Linden Medical Group

Updated 26 September 2016

Linden Medical Group provides care for approximately 14,200 patients. The service covers Kettering town, Barton Seagrave, Cranford, Geddington, Grafton Underwood, Isham, Pytchley, Warkton and Weekley. The practice holds a General Medical Services contract, a nationally agreed contract. There was a slightly higher than average age group of 40-55 years and female 60-69 years of patients who were registered at the practice, the remainder were in line with national averages.

The premises were purpose built with all consulting rooms located at ground level for ease of access for patients who have limited mobility. There was a dedicated car park and some spaces allocated for disabled patients.

The practice has five GP partners (four male, one female) who between them provide 37 clinical sessions per week. There are two salaried GPs who provide a further 10 clinical sessions per week and a regular locum GP who provides up to eight sessions per week. Senior staff told us they were trying to recruit another GP. GPs are supported by three nurse prescribers who between them spend 57 hours seeing patients with minor ailments. There are also six practice nurses and two health care assistants (HCA) who provide cervical screening, vaccinations, reviews of long term conditions and phlebotomy (taking blood samples) services. The practice has recruited a pharmacist who provides advice to GPs about their prescribing methods. The practice employs a practice manager, a reception manager, a deputy reception manager and 16 reception/administration staff and three bank receptionists. An estates manager provides management of the premises and health and safety aspects of the service.

The practice is a designated training practice for trainee GPs. These are qualified doctors who are learning the role of a GP. They currently do not have a doctor (registrar) working at the practice.

The practice offers a range of clinics for chronic disease management, diabetes, heart disease, cervical screening, contraception advice, minor surgery, injections and vaccinations. A GP from the practice provide health care services for the residents of four care homes.

The practice is open from 8am until 6.30pm every weekday.

Appointments times vary between GPs:

• From 8am to 8.30am until 11.45am
• From 2pm to 2.30pm until 5.30pm.

Extended hours are:

• From 8am until 11.30am each Saturday by pre-booked appointment. This session is provided by a GP and a practice nurse or HCA who carry out health checks.

There is a branch practice:

• Ise Medical Centre, French Drive, NN15 5BT, 01536 481743. It is 1.2 miles from Linden Medical Group practice. Opening hours are from 8am until 12.30pm weekdays.

We did not visit the branch practice during our inspection. All registered patients could access either site.

The practice has opted out of providing GP services to patients out of hours such as nights and weekends. During these times GP services are provided currently by a service commissioned by NHS Nene Clinical Commissioning Group (CCG); Integrated Care 24 Limited. When the practice is closed, there is a recorded message giving out of hours’ details. The practice leaflet also includes this information and there are leaflets in the waiting area for patients to take away with them.

Updated 26 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Linden Medical Group on 6 July 2016. Overall the practice is rated as good.

Our key findings across all of 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 and reviewed and the results shared with staff including lessons learned.

• Safe arrangements were in place for staff recruitment that protected patients from risks of harm. Staff numbers were regularly reviewed to enable them to meet patients’ needs and plans were in place to increase clinical sessions.

• There were robust on-going arrangements in place to protect patients and others from unnecessary infections.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training had been encouraged and planned.

• Patients told us they were treated with compassion, dignity and respect and they were involved in decisions about their treatment.

• Information about how to make a complaint was readily available and easy to understand. Complaints received were dealt with appropriately and clear explanations given to complainants.

• The practice had good facilities and was well equipped to assess and treat patients.

• There was a clear leadership structure and staff told us they felt well supported by senior staff. Management sought feedback from patients which it acted on.

• The provider was aware of the requirements of the Duty of Candour and we saw where this had been applied concerning a complaint.

We saw an area of outstanding practice:

• The practice was pro-active in identifying patients who were carers and had registered 3% of the practice population as carers. An additional support mechanism included a designated member of staff who maintained telephone contact with carers. The Northamptonshire Carers Association had given the practice two awards for the work they carried out for carers. Staff had commenced work in identifying young carers aged between five and 17 years. The carers pack included support services that were available for young carers including social activities. The practice website included a wealth of information about carers.

However, there was an area of practice where the provider needs to make improvements.

The provider should;

• Continue working towards ensuring correct coding is applied for patients with long-term conditions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 September 2016

The practice is rated 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.

• A diabetes specialist nurse worked at the practice one day per week. They worked alongside practice nurses who managed patients with diabetes and saw patients who had complex needs.

• Longer appointments and home visits were available when needed.

• Patients with long-term conditions had structured annual reviews to check that their health and medicine needs were being met. Where necessary reviews were carried out more often.

• Clinical staff worked with health care professionals to deliver a multidisciplinary package of care for patients.

• Where necessary patients in this population group had a personalised care plan in place and they were regularly reviewed.

• Clinical staff were participating with a pilot for carrying out an additional test of patients who had asthma. Upon completion the results of this would be shared with other practices.

Updated 26 September 2016

The practice is rated 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.

• Alerts were put onto the electronic record when safeguarding concerns were raised.

• There was regular liaison and monthly meetings with the health visitor to review those children who were considered to be at risk of harm.

• All children up to the age of 12 years were triaged and if necessary seen the same day.

• Patients and their children told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

• Childhood vaccinations were in line with the local and national averages.

• A clinical session was held by a GP every Saturday from 8am until 11.30am for patients who had pre-booked an appointment. A practice nurse or health care assistant (HCA) attended the sessions and carried out patient health checks.

Updated 26 September 2016

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

• Practice staff offered proactive, personalised care to meet the needs of older patients.

• Staff kept up to date registers of patients’ health conditions and information was held to alert staff if a patient had complex needs.

• Home visits were offered to those who were unable to access the practice and patients with enhanced needs had prompt access to appointments.

• Extended appointments were available to ensure all aspects of their care needs were assessed.

• A designated GP routinely carried out weekly visits to four care homes to monitor patient’s health needs. GPs would attend at short notice when a patient became unwell.

• Practice staff worked with other agencies and health providers to provide patient support.

Updated 26 September 2016

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

• The practice had adjusted its services to accommodate the needs of this population group.

• Telephone consultations were provided for those patients who found it difficult to attend the practice or if they were unsure whether they needed a face to face appointment.

• Extended hours were provided to improve patient access.

• Online services were available for booking appointments and ordering repeat prescriptions.

• The practice website gave advice to patients about how to treat minor ailments without the need to be seen by a GP.

• Patients we spoke with told us that clinical staff routinely provided healthy living advice to promote their well-being.

• Of eligible female patients 78% had attended for cervical screening. Clinical data told us that breast screening and bowel cancer testing results were in line with local and national averages

Updated 26 September 2016

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

• 92% of patients who experienced poor mental health had received a mental and physical health check during 2014-2015 and were involved in developing their care plans.

• Practice staff regularly worked with multi-disciplinary teams in the case management of patients who experienced poor mental health, including those with dementia.

• GPs carried out assessments of patients who experienced memory loss in order to capture early diagnosis of dementia. This enabled staff to put a care package in place that provided health and social care support systems to promote patients well-being.

• Referrals to other health professionals were made when necessary.

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

Updated 26 September 2016

The practice is rated 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 who had a learning disability.

• Invitation letters for health reviews and for cervical screening were available in easy read format to assist patients who had a learning disability in their understanding of their care needs.

• One GP and a senior nurse practitioner had attended training for care of patients who had a learning disability and carried out their annual health reviews with an extended appointment time.

• Practice staff regularly worked with multi-disciplinary teams in the case management of vulnerable patients.

• Staff knew how to recognise signs of abuse, the actions they should take and their responsibilities regarding information sharing.

• There was a clinical lead for managing with vulnerable adults and children.

• The practice was pro-active in identifying patients who were carers and had registered 3% of the practice population as carers. The Northamptonshire Carers Association had given the practice a bronze award followed by a silver award in January 2016.

• There was a register to manage end of life care and unplanned admissions to hospital.