Moulton Medical Centre

Updated 10 May 2017

Drs Thorpe, Burgess Jones and Stone – Moulton Medical Centre provides primary medical services to approximately 5,453 patients.

Moulton Medical Centre covers the rural parishes of Moulton, Weston and Whaplode and is situated between the market towns of Spalding and Holbeach. The practice dispenses medicines to over 90% of their patients who live more than 1.6km (1 mile) from their nearest pharmacy.

At the time of our inspection the practice employed three male GP’s (two full time and one part time),a practice manager, a nurse manager, two nurses, one health care support worker, four administration staff, eight dispensers/receptionists and two cleaner's.

The practice has a General Medical Services Contract (GMS). The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities.

We inspected the following location where regulated activities are provided:-

Moulton Medical Centre, High Street, Moulton, Spalding, Lincs. PE12 6QB.

The practice were in the process of changing their registration with the Care Quality Commission (CQC). A GP partner had retired two days before the inspection and the practice have submitted notification that they will be known for a short period of time as Drs Burgess, Jones and Stone. A new GP partner is due to join the practice in April 2017 and discussions would take place on the name of the practice going forward. The GP partners will complete further notifications to the CQC to ensure they are correctly registered.

Since the last inspection the practice have appointed a practice manager. The practice manager provides leadership and management skills to enable the practice to meet its agreed aims and objectives with a safe and effective working environment.

The practice was open from 8 am until 6.30 pm Monday to Friday. The practice offered open surgeries each morning to ensure that all patients who wanted to see a GP can do so without the need for a prebooked appointment. Pre-bookable appointments were available in the afternoon with both GP and Nursing Team. Appointments were bookable seven days in advance for GPs and three weeks in advance for the nursing team. The registered manager we spoke with told us that the practice did not offer extended hours as these were not popular with their patients.

The practice had a website which we found had an easy layout for patients to use. It enabled patients to find out a wealth of information about the healthcare services provided by the practice. Information on the website could be translated in many different languages by changing the language written. This enabled patients from eastern Europe to read the information provided by the practice.

Moulton Medical Centre had opted out of providing out-of-hours services (OOH) to their own patients. The OOH service is provided by Lincolnshire Community Health Services NHS Trust.

Updated 10 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of the practice on 10 February 2015. A breach of legal requirements was found. After the comprehensive inspection the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach of Regulation 12, 16 and 17.

The purpose of this comprehensive inspection was to ensure that sufficient improvement had been made following the practice being given an overall rating of Requires Improvement as a result of the findings at our inspection on 10 February 2015. We also checked that they had followed their action plan from the last inspection and to confirm they now met their legal requirements.

Following this most recent inspection on 2 March 2017 we found improvements had been made which has resulted in the practice being given an overall rating of Good.

Our key findings across all the areas we inspected were as follows:

• We found that the system in place for significant events had been reviewed. The policy had been updated. Investigations were detailed and actions were identified and implemented and meetings minutes represented the discussion that took place.

• Overall risks to patients were assessed and well managed.

• The practice had reviewed and updated its disaster handling and business continuity plan.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. However we found that this guidance was not discussed at meetings held within the practice.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Monitoring of staff training now took place but further work was required to ensure that all staff completed mandatory training.
• CQC comments cards were reviewed told us that patients 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 and lessons were shared with staff.
• The practice had open surgery each weekday morning and patients could choose which GP they saw.
• 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.
• Regular governance meetings were now held and minuted.
• Policies and procedures had been reviewed and updated where appropriate.
• The provider was aware of and complied with the requirements of the duty of candour.

The provider should:

• Ensure the newly introduced processes for assessing the suitability of tablets and capsules for inclusion in weekly blister packs, and for accuracy checking the preparation of the packs are established and monitored.

• Implement and monitor the revised procedure for handling patient safety alerts to ensure that they are received and acted on

• Continue to monitor and further embed the current systems in place for safeguarding, high risk medicines and staff training.

• Ensure water temperature monitoring for legionella takes place on a monthly basis.

• Ensure all staff files have the appropriate recruitment documents as per the practice policy.

• Consider discussion of national guidance and guidelines at practice meetings to ensure all clinicians are kept up to date.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 May 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.
• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 150/90 mmHg or less was 95.7% which was 2.2% above the CCG average and 4.4% above the national average. Exception reporting was 2.7% which was 1.8% below the CCG average and 2.8% below national average.
• The percentage of patients with asthma, on the register, who had an asthma review in the preceding 12 months that included an assessment of asthma was 81% which was 3% above the CCG average and 5.4% above the national average. Exception reporting was 2.2% which was 0.9% below the CCG average and 5.7% below national average.
• The percentage of patients with hypertension in whom the last blood pressure reading (measured in the preceding 12 months) was 150/90 mmHg or less was 81.4% which was 5.1% below the CCG average and 1.4% below the national average. Exception reporting was 1% which was 2.1% below the CCG average and 2.9% below national average.
• The percentage of patients with COPD who had a review, undertaken by a healthcare professional was 91% which was 2.6% below the CCG average and 1.4% above the national average. Exception reporting was 10.5% which was 2.7% above the CCG average and 1% below the national average.

• Longer appointments and home visits were available when needed.
• Patients had a named GP and the practice had a system in place for recalling patients for a structure annual review to check their health and medicines needs were being met.

Updated 10 May 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.
• The practice were signed up to the C-Card Scheme and all staff had been trained. This scheme enables the practice to give free contraception, for example, condoms to young people aged 13-24.

• The practice had an effective system in place in regard to cervical screening. A practice nurse was the lead nurse. The practice’s uptake for the cervical screening programme was 80%, which was comparable to the CCG average of 79% and the national average of 73%. There was a policy to offer telephone reminders for patients who did not attend for their cervical screening test.

• Appointments were available outside of school hours and the premises were suitable for children and babies, for example for immunisations and eight week baby checks. We saw examples of joint working with local community midwives.

Updated 10 May 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.
• 87% of patients on four medicines or more had received a review in the last 12 months.
• 78% on repeat prescriptions had received a review in the last 12 months.
• The practice had one care home with patients registered at the practice. A GP had lead responsibility. The practice also had access to beds in a GP led unit and local community hospital and these were used for palliative care patients and avoidance of admission to secondary care.

Updated 10 May 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. For example open surgery each morning.
• Minor surgery clinics are held at the practice to reduce the need for patients to be referred to secondary 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.

Updated 10 May 2017

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

• 88% of patients who had a mental health problem had received a review in the last 12 months, 100% had a care plan in place which was above the CCG average of 94% and national average of 89%.

• The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was 97.8%. 75% had a care plan in place which was below the CCG average of 88% and the national average of 84%. Exception reporting was 2.2% which was 2.3% below the CCG average and 5.3% below the national average.

• 100% of patients with a diagnosis of depression had received a review in the last 12 months.

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

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. For example, referrals to Addaction for patients who experienced alcohol and substance misuse problems.

• Staff had a good understanding of how to support patients with mental health needs and dementia. All staff had received mental capacity and dementia awareness training.

Updated 10 May 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 palliative care patients and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice planned to start learning disability health checks from April 1 2017. However 67.6% of patients with a learning disability had received a review at the practice in the last 12 months and 17.6% in secondary care.
• 100% of patients on the palliative care register had had their care reviewed in the last 12 months.
• 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.