Trumpington Street Medical Practice

Updated 28 July 2016

Trumpington Street Medical Practice has a long history dating back to before the start of the NHS, and serves a population dominated by the provision of care to universitiy, students and staff alongside the local residential population. The surgery is situated within a university owned building in a central urban area. The main practice site does not provide car parking facilities and there is no room for further extension or development. Treatment and consultation rooms are located on the ground and basement floors. The practice is open between 8am and 6pm Monday to Friday. Appointments are from 8.20am to 12am with GPs and 8.20am to 12.30 with nurses every morning. Afternoon appointments are from 2.30pm to 5.50pm with GPs and 2pm to 5.30pm with nurses. In addition to pre-bookable appointments that can be booked up to six weeks in advance, urgent appointments are also available for people that need them.

There is a branch surgery located in Trumpington, Cambridge. This provides alternative access to medical services for patients who can not access central Cambridge, students or patients with a disability or requiring parking facilities. It operates on a daily basis from Monday to Friday, with appointments available from 8.30am to 1pm and 2pm to 5.30, with both GP and nurses offering appointments. The branch surgery is in the process of undergoing a new purpose built premises. We did not visit the branch surgery in our inspection.

According to information taken from Public Health England, the patient population has a higher than average number of patients aged 15-34 years, a lower than average number of patients aged 0-14 years and a lower than average number of patients aged between 35-85+ years compared to the practice average across England.

The practice team consists of four GP partners, three salaried GPs, one independent nurse prescriber, three practice nurses and two health care assistants. The practice manager is supported by two deputy managers and a number of secretarial and reception staff.

The practice is a training practice and supports the training of medical students.

Updated 28 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Trumpington Street Medical Practice on 3 May 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.

• 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.
• Patients said they found it easy 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 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.

The areas where the provider should make improvement are:

• Ensure patients waiting for their appointments in all areas of the practice can be clearly seen by reception staff to enable closer monitoring in case of change in condition.
• Keep detailed and up to date records relating to the recruitment and management of staff. This includes qualifications, registration and staff recruitment interviews.
• Ensure that the learning from complaints and significant events is shared and disseminated with the appropriate staff within the practice.
• Continue to encourage and improve the uptake of breast screening for patients.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Updated 28 July 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. GPs were clinical leads for long term conditions and worked closely with the nurse practitioner and the nursing team.
• 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 100%, which was above the CCG average by 10.5% and the national average by 10.8%.
• The practice had an significant number of patients with type 1 diabetes and had identified the high number of patients from the student population as a predominant factor.
• Longer appointments and home visits were available when needed.
• Patients with a long term condition 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 28 July 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 83%, which was comparable to the CCG average of 82% and the national average of 82%. There was a policy to offer telephone reminders for patients who did not attend for their cervical screening test.
• 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 medical care to two local boarding schools and started appointments from 8.00 am to ensure students were able to be seen and avoid missing lessons.

Updated 28 July 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. They had identified an increase in their list size with an growth in older patients. As a direct result the practice had recruited new GPs with a special interest in elderly medicine and staff had received specialised training from the local dementia team, which included areas such as behavioural support and mental capacity decisions.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice contacted all patients after their discharge from hospital to address any concerns and assess if the patient needed GP involvement at that time.
• The practice offered health checks for patients aged over 75.
• The practice triaged all home visit requests to facilitate earlier visits where hospital admission may be an outcome.
• Nationally reported data showed that some outcomes for patients for conditions commonly found in older people, such as rheumatoid arthritis, were above local and national averages.

Updated 28 July 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 reflected the needs of this age group.
• The practice encouraged its patients to attend national screening programmes for bowel and breast cancer screening. The practice uptake for patients aged 60-69, screened for bowel cancer in last 30 months was 59%; this was in line with the CCG average of 59% and the national average of 58%. The practice uptake for female patients screened for breast cancer in the last 36 months at 64%, which was below the CCG and national average of 72%.
• A GP had developed a student health website and continued to regularly maintain this. Another GP had a special interest and training in sports medicine and provided access to sports medicine for both student and non-student patients.
• The practice has a greater than average number of transgender patients and provided specialised support and care.
• A GP had undertaken dermatology training and was able to assess skin complaints within the practice, therefore reducing secondary care referrals.

Updated 28 July 2016

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

• 74% of patients diagnosed with dementia had received a face to face care review in the last 12 months (01/04/2014 to 31/03/2015), which was below the national average of 84%
• 88% of patients experiencing poor mental health had a comprehensive care plan agreed in the last 12 months (01/04/2014 to 31/03/2015), which was in line with CCG and national averages. At the time of our inspection we saw that this had increased to 93% in the previous 12 months (01/04/2015/01/04/2016).
• 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.
• The practice had a higher than average number of patients with mental health issues, such as eating disorders. Clinicians had experience and interest in supporting and caring for patients with such mental health issues. A GP in their previous role as CCG Lead for Mental Health had developed a number of resources on mental health which were available for the practice on the CCG website, these included top tips and access to self-help resources.

Updated 28 July 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 computer system alerted staff to vulnerable patients.
• The practice offered longer appointments for patients with a learning disability. Two of the four patients on the practice learning disability register had received a face to face review of their care plan in the past 12 months.
• 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.
• A GP had developed learning disability resources in their previous CCG role. This included invitations for health checks suited to patients with a learning disability, such as easy read and pictorial formats. These resources were available on the practice intranet in addition to the local CCG website.