Archived: North Hill Medical Group

Updated 9 March 2017

North Hill Medical Group provides primary care services to approximately 13,523 patients over three locations. The main location is in Colchester, there is a further location in West Bergholt and another in Nayland. We visited the main location on North hill in Colchester and the dispensing location in Nayland; we did not visit the West Bergholt location. The three locations have completely different practice population types: North Hill (Colchester Town – mixed urban) West Bergholt (commuter, rural) Nayland (elderly, rural)

The medical group’s boundary extends from Colchester town out for 10 miles to encompass rural Suffolk. The deprivation score is low for the practice area in comparison with other local and national GP practices. There are six large care and nursing homes with over 200 patients that are registered at the practice.

North Hill Medical Group holds a ‘General Medical Service’ (GMS) contract which includes a dispensing service. The medical group are a training practice that supports qualified doctors, known as registrars to complete the final stages of their GP training.

There are 53 members of staff working over the three locations; three GP partners one female and two male, and seven salaried GPs six female and one male. The GPs were supported by three advanced nurse practitioners, two nurse practitioners, three practice nurses, three healthcare assistants, three phlebotomists, a dispensary manager and three trained dispensers, these staff members were female. The clinical teams were supported by a practice manager, a human resources manager, a finance manager and 22 other administrative staff members with a range of roles; secretaries, administrators and receptionists that work full or part-time hours work patterns.

The North Hill and West Bergholt location opening hours are 8am until 6.30pm every weekday and from 8.30am until 1pm one Saturday each month. The Nayland location opens from 8am until 6pm each weekday and from 8.30am until 1pm one Saturday each month. The clinical sessions operate during the opening hours and include clinics for asthma, chronic obstructive pulmonary disease (COPD), diabetes, contraception, including coils and implants, smoking cessation, phlebotomy (blood taking), childhood immunisation and holiday vaccinations, and minor injuries.

The practice has opted out of providing GP out of hour’s services. Patients calling the practice outside normal practice working hours are advised by the answerphone message to contact the 111 non-emergency services. Patients requiring urgent treatment are advised to contact the out of hour’s service which is provided by Care UK.

Updated 9 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at North Hill Medical Group on 10 January 2017. Overall the practice is rated as good.

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

• Staff members knew how to raise concerns, and report safety incidents. Safety information was appropriately recorded and lessons learned were identified. However we found the lessons learned from incidents relevant to all staff members were not shared with the administrative staff members.

• The Infection control policy and had not been recently updated or the audits analysed to monitor issues arising. Within 48 hours of the inspection we received an updated version of the policy.

• Risks to patients and staff members were assessed, documented and acted on appropriately.

• Staff assessed patients’ treatment and care needs and delivered care in line with current evidence based guidance.
• Staff had 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.
• Patients said they were able to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• 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 patient participation Group (PPG) proactively sought feedback from patients, which was acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvements are:

• Lessons learned from incidents should be shared with administrative staff members to ensure learning at all levels within the practice.

• The Infection control policy should be maintained with current local contacts and regularly reviewed. The Infection control audits undertaken to monitor patient safety should be reviewed and analysed to monitor issues arising.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 March 2017

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

• Nursing staff and GPs had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Personalised care plans had been created, agreed with patients, and shared to ensure continuity of care.
• Diabetic quality data from 2015 to 2016 showed they were comparable with the local CCG and national averages.

Other services provided by the practice for this population group were:

• Longer appointments and home visits when needed.
• People with long-term conditions were provided a named practice GP and a structured annual review to check their needs were met. The named GP worked with relevant health and social care professionals to deliver a multidisciplinary package of care, to reduce the need for hospital visits.
• Practice prescribers used clinical templates designed to ensure patient’s received the blood tests, and diagnostic checks required before repeat prescriptions were given to patients.

Updated 9 March 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 or at risk, for example, those who had a high number of A&E attendances.
• Immunisation rates were high for all standard childhood immunisations.
• There was a GP designated child safeguarding lead. The weekly clinical meeting agenda had a standing safeguarding item.
• A wide range of contraception services including implants and intrauterine devices was available.
• Cervical screening data showed the practice was comparable with other local CCG and national practice data.
• Appointments were available outside of school hours and college hours, and the premises were suitable for children and babies.
• On-line appointments were available for both advanced and on the day appointments.

Updated 9 March 2017

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

• The practice offered personalised care to meet the needs of the older people in its population.
• The practice responded to the needs of older people, and offered home visits and urgent appointments for those that needed them.
• All older people had a named GP.
• GPs provided a named GP for the residential care and nursing homes to ensure they received continuity of care.
• Palliative care meetings every six to eight weeks were used to understand and discuss patients identified as frail and at risk of deteriorating health.
• They had a high uptake for shingles and flu vaccinations and actively campaigned across a variety of media, for example; prescription repeat forms, posters in the waiting room, on their website and opportunistically during routine appointments.
• Senior health checks were offered, on an ad hoc basis to maximise their uptake.
• A care advisor visited the practice regularly to help patients deal with benefits and equipment needs.
• Prescribing and monitoring for patients at risk of forgetting their medicine were provided person specific prescriptions. We were told for dispensing patients this could be in a single dose pack dossett container.

Updated 9 March 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 offered.
• The practice offered online services as well as a full range of health promotion and screening that reflected the needs for this age group.
• Saturday clinics were available at each of the three sites once a month, GPs and nurses were available during these clinics.
• There were three bookable telephone appointments daily within every GP session. There were also telephone advice options for patients on the same day.

Updated 9 March 2017

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

• 91% of people diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was higher than the local CCG and national average.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• Staff members had received training in adult safeguarding and were familiar with the Mental Capacity Act.
• 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.
• Staff members told us they would find a suitable quiet area for patients to wait if they were feeling anxious, depressed, or too unwell to wait in the busy waiting rooms.
• Prescribing and monitoring for patients at risk of forgetting or overdosing with medicine were provided person specific prescription frequencies. We were told this could be daily, weekly, or fortnightly.

Updated 9 March 2017

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

• The practice recognised patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• The practice offered longer or double appointments for patients with a learning disability. They had recognised 73 people with a learning disability and each of those patients had been offered a health review.
• The practice clinical members of staff worked with other health care professionals in the case management of vulnerable patients. They worked closely with local care homes to provide, treatment planning, and home visits when needed.
• The practice provided information to vulnerable patients about how to access various support groups and voluntary organisations.
• Nursing home visits were provided by the nurse to provide regular support for patients.
• Staff members knew how to recognise the signs of abuse and were aware of their responsibilities concerning the sharing of information regarding safeguarding concerns. The practice safe guarding policy set out the details to contact relevant local agencies during normal working hours and out of hours.
• All staff members had undergone safeguarding training of vulnerable adults and children.
• The GP safeguarding leads at the practice attended forums when possible.