Archived: Park Medical Centre

Updated 3 July 2017

Park Medical Centre is situated in central Peterborough, Cambridgeshire. The practice provides services for approximately 9,200 patients. It holds a General Medical Services contract with Cambridgeshire and Peterborough Clinical Commissioning Group.

We reviewed the most recent data available to us from Public Health England which showed that the practice population is similar to the national average. The practice is in an urban area with a high level of deprivation, and has a high percentage of patients from a variety of ethnic minority groups. Income deprivation affecting children is 25%, which is higher than the local average of 16%. 61% of patients have a long standing health condition, which is higher than the local practice average of 51%.

The practice clinical team consists of two male GPs, two female GPs, an advanced nurse practitioner, a primary care community matron, three practice nurses and a healthcare assistant. Furthermore, three long term locum GPs work at the practice. The clinical team are supported by a practice manager and reception, administration and secretarial staff.

Park Medical Centre is open from Monday to Friday. It offers appointments from 8.30am to 11.40am and 3pm to 5.30pm daily. Extended hours appointments are available with the advanced nurse practitioner from 7.10am to 8am daily, and with a GP or practice nurse from 6.30pm to 8pm on Tuesday evenings. In addition to this, patients registered at the surgery are able to access evening and weekend appointments at another local surgery as part of the Prime Minister’s Challenge Fund. Out of hours care is provided via the NHS 111 service by Herts Urgent Care.

Updated 3 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Park Medical Centre on 11 April 2017. The overall rating for the practice was good, with requires improvement for providing safe services. The full comprehensive report on the April 2017 inspection can be found by selecting the ‘all reports’ link for Park Medical Centre on our website at www.cqc.org.uk.

We undertook a focused inspection on 20 June 2017 to check they had followed their action plan and to confirm they now met legal requirements in relation to the breach identified in our previous inspection on 11 April 2017. This report only covers our findings in relation to those requirements.

Overall the practice is now rated as good.

Our key findings from this inspection were as follows:

• Extensive work had been undertaken to ensure that there was an effective recall system in place to support patients who were prescribed medicines that required specific monitoring.
• The practice had implemented a new process for monitoring the expiry dates of medicines held in clinical fridges.
• A clear policy had been written to ensure that GPs authorised the destruction of uncollected prescriptions. A system had been instigated to ensure that an audit trail was in place and that vulnerable patients were contacted to arrange collection.
• The practice had developed an effective process for tracking blank prescription stationery held on the premises.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 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 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 2015/2016 showed that performance for diabetes related indicators was 82%, which was below the local average of 91% and the national average of 90%. Exception reporting for diabetes related indicators was 15%, which was in line with the local average of 14% and the national average of 12% (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). Furthermore, performance for asthma related indicators was 100%, which was in line with the local and national averages of 97%. Exception reporting for these indicators was 8%, which was in line with the local average of 8% and the national average of 7%.
• Longer appointments and home visits were available when needed.
• Patients with complex needs 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 26 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.
• Immunisation rates were generally in line with local and national averages for all standard childhood immunisations. A new system had recently been introduced to remind parents of upcoming immunisation appointments, and this had resulted in a reduction of missed appointments.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 77%, which was in line with the local average of 82% and the national average of 81%. Exception reporting for this QOF indicator was 3%, which was lower than the local average of 9% and national average of 7%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• A walk-in minor illness clinic was held from 8.30am to 11.15am daily.
• The practice offered a full range of contraception services and chlamydia screening.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 26 May 2017

The practice is rated as good for the care of older people.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. All home visits were triaged by the community matron to prioritise visits and ensure appropriate and timely intervention.
• The practice contacted all patients after their discharge from hospital to address any concerns and assess if the patient needed GP or nurse involvement at that time. Medicine reviews were arranged if necessary to ensure that patients had a good understanding of any newly prescribed medicines, and to check for contraindications.
• Older adults, including those aged over 90 or those living in a nursing home, were continually reviewed by the in house community matron. Data showed that the practice’s rate of emergency admissions, referral rates and accident and emergency presentations were lower than the local commissioning group averages.
• Nationally reported data showed that outcomes for patients with conditions commonly found in older people, including rheumatoid arthritis and heart failure, were above local and national averages.

Updated 26 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 where possible.
• 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.
• Extended hours appointments were available with the advanced nurse practitioner from 7.10am to 8am daily, and with a GP or practice nurse from 6.30pm to 8pm on Tuesday evenings. In addition to this, patients registered at the surgery were able to access evening and weekend appointments at another local surgery as part of the Prime Minister’s Challenge Fund.
• Telephone appointments with a GP were available throughout the day.
• Practice staff carried out NHS health checks for patients between the ages of 40 and 74 years.
• The practice offered many NHS services in house, reducing the need for outpatient referral and therefore improving patient convenience.

Updated 26 May 2017

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

• 92% of patients diagnosed with dementia had received a face to face care review in the last 12 months, which was above the local average of 87% and the national average of 84%. Exception reporting for this QOF indicator was 7%, which was in line with the local average of 8% and the national average of 7%. The primary care community matron carried out scheduled and opportunistic dementia screening for housebound patients and patients living in care homes.
• 92% of patients experiencing poor mental health had a comprehensive care plan, which was above the local average of 90% and the national average of 89%. Exception reporting for this QOF indicator was 3%, which was lower than the local average of 15% and the national average of 13%.
• 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.

Updated 26 May 2017

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including travellers and those with a learning disability.
• Many patients registered at the practice did not speak English as a first language. The practice made regular use of telephone translation services to ensure that screeing and immunisation appointments were attended.
• The practice offered longer appointments for patients with a learning disability.
• The practice identified and visited the isolated, frail and housebound regularly. Chronic disease management was provided for vulnerable patients at home and the practice was active in developing care plans and admission avoidance strategies for frail and vulnerable patients.
• The practice had recognised the growing need for integrated care services in the local area and had employed their own in-house primary care community matron. The community matron worked to ensure that housebound patients and patients unable to attend the surgery could be appropriately assessed and receive support in the community. Data showed that the practice’s rate of emergency admissions, referral rates and accident and emergency presentations were lower than the local commissioning group averages. For example, data from the clinical commission group showed that the rate of emergency admissions following the introduction of the community matron maintained a flat trend below the local average, despite a rise in practice list size. The primary care community matron contacted all patients after their discharge from hospital to address any concerns and assess if the patient needed GP or nurse involvement at that time. Medicine reviews were arranged if necessary to ensure that patients had a good understanding of any newly prescribed medicines, and to check for contraindications.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients, and held weekly multidisciplinary team meetings. Monthly whole team meetings were also held to ensure that non-clinical staff were aware of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• The practice was engaged with the local carers support group, which provided guidance, support and respite for carers. Written information was available to direct carers to the various avenues of support available to them.
• 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.