Archived: Asquith Surgery

Updated 8 January 2018

Background to Asquith Surgery

The Asquith Surgery is located at 693 Welford Road Leicester LE2 6FQ, near the border between Leicester City and Leicestershire. The Asquith Surgery was a long established practice until 2014 when the provider retired.

The practice then had a two different providers during the next two years. In April 2016, the practice went into an emergency caretaking arrangement at short notice. As the CCG explained to us, ‘Emergency caretaking is a short to medium term solution whereby a provider is identified to manage, i.e. care take, a GP practice whilst a permanent solution is found.’

In this case the provider that took on the care taking contract was Fosse Medical Practice. They explained to the inspection team that as the initial contract was for six months their initial aim was to maintain the service and where possible improve it. They also felt that it was very important to work with and support the existing staff. The care taking contract was extended for two further six month periods and will have been for 18 months when it ends on 30 September 2017. Fosse Medical Practice did not bid for the future contract.

The surgery is housed in a two-storey detached property, which was formerly a domestic property and is owned by NHS Estates. It has automatic entrance doors, a disabled parking space and on street parking. Patients with mobility problems are offered longer appointments and are seen in downstairs consulting rooms. The waiting area is separated from the reception desk and there are on-screen announcements of appointments.

• There is a salaried male GP who works for ten sessions a week and a long-term female locum GP who works for eight sessions per week. A GP partner from the provider spends a minimum of two sessions a week at the Asquith Surgery to see patients and support staff.
• The practice nurse and health care assistant are female and work 75% and 50% of the week respectively.
• There is a range of support staff including receptionists, a practice manager and assistant practice manager.
• The practice is open between 8am and 6.30pm Monday to Friday. Routine appointments are from 9am to midday and 3pm to 6pm. The duty doctor is available from 8am to 6.30pm. Extended hours appointments are offered from 7am on Thursday and Friday mornings with a GP or nurse.
• Out of hours services are provided by Derbyshire Health United (DHU) via the NHS 111 telephone number.
• Patients registered with Leicester City practices can also access (initially by telephone) three ‘Healthcare Hubs’ (located at health centres/GP practices in the city) during evenings and weekends.
• The number of patients registered with the practice is 4,000 and this had increased by about 3% over the previous 12 months.
• Some patients live within the Leicester city boundary and others are within Leicestershire which can create some difficulties when arranging social care and support.
• 50% of the practice’s patients are White British and 30% are Asian or Asian British.
• 9% of the practice’s patients are aged over 75 years which is twice the CCG average.
• Social and economic deprivation is relatively low.

Updated 8 January 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Asquith Surgery on 12 July 2017. 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 a system in place for reporting, recording and reviewing significant events.
• The practice had systems to minimise risks to patient safety.
• Prescription forms and pads were stored securely and patients receiving high risk medicines were regularly reviewed.
• Staff were aware of current evidence based guidance and their training had provided them with the skills and knowledge to deliver effective care and treatment. There was also a focus on ongoing learning and training to maintain and develop skills.
• The practice aimed to provide patient centred care taking into account patients’ needs, circumstances and preferences.
• Results from the national GP patient survey were comparable with local and national averages and showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain or raise concerns was available. Improvements were made to the quality of care because of complaints and concerns.
• Patients who commented on their care described the service as good and said they were treated as individuals. They said they found it relatively easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• 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 patient participation group was actively involved with the practice, for example ensuring that information in the waiting room was kept up to date.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
• The provider had taken its role in caretaking the practice seriously and had supported staff and tried to improve the service. For example, it had increased the numbers of NHS checks undertaken from 17 to 285 over a 12 month period, and carried out a project to identify those patients who would benefit from an advance care plan and provided these.
• Several patients and the patient participation group felt the practice had improved during the caretaking period.

There were areas where the provider should make improvements:

The practice should ensure that all significant events discussed at the weekly clinical meetings are also documented in the significant events folder to ensure that any trends are identified and learning shared with all staff.

The practice should ensure that staff continue to undertake clinical audits and quality improvement.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 January 2018

The practice is rated as good for the care of people with long-term conditions.

• The practice had identified patients at risk of hospital admission and alerts on their records ensured same day contact with a GP and home visits where necessary.

• Nursing staff had lead roles in long-term disease management such as Chronic Obstructive Pulmonary Disease and were supported by the GPs and specialist nurses.

• The practice had started providing blood tests for patients who needed anti-coagulation therapy. Previously patients had to attend hospital based clinics for this.

• When patients with long-term conditions were discharged from hospital the practice reviewed their care plans and ensured they were updated to reflect any changed needs such as medicines.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• There was a system to recall patients for a structured annual review to check their health and medicines needs were being met. Where possible patients with multiple long-term conditions were invited for one appointment to review all the conditions.

• 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.

• The practice referred patients to health and social care coordinators for support to live independently in their own homes.

Updated 8 January 2018

The practice is rated as good for the care of families, children and young people.

• The practice had systems in place to identify children who might be vulnerable, for example, those who had a high number of accident and emergency attendances, or who did not keep appointments, and reviewed these cases, taking appropriate action where necessary.
• Immunisation rates were relatively high for all standard childhood immunisations. The practice contacted parents who had not attended.
• Children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice provided 24 hours baby checks and 6 week post-natal assessments which included family planning advice.
• The practice provided support for premature babies and their families before and following discharge from hospital.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of antenatal, post-natal and child health surveillance clinics.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications. Clinicians were aware of guidance to help identify and treat sepsis.

Updated 8 January 2018

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

• The practice told us that they treated their older patients with care, respect and dignity and offered proactive, personalised care to meet their needs.

• The practice had written to all their patients over 65 informing them of the named accountable GP responsible for their care. This helped to ensure continuity of care.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs, and when necessary arranged urgent home visits from the crisis response team (CRT)

• The provider had realised that relatively few patients had advanced care plans in place and had employed a specialist advanced nurse practitioner (ANP) to review this. Patients and their families or carers were contacted and offered appointments. Where appropriate these took place in patient’s homes at weekends. 106 patients were visited at home and by the end of the project over 138 advanced care plans had been put into place. This work was then continued by the permanent staff.

• The practice was able to identify older patients who might need palliative care as they were approaching the end of life and involved patients families and carers in decisions about this.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any changes to their care or medicines.

• Staff were able to recognise the signs of abuse in vulnerable older patients and knew how to escalate any concerns.

• Staff knew many of the patients well and if concerned about them, for example, if they had become confused raised this with the clinical staff to help ensure care and support.

• Where older patients had complex needs, the practice shared summary care records with local care services. The practice held regular multi-disciplinary meetings where the needs of patients, for example, receiving end of life care were discussed.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. Patients were referred tolocal health and social care coordinators (‘Care Navigator’) which provided practical support and advice to help people in live as independently as possible in their own homes.

Updated 8 January 2018

The practice is rated as good for the care of working age people (including those recently retired and students).

• The practice had taken into account the needs of these patients and had adjusted the services it offered to ensure these were accessible flexible and offered continuity of care. It offered, for example, extended opening hours on Thursday and Friday mornings from 7am.

• The practice offered pre-bookable telephone consultations which working people found useful.

• The practice had developed online services, for example repeat prescribing and on-line booking which had not previously been available.

• The practice had realised that few NHS health checks had previously been offered and had worked with the PPG to encourage take-up of these, increasing the number done from 17 to 285 over a 12 month period.

• The practice offered smoking cessation advice and referrals, and alcohol/drug abuse service referrals

Updated 8 January 2018

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

• Patients at risk of dementia were identified and offered an assessment.

• 91%

• The practice specifically considered the physical health needs of patients with poor mental health and dementia, for example, offering regular health checks and medicines reviews.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• The practice had achieved maximum QOF results for its treatment of patients with mental health issues.

• 90% of patients living with dementia had received a face to face review in the previous 12 months.

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

• The practice referred patients with poor mental health to a variety of services which provided counselling, cognitive behavioural therapy and advice and listening. It worked closely with the local mental health coordinator

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia, for example, by offering longer appointments with the patient’s regular GP unless in an emergency.

Updated 8 January 2018

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 carers, and those with a learning disability.

• People who were homeless were directed to a local primary care service specifically designed for homeless people

• The practice delivered end of life care in a coordinated way which took into account the needs of those whose circumstances made them vulnerable.

• The practice offered longer appointments for patients with a learning disability and for those with mobility problems.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations and where appropriate referred them directly.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.

• Staff were able to describe situations where they had had concerns for patients and took action to keep them safe.