champion of care of older people.

• All patients over the age of 75 years have a named accountable GP

• Older patients made up 25% of the practice population.

• 82% of patients over 65 had an immunisation against influenza.

• The practice had a care co-ordinator who provided support to patients at risk of an unplanned hospital admission and losing their independence. They worked with multi-disciplinary teams, for example social services, Neighbourhood team and Lincolnshire Well-being service to support the care of older people. Staff had completed care plans for 3.6% of patients who had been assessed as being at risk which was above the national average of 2%.

• The practice had three residential homes in the area with patients who were registered with the practice. Each had a designated lead GP.

• The practice worked closely with the District Nursing Team to provide co-ordinated care to older people. The District Nursing Team was located in the practice within the Ancaster Surgery.

• The care for patients at the end of life was in line with the Gold Standard Framework. This meant practice staff worked, as part of a multi-disciplinary team and with out-of-hours providers to ensure a consistent approach to care and a shared understanding of the patient’s wishes.

Updated 21 June 2016

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

• An Associate GP was the practice champion of 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.

• 56.5% of the patients registered with the practice are working age.

• The practice offer extended access evening appointments from 6.30 until 8.30pm on Mondays at Caythorpe Surgery and Tuesdays at Ancaster Surgery. Appointment times were extended to fifteen minutes, to allow patients who may not be able to attend regularly, due to work commitments, to discuss a number of issues if needed in one consultation.

• A GP partner, with the support of Lincolnshire County Council, introduced a “Bicycles for exercise programme” The practice purchased 13 electric bicycles and these were loaned to identified “at-risk” patients, for example, those with cardiovascular disease, to encourage them to become more physically active.

• A GP partner, with support from local agencies, had helped to develop local walking groups. These were initially surgery based but had now become autonomous and self-sustaining under the “Walk for Life” scheme.

• 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.

Updated 21 June 2016

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

• A GP partner was the practice champion of care of people experiencing poor mental health (including people with dementia).

• 100% of patients who had been diagnosed with dementia had a care plan in place.

• The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was 87.3% which was 1.8% below the CCG average and 3.3% above the national average. Exception reporting was 11.3% which was 4% above the CCG average and 3% above the national average.

• The dementia diagnosis rate was 100% which was 18.1% above the CCG average and 18.5% above the national average. Exception reporting was 35.7% which was 29.8% above the CCG average and 27.3 above national average. Following a practice review of dementia screening/assessment in October 2015 the practice had implemented new measures to improve the screening and initial assessment. They utilised an algorithm on their clinical software that alerted the practice to those patients who were considered to be at high risk of 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 had told patients experiencing poor mental health about how to access various support groups and voluntary organisations, for example, to the local Steps2change or Drug and Alcohol Recovery Team (DART).

• The practice referred, as appropriate, to the local Crisis Team or local community mental health services.
• The practice promote continuity of care and encourage patients who experience poor mental health to attend for regular review with the doctor of their choice
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 21 June 2016

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable.

• An Associate GP was the practice champion of 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.

• The practice offered longer appointments for patients with a learning disability. Patients were offered an extended twenty-minute appointment with the HCA followed by a twenty-minute appointment with a GP to allow adequate time to perform a comprehensive health assessment.

• 92% of patients with a learning disability had received an annual review.

• 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.