Portland Medical Practice

Updated 8 December 2016

Portland Medical Practice provides primary medical services to approximately 8,871 patients in the city of Lincoln and surrounding areas. The practice has a branch surgery located in Newland Health Centre in the city of Lincoln. The practice also provides services to patients residing in 19 nursing and residential homes in the surrounding area.

The practice is registered with the Care Quality Commission to provide the regulated activities of; the treatment of disease, disorder and injury; diagnostic and screening procedures; family planning, maternity and midwifery services and surgical procedures.

At the time of our inspection, the practice employed three male GP partners, one female associate GP, two GP registrars, a practice manager, office manager, practice administrator, two advanced nurse practitioners, three practice nurses, an assistant practitioner, a phlebotomist and a health care assistant, a team of reception, secretarial and administration staff and a caretaker and domestic.

The practice is a training practice and delivers training to GP Registrars. (A GP Registrar is a fully qualified Doctor who is training to become a GP). The practice delivers teaching sessions to medical students on a rotational basis who are enrolled with the University of Nottingham. Portland Medical Practice is also a research accredited practice.

The practice is a training practice for nurse students who are enrolled with the University of Lincoln. Members of the nursing team are trained to support student nurses during placement with the practice.

Portland Medical Practice is open from 8am to 6.30pm Monday to Friday with the exception of a Monday and a Thursday when the practice is open until 7.45pm.

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

The practice has a higher population of patients between the ages of 20-39 years of age and the patient list has higher than average levels of deprivation and ethnic minorities.

The practice has an active patient participation group (PPG) which has been in place for approximately eight years and meet on a regular basis.

The practice offers on-line services for patients including ordering repeat prescriptions, booking routine appointments and viewing patient summary care records including detailed coded medical records.

The practice has opted out of the requirement to provide GP consultation when the surgery is closed, the out-of-hours service is provided by Lincolnshire Community Health Services NHS Trust.

Updated 8 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Portland Medical Practice on 5 July 2016. 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 an effective system in place for reporting and recording significant events.

• Risks to patients were assessed and well managed. There was a risk register in place with various health and safety risk assessments carried out and reviewed on a regular basis.

• 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.

• Patients said they 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.

• The practice had implemented an automated telephone system called ‘patient partner’ which allowed patients to book, check and cancel appointments and request repeat prescriptions 24 hours a day, seven days a week without the need to speak to a member of the reception team.

• The practice provided a touch screen tablet at the reception desk which provided a translation service in numerous different languages for patient and staff use. This was also voice activated and enabled patients to talk into the tablet and translated speech to the receptionist. The reception staff were also able to use this as a translation tool to speak back to the patient.

• The practice had good facilities and 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, which it acted on.

• The provider was aware of and complied with the requirements of the duty of candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 December 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.

• Performance for diabetes related indicators was 92% which was better than the national average of 89% (Overall exception reporting rate was 12% which was higher than the local average of 11%).

• Longer appointments and home visits were available when needed.

• All these 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 multi-disciplinary package of care.

• The practice had a ‘blue card’ scheme in place for patients identified by the practice as high risk such as those with long term conditions. Patients were recorded on their care record as having a ‘blue card’ which alerted the reception team when these patients contacted the practice. These patients were offered same day access to a GP or nurse appointment.

• The practice provided an in-house anti-coagulation clinic for those patients prescribed warfarin.

Updated 8 December 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.

• The practice’s uptake for the cervical screening programme was 66%, which was lower than the CCG average of 78% and the national average of 74%.

• 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.

• The practice provided midwifery led clinics twice a week.

• The practice also held events twice a year at a local school of which pupils spoke approximately 21 different languages. These events were aimed to promote the services offered by the practice, improve communication due to the high number of languages spoken by pupils and to promote health advice and the importance of childhood immunisations with an aim to improve uptake rates.

Updated 8 December 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 provided a frailty service and worked closely with the frailty and hospital avoidance team.

• Members of the nursing team provided home visits for patients who were housebound.

• The practice provided an automated telephone service for booking of appointments and also to request a repeat prescription.

• The practice ensured patients had a named care coordinator to give additional support and ensured care plans were implemented and reviewed on a regular basis for older people.

Updated 8 December 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 provided an in-house phlebotomy service.

• The practice provided extended hours appointments until 7.45pm on a Monday and a Thursday evening.

Updated 8 December 2016

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

• Performance for mental health related indicators was 72% which was lower than the national average of 93%. (Overall exception reporting rate was 13% which was better than the local average of 15%).

• 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 8 December 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 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.