Mile End Road Surgery

Updated 10 July 2017

Mile End Road Surgery is situated in Norwich, Norfolk and is run by the Castle Partnership. It has branch surgery locations in two other areas of Norwich: Tuckswood Surgery and Gurney Surgery. The practice provides services to approximately 16,700 patients across the three locations. It holds a General Medical Services contract with NHS Norwich CCG.

According to Public Health England, the patient population has a lower number of patients aged below 25 in comparison to the practice average across England. It has a higher proportion of patients aged 60 and above compared to the practice average across England, with a considerably higher proportion of females over the age of 85. Income deprivation affecting children is higher than the practice average across England, but lower than the local average. Income deprivation affecting older people is higher than the local and the practice average across England.

The practice has eight GP partners, four male and four female. There are five salaried GPs and two GP registrars. There are four nurse practitioners, four practice nurses and five health care assistants active across the three locations. The practice also employs a business manager who is supported by an assistant manager, as well as surgery managers and team leaders at each location. There are shared secretarial an IT teams across the three sites. There are also administration and reception teams with individual leads.

All three locations provide opening hours on Monday to Friday from 8am to 5.30pm. Extended hours clinics are available Saturday morning from 8.30am to 11am, these are held at each location on a rotational basis. Patients are able to attend appointments at all three locations. Out-of-hours care is provided by Integrated Care 24.

The practice is a training practice and teaches medical students as well as GP registrars (trainee doctors). The practice was also actively involved in various research projects.

Updated 10 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Mile End Road Surgery on 5 May 2016. The overall rating for the practice was good, with the safe domain being rated as requiring improvement. The full comprehensive report on the 5 May 2016 inspection can be found by selecting the ‘all reports’ link for Mile End Road Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 20 June 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulation that we identified in our previous inspection on 5 May 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice remains rated as good.

Our key findings were as follows:

• We reviewed safety records, incident reports, patient safety alerts and the amended recording process that had been implemented after our last inspection. We saw evidence that lessons were shared and action was taken to improve safety in the practice.
• Cleanliness concerns and premises related risks were addressed appropriately, including outstanding actions following a legionella assessment.
• The provider had reviewed its carers’ register and identified additional carers. The register had increased from 140 (just under 1%) at our 5 May 2016 inspection, to 227 (over 1%) at our 20 June 2017 inspection. The provider explained they worked closely with local carers groups and signposted patients when required. Various carers’ information was available in the practices.
• After our 5 May 2016 inspection we requested the provider to ensure that annual reviews for patients experiencing poor mental health or with a learning disability were undertaken in a timely manner. At our 20 June 2017 inspection the provider had 216 registered patients experiencing poor mental health, of which 141 had undergone a review in 2016/17. 25 patients had refused a review and 11 patients were noted as exempt from a review. 39 patients had not attended despite the provider sending multiple invitations. The provider had 103 patients with confirmed learning difficulties, of whom 55 had undergone a review in 2016/17. The provider had contacted all patients with learning difficulties and sent multiple invitations. The coding system for these patients had been reviewed and amended with the aim to increase the number of patients on the register. The provider had also undertaken various other actions with the aim to improve the number of reviews for these patients. These included the addition of system alerts on patient records, ensuring the same GP was available and making every effort to contact any patients that didn’t attend, which included referral to external learning disability services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 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 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 2014/2015 showed that performance for diabetes related indicators was 100%, which was 11.4% above the CCG average 10.8% above the national average. The practice reported 14.1% exception reporting for diabetes related indicators, which was 1.3% above the CCG average 3.3% above the national average.
• Longer appointments and home visits were available when needed.
• 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 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.
• Immunisation rates were generally in line with the local 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, and we saw evidence to confirm this.
• The practice had a comprehensive cervical screening programme. The percentage of patients receiving the intervention according to 2014-2015 data was 83.6%, which was above the local average of 83.1% and the England average of 81.8%. Patients who did not attend their appointment were followed up with letters and telephone calls.
• 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.

Updated 13 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.
• 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.
• The practice provided GP cover to six local care homes. GPs or a nurse practitioner visited each home every week to support residents living there.

Updated 13 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.
• 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.
• Extended hours appointments were available on Saturday mornings.

Updated 13 June 2016

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

• The practice had 225 registered patients with dementia, 170 of these patients had a care plan in place.
• The practice had 208 registered patients experiencing poor mental health, of which 134 had a care plan in place. 47 of these patients had refused or not responded.
• 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.

Updated 13 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 those with a learning disability. The practice had 129 registered patients with a learning disability, of which 79 had received an annual review. The practice informed us they were proactively inviting patients that were overdue a review and had experienced numerous non-attendances. Some patients had only recently been diagnosed and as such were not yet due a review.
• 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.
• Patients who were carers were proactively identified and signposted to local carers’ groups.
• 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.