Navenby Cliff Villages Surgery Also known as Cliff Villages Medical Practice

Updated 24 March 2017

Cliff Villages Medical Practice provides primary medical services to approximately 8,200 patients who are registered across two practices in a rural area south of Lincoln and reside in nine villages. The practices also provide services to patients in outlying areas which included a further five villages. The practice is located close to RAF Waddington and RAF dependents of RAF service men and women form approximately 8 percent of the practice patient list. The main practice is situated in the village of Navenby and the branch practice is situated in the village of Waddington. Both practices are located in purpose built premises with car parking available. Both practices have an on-site dispensary and dispense to approximately 20 percent of the patient list. Alternatively, for those patients who are not eligible to receive their medication at the practice dispensaries there are a number of pharmacies available to patients within the area.

The practice provides services to patients who reside in five residential and nursing homes, two of these homes have a dementia unit and are located in the surrounding area.

It is located within the area covered by NHS Lincolnshire West Clinical Commissioning Group (LWCCG). It is registered with the Care Quality Commission to provide the regulated activities of; the treatment of disease, disorder and injury; diagnostic and screening procedures; maternity and midwifery services and surgical procedures.

At the time of our inspection, the practice employed four GP partners, two practice nurses, two health care assistants (HCA), a senior dispenser, two dispenser/receptionists, a team of nine administration, reception and secretarial staff which included apprentices. The practice also employed one housekeeper. All staff were supported by a practice manager.

The practice is open from 8am until 6.30pm Monday to Friday. Appointments are available between these times. The practice offers extended hours appointments on a Tuesday each week until 8.30pm.

The practice has General Medical Services (GMS) contract which is a contract between the GP partners and the CCG under delegated responsibilities from NHS England.

The practice has a higher number of patients between the ages of 40 and 69 years of age and over the age of 85.

The practice provides on-line services for patients such as to book routine appointments and ordering repeat prescriptions.

The practice is part of a federation called ‘South Lincolnshire Healthcare’ which includes eight member practices within NHS Lincolnshire West CCG.

When the surgery is closed GP out-of-hours services are provided by provided by Lincolnshire Community Health Services NHS Trust which can be contacted via NHS111.

Updated 24 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Navenby Cliff Villages Surgery on 31 August 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. The practice had a risk register in place.
• 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.
• 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 named GP and there was continuity of care, with urgent appointments available the same day.
• The practice provided a patient liaison officer service which enabled patients who were frail elderly, had special needs or were recently bereaved to ensure they had access to a point of contact within the practice.
• The practice was an accredited yellow fever centre which was registered with NATHNaC (National Travel Health Network and Centre).
• 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.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Review process and methods for identificationof carers and the system for recording this. To enable support and advice to be offered to those that require it.

• Review recruitment procedures in relation to where the decision has been made not to carry out a DBS check on apprentice administration and reception staff during their probationary period ensuring a clear rationale as to why a DBS is deemed not necessary.

• Review process for method of recording near misses within the dispensaries.

• Review process for checking vaccination fridge temperatures at the branch site when there are no clinical staff on duty.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 March 2017

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.

• Performance for diabetes related indicators was 87% which was lower than the CCG average of 91% and the national average of 90%. Exception reporting rate was 6% which was lower than the CCG average of 10%.

• 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 24 March 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, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high 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’s uptake for the cervical screening programme was 77%, which was comparable to the CCG average of 78% and higher than the national average of 74%.

• 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.

• Childhood immunisation rates for the vaccinations given were comparable to CCG/national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 89% to 99% and five year olds from 86% to 95%.

Updated 24 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.

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

• The practice also encouraged its patients to attend national screening programmes for bowel and breast cancer screening. 61% of patients aged 60-69 years of age had been screened for bowel cancer within six months of invitation compared to the CCG average of 61% and the national average of 58%.

Updated 24 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 reflects the needs for this age group.

• The practice provided on-line services for patients such as to book routine appointments and ordering repeat prescriptions.

• The practice offered extended hours appointments on a Tuesday each week until 8.30pm.

Updated 24 March 2017

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

• Performance for mental health related indicators was 100% which was higher than the CCG average of 92% and the national average of 93%. Exception reporting rate was 7% which was lower than the CCG average of 15% and the national average of 11%.

• 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.

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

• Members of staff had received ‘dementia friends’ training.

Updated 24 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 homeless people, travellers and those with a learning disability.

• 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.

• 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.