Cathedral Medical Centre

Updated 13 January 2017

Cathedral Medical Centre is situated in Ely, Cambridgeshire. The practice provides services for approximately 10300 patients. It holds an Alternative Provider Medical Services contract. The practice has one female and five male GP partners and one male and four female salaried GPs. The team also includes three female practice nurses and two health care assistants one male, one female. They also employ a practice manager, a managerial assistant and a team of secretarial, administration and reception staff.

The practice is open between 8am and 6.30pm Tuesday to Friday and 8am to 8.30pm Mondays with additional weekend appointments available on a Saturday between 9am and 12.30pm. During out-of-hours GP services are provided by the NHS 111 service.

We reviewed the most recent data available to us from Public Health England which showed that the practice had a lower than average practice population aged between 15-29 and 50-85 and a higher than average practice population between 0-14 and 30-49 compared with the national England average. The deprivation score was significantly lower than the average across England.

Updated 13 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 22 September 2016. We set a requirement in relation to safe care and treatment. The practice sent in an action plan informing us about what they would do to meet legal requirements in relation to the following;

• The systems and processes to address risk were not robust enough to ensure patients were kept safe. The practice did not risk assess the need to make appropriate emergency medicines immediately available in the practice.

During the initial inspection we also found areas where improvements should be made:

• The practice should be proactive in identifying carers.
• Ensure that the practice is following the guidance around infection control monitoring set out in the Code of Practice by the Department of Health.
• Ensure the practice holds a copy of the legionella risk assessment.
• Ensure all medical equipment is regularly calibrated.
• Ensure regular fire drills are undertaken.

The practice told us these issues were addressed by 26 September 2016 and have provided us with evidence to show they had taken the action to address the concerns.

We undertook a desk top review on 19 December 2016 to make a judgement about whether their actions had addressed the requirements.

The overall rating for the practice is good. You can read our previous report by selecting the ‘all reports' link for on our website at www.cqc.org.uk

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 November 2016

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 practice used the information collected for the Quality and Outcomes Framework (QOF) to monitor outcomes for patients (QOF is a system intended to improve the quality of general practice and reward good practice). Data from 2014/2015 showed that performance for diabetes related indicators was 98%, which was 8% above the CCG average and 9% above the national average. The practice exception reporting for clinical indicators was 14% which was higher than the CCG average of 13% and the England average of 11%. (Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).
• Longer appointments and home visits were available when needed.
• 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 November 2016

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.
• 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 3 November 2016

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 had 32 patients on their palliative care register and the practice worked closely with the multi-disciplinary team, out-of-hours and the nursing team to ensure proactive palliative care planning.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis, dementia and heart failure were above the local and national averages.
• The practice looked after patients living in local care homes. Named GPs were allocated to each care home and the GP visited patients as and when required.

Updated 3 November 2016

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’s uptake for the cervical screening programme was 81% which was similar to the CCG and England averages of 82%. The practice exception reporting for the clinical domain was 3% which was lower the CCG average of 8% and the England average of 6%.

Updated 3 November 2016

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

• 87% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was better than the CCG and the national average by 3% with a 7% exception reporting which was lower than the CCG average of 11% and the England average of 8%.
• The practice achieved 100% for mental health related indicators in QOF, which was above the CCG average by 8% and the England average by 7%. The rate of exception reporting for these indicators was 8% which was lower than the CCG average of 13% and England 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.

Updated 3 November 2016

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 had 42 patients on the learning disabilities register. Last year 39 out of the 42 patients had received a care review. 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 during out-of-hours.