Archived: Musgrove Park Medical Practice

Updated 13 April 2017

Musgrove Park Medical Practice offers general medical services to people living and working in Ashford, Kent and surrounding areas. There are approximately 7,322 patients on the practice list. The practice population has a higher than average proportion of patients with a long standing health condition. They also have a higher than average percentage of unemployment and higher than average single parent families with higher income deprivation affecting children. The practice is placed in the fifth most deprived decile. The practice building is single storey, with easy parking and full disabled access.

The practice is similar across the board to the national averages for the number of patients in each patient population group. For example, 20% of patients are aged 0 -14 years of age compared to the clinical commissioning group (CCG) and national average of 17%. The practice is located near Ashford town centre, Kent, where there are areas of deprivation and has a large Nepalese patient population and child immigrants seeking asylum.

The practice holds a General Medical Service contract and consists of one GP partner (male) and one salaried GP (female). The GPs are supported by a practice manager, a clinical nurse manager/nurse prescriber, five practice nurses (female), five healthcare assistants (four female and one male), a phlebotomist (female) and an administrative team. A wide range of services and clinics are offered by the practice including asthma and diabetes.

The practice is not a a training practice.

Musgrove Park Medical Practice is open 8.00am to 6.30pm Monday to Friday and 8.30am to 2pm on Saturday (for pre booked appointments only). There are arrangements with other providers (Integrated Care 24) to deliver services to patients outside of the practice’s working hours.

Services are provided from:

• Musgrove Park Medical Practice, Beaver Road, Ashford, Kent, TN23 7SP.

Updated 13 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Musgrove Park Medical Practice on 23 November 2016. Overall the practice is rated as requires improvement.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, reviews and investigations were not always thorough enough.
• Risks to patients were not always assessed and well managed.

• Data showed patient outcomes were low compared to the national average. Although some audits had been carried out, the practice was unable to demonstrate that audits were used to support quality improvement activity.

• The majority of patients said they were treated with compassion, dignity and respect.

• 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.

• Information about services and how to complain was available and easy to understand. However, the practice was unable to demonstrate that improvements were made to the quality of care as a result of complaints and concerns or that lessons were learnt and shared to prevent instances of a similar nature occurring again.
• Patients said they did not find it easy to make an appointment with a named GP and there was no continuity of care, but urgent appointments were available the same day.
• The practice 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.
• Governance arrangements were not always effectively implemented.The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are

• Ensure that significant events and complaints are investigated thoroughly and that lessons learned are disseminated to all relevant practice staff.

• Revise risk management to ensure that all risks to patients, staff and visitors are assessed and effectively managed in a timely manner.
• Ensure that the quality of services provided are assessed, monitored and improved where required.
• Ensure clinical audit cycles are carried out to drive improvements to patient outcomes.
• Revise governance arrangements to ensure that systems and processes to govern activity are effectively managed and implemented.

In addition the provider should:

• Continue to act upon patient feedback with regard to access to services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 April 2017

The practice is rated as requires improvement for providing safe, effective, responsive and well-led services and rated good for providing caring services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 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 were comparable to the local and national average. For example, 70% of patients with diabetes, on the register, in whom the last IFCCHbA1c is 64 mmol/mol (a blood test to check blood sugar levels) or less in the preceding 12 months (local average 80% and national average 78%).

Longer appointments and home visits were available when needed. All of these patients had a named GP, a personalised care plan or structured annual review to check that their health and care needs were being met.

Updated 13 April 2017

The practice is rated as requires improvement for providing safe, effective, responsive and well-led services and rated good for providing caring services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• There were systems to help 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 accident and emergency (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 78%, which was comparable to the CCG average of 82% and the national average of 82%.

• 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 April 2017

The practice is rated as requires improvement for providing safe, effective, responsive and well-led services and rated good for providing caring services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice offered proactive, personalised care to meet the needs of the older people in its patient population.

The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. For example, there was a named GP who visited five care homes, one of which had over 90 patients with dementia.

Updated 13 April 2017

The practice is rated as requires improvement for providing safe, effective, responsive and well-led services and rated good for providing caring services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 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. For example, the practice was open 8.30am to 2pm on Saturday (for pre booked appointments only).

Updated 13 April 2017

The practice is rated as requires improvement for providing safe, effective, responsive and well-led services and rated good for providing caring services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 84% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average.

• Performance for mental health related indicators were higher than the local and national average. For example, 90% of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, had an agreed care plan documented in their record, in the preceding 12 months (local average 86% and national average 88%).

• 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 to follow up patients who had attended accident and emergency (A&E) 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.

Updated 13 April 2017

The practice is rated as requires improvement for providing safe, effective, responsive and well-led services and rated good for providing caring services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 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.