Liquorpond Surgery

Updated 10 February 2017

Liquorpond Surgery provides primary medical services to 11,500 patients from a single surgery situated in Boston town centre, Lincolnshire. The building has been extended and improved to meet the needs of patients. The practice occupies two floors of the building with patient consultations taking place on both floors. A stair lift is available for patients and carers.

At the time of our inspection the practice consisted of five GP partners (whole time equivalent WTE 4.60), two nurse practitioners ( whole time equivalent WTE 2.00) , six practice nurses (WTE 3.75), three health care assistants (WTE 2.39) .They are supported by a team of management, administration, reception and housekeeping staff. In all 41 people work at the practice.

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 percentage of patients (9.7%) over the age of 75 compared to the national average of 7.8%. Seven patients were aged over 100.

Boston and South Holland have some of the highest levels of migrant workers in England, they being predominantly from eastern Europe, in particular, Lithuania ,Poland and Latvia. Many of these patients are employed in agriculture, horticulture, food production , processing and manufacturing. Boston still has a sizable Portuguese community, a legacy from the previous influx of migrant workers. Approximately 25% of patients do not have English as their first language.

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

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 10 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Liquorpond Surgery on 21December 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. However it was not recorded that learning was cascaded to staff.
• 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.
• The practice had engaged with the migrant population to help them understand the services available to them.
• 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. However there was dissatisfaction with the telephony system which meant that it was sometimes difficult to get through on the telephone.
• 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.
• Patient records in paper format were not stored in a manner that ensured their security.

The areas where the provider should make improvement are:

• Keep records to show that learning from serious events and complaints is cascaded to staff.

• Implement a system to show that staff had read policies.

• Complete a full fire drill at a time when patients are present in the premises.

• Should consider an alternative means of calling patients for their consultation to cater for those with a hearing impairment.

• Should inform the Care Quality Commission when appropriate storage cabinets for patient records in paper format have been installed.

• Continue to address the issues with the telephone system to enhance patient access.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 February 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.

• Overall diabetes QOF achievement was 93%, the same as the CCG average and 3% higher than the national average.

• 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 10 February 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.

• Immunisation rates were comparable for all standard childhood immunisations to both the CCG and national averages.

• The practice offered a range of reversible contraception.

• 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 and advertised in the local Polish language newspaper.

• We saw positive examples of joint working with midwives, health visitors, district nurses and school nurses.

Updated 10 February 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 was responsive to the needs of older people, and offered home visits and urgent same day appointments for those with enhanced needs.

• There was a strong emphasis on providing access to healthcare for patients in this population group with 72% of home visits being to patients aged 75 or over.

Updated 10 February 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. Re-call letters were sent in the appropriate language.

• Extended opening hours were available on two evenings a week.

• Sit and wait consultations were available from 12 noon and 6pm Monday to Friday after the end of morning an afternoon surgeries.

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

• In house physiotherapy was available twice weekly to assist in an early return to work.

Updated 10 February 2017

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

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  The practice made referrals to counselling, talking therapies and the Steps for Change program.

• 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 997 (8.7%) patients on the mental health, dementia or depression registers. They provided them with information on how to access various support groups and voluntary organisations.

• 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 10 February 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 and the travelling community.

• 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.

• The practice recognised the needs of people such as travellers and the homeless and registered them as patients using the practice address.

• The practice was enabled to issue vouchers for food banks and patients with financial problems were referred to the Citizens Advice Bureau.

• 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.