Archived: Binbrook Surgery

Updated 3 March 2017

Caistor Health Centre provides primary medical services to approximately 5,450 patients from a single surgery situated in the small town of Caistor, set in the Lincolnshire Wolds , 12 miles from Grimsby and Lincoln 26 miles distant.

Public transport links are poor and there are pockets of rural deprivation and isolation.

The practice has a higher number of older patients than the national average. The practice has a higher number of patients with long term conditions than the national average.

At the time of our inspection the practice healthcare was provided by two GP Partners, one nurse practitioner, who is an independent prescriber (whole time equivalent WTE 0.88), two practice nurses (WTE 1.53) and three health care assistants (WTE 1.00). They are supported by a team of dispensers, 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 a dispensing practice and provides the service to 43% of its patients.

The surgery is open from 8am to 6.30pm Monday to Friday.

.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.

We had not previously inspected this practice.

Updated 3 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Caistor Medical Centre on 14 December 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.
• Although staff were aware of the Mental Capacity Act and the issues of assessing a patients mental capacity, no formal training had been provided and some lacked confidence in it’s use.
• 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. However we observed a patient receiving treatment through an unobscured window.
• 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.
• The access to GPs and clinicians through the telephone triage system was effective and same day face to face appointments were available where appropriate.
• The practice facilities and equipment met patient needs.
• There was a clear leadership structure and staff felt supported by management.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Impress upon staff the importance of patient privacy being maintained at all times.

• Ensure staff receive appropriate training with regard to the Mental Capacity Act and the Deprivation of Liberty Safeguards.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 March 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.

• Data from the Quality and Outcomes framework showed that the clinical indicators for diabetes care were 99%, which was 6% above the CCG and 9% above the national average.

• The practice offered recalls for ‘non-QOF’ conditions such as pre-diabetes, valvular heart disease and metabolic monitoring.

• Home visits to patients with long term conditions who were unable to attend the surgerywere undertaken by the nurse practitioner.

• 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 3 March 2017

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

• The practice offereda full range of long-acting reversible contraception.

• Nurses provided sexual health and contraceptive advice to patients of all ages.

• Children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• Rates of cervical screening were in line with both CCG and national figures.

• 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. Immunisation rates were comparable to other practices for standard childhood immunisations.

Updated 3 March 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.

• They had identified 556 patients aged 75 and over all of whom had a named accountable GP.

• Offered new patient reviews following registration as well as regular reviews by GP and nurses through a variety of prompts.

• The nurse practitioner conducted a weekly visit to the largest of its care homes where patients of the practice lived.

• The practice participated in the clinical commissioning group initiated Older Adults Service and provided additional care to meet the needs of this group of patients.

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

Updated 3 March 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.

• NHS ‘well person’ checks are offered for patients aged 40-74 and the practice has achieved 68% of its target for undertaking these checks.

• Weekend influenza clinics have been held to meet the needs of working patients.

• Appointments outside of normal consultation hours can be offered where necessary.

Updated 3 March 2017

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

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive agreed care plan documented in the record in the preceding 12 months was 97%, which was 17% above the CCG and 8% above the national average.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

• The practice carried out advance care planning for patients living with dementia.

• The practice had identified 51 patients experiencing poor mental health and told them how to access various support groups and voluntary organisations.

• There was a good understanding of how to support patients with mental health needs and dementia. Staff had received specific training in dementia awareness.

Updated 3 March 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.

• The practice had 16 patients on its learning disability register and offered longer appointments for patients in this group.

• 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.

• Staff had received training in learning disability awareness.