Clarendon Lodge

Updated 28 April 2017

Clarendon Lodge Medical Practice provides services for the northern part of the town of Leamington Spa and the surrounding villages of Hunningham, Weston under Wetherley and Bubbenhall. The practice is situated in a residential building which has undergone much extension and conversion over the years.

At the time of the inspection the practice served a population of 13,425 patients. The practice has a General Medical Services (GMS) contract with NHS England. The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities. The practice is an active member of the Warwickshire Clinical Commissioning Group (CCG) and the GP federation. A GP federation is formed of a group of practices who work together to share best practice and maximize opportunities to improve patient outcomes.

The practice has a higher than average older population at 10% compared with the national average of 8%. Services are provided to 11 care and nursing homes locally and the practice serves a student population at a nearby university.

There are seven GP partners and two salaried GPs (four males and five females) at the practice. The GPs are supported by a practice manager, an administration manager, a nursing team manager, a reception team manager, three practice nurses, a community liaison nurse, two healthcare assistants, administration, maintenance and reception staff.

Opening hours are from 8am to 6pm on Monday to Friday each week with appointments between these times. Patients calling between 6pm to 6.30pm are directed to the duty GP practice mobile.

The practice is closed at weekends. Extended hours appointments are available for pre-bookable appointments on Monday and Thursday evenings until 7.30pm and from 8am till 10.10am on the first Saturday of each month.

The practice does not provide an out-of-hours service but has alternative arrangements for patients to be seen when the practice is closed. For example, if patients call the practice when it is closed, an answerphone message gives the telephone number they should ring depending on the circumstances. Information on the out-of-hours service (provided by Care UK) is available in the patient practice leaflet and on the website.

Home visits are available for patients who are housebound or too ill to attend the practice for appointments. There is also an online service which allows patients to order repeat prescriptions and book appointments with GPs.

The practice treats patients of all ages and provides a range of medical services. This includes disease management such as lung diseases, asthma and diabetes. Other appointments are available for health checks, childhood vaccinations and contraception advice.

Clarendon Lodge Medical Practice is an approved training practice for trainee GPs with three GP trainers. A trainee GP is a qualified doctor who is training to become a GP through a period of working and training in a practice.

Updated 28 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Clarendon Lodge Medical Practice on 8 November 2016. The overall rating for this practice is good.

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

• The practice was aware of and provided services according to the needs of their patient population. Staff received regular training and skill updates to ensure they had the appropriate skills, knowledge and experience to deliver effective care and treatment.
• Risks to patients were assessed and well managed.
• Patients told us they were treated with dignity and respect and that they were fully involved in decisions about their care and treatment.

• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There were processes and procedures to keep patients safe. These included a system for reporting and recording significant events, keeping these under review and sharing learning where this occurred.
• The practice was aware of the requirements of the duty of candour and systems ensured compliance with this.
• Regular meetings and discussions were held with staff and multi-disciplinary teams to ensure that patients received the best care and treatment in a coordinated way.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Annual carers events were held at the practice providing opportunities for networking and support.
• There was a clear leadership structure which encouraged a culture of openness and accountability. Staff told us they felt supported by management.
• The practice had a clear vision which had quality and safety as its top priority. Planning was in place to demonstrate the intended development of the services provided by the practice.
• The practice demonstrated a strong commitment in working with their Patient Participation Group (PPG) to improve services for patients. Suggestions for improvements and changes to the way it delivered services as a result of feedback from patients and from the PPG were evident. For example, changes to the telephone system were made to improve access to appointments.
• The practice was an approved training practice for trainee GPs and had achieved the South Warwickshire GP Award for Excellence in Medical training for 2015/2016.
• With the appointment of the practice community liaison nurse the practice had achieved consistently lower than local averages for emergency admissions for patients with various conditions including diabetes, cancer and care/nursing home patients.
• Information about services and how to complain was available and patients told us that they knew how to complain if they needed to.
• There was a strong focus on continuous learning and improvement at all levels, with engagement in pilot opportunities.

We saw several areas of outstanding practice including:

• The practice used innovative and proactive methods to improve patient outcomes and working with other local providers to share best practice. For example, the practice provided dedicated support to 11 local care and nursing homes. Daily contact by the practice employed community liaison nurse was provided to patients. They also provided education and support to care and nursing home staff to enable end of life care to achieve a dignified death for patients.
• The practice achieved consistently lower than local averages for emergency admissions for patients with various conditions including diabetes, cancer and care home patients. For example, audits had been completed over a two year period which demonstrated a 54% reduction in emergency admissions by care/nursing home patients by November 2016. We were told that dedicated ward rounds and working with care/nursing home staff were seen as contributory factors for these results.

• The PPG were very involved in the development of the practice website which they described as developed by patients for patients. Members of the PPG had spent time visiting care homes supported by the practice to gain views about the services they received from the practice. The PPG produced a newsletter in which they took the opportunity to share practice responses to patient surveys, including local and national survey results.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 April 2017

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

• The practice nurses had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Nursing staff had received appropriate training in chronic disease management, such as asthma and diabetes.
• Longer appointments and home visits were available when needed.
• All patients diagnosed with a long term condition had a named GP and a structured annual review to check that their health and medicine needs were being met.
• Performance for diabetes related indicators was in line with the local average and higher than the national average. For example, patients who had a blood glucose level within the acceptable recommended range was 81% compared the CCG and the national averages of 82% and 78%. The practice exception rate of 6% was below the CCG and the national averages of 10% and 12%.
• Clinical staff had close working relationships with external health professionals to ensure patients received up to date care.
• The practice achieved consistently lower than local averages for emergency admissions for patients with various conditions including diabetes, cancer and care home patients.
• A domiciliary flu vaccination service was provided for those patients who were housebound or patients’ temporarily unable to attend the clinics at the practice including patients discharged from hospital. This service was provided to 50 patients during last year.
• NHS health checks were offered for early identification of chronic disease and there was proactive monitoring.
• Domiciliary visits were carried out for patients with long term conditions so that regular reviews of their care were maintained. The practice had completed 628 domiciliary patient reviews during last year.
• A community Health Care Assistant (HCA) service had been introduced to carry out home visits to patients for blood pressure checks and take blood samples. The practice had carried out 197 of these visits to patients in the period from January 2016 to November 2016, to ensure that tests were done in a timely manner.
• The practice patient leaflet provided information about other organisations and websites patients could access.

Updated 28 April 2017

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

• The practice was proactive in offering online services as well as a full range of health promotion and screening services that reflected the needs of this age group.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• There were systems to identify and follow up children living in disadvantaged circumstances and who were considered to be at risk of harm. For example, children and young people who had a high number of accident and emergency (A&E) attendances.
• The practice worked with midwives and health visitors to coordinate care.
• The practice nurses had oversight for the management of a number of clinical areas, including immunisations, cervical cytology and some long term conditions.
• Childhood immunisation rates for the vaccinations given were comparable to local and national averages.
• The practice offered a number of online services including requesting repeat medicines and booking appointments.
• Baby changing facilities and breast feeding rooms were available to those who needed it.

Updated 28 April 2017

The practice is rated as outstanding for the care of older patients.

• The practice offered personalised care to meet the needs of the older patients in its population. It was responsive to the needs of older patients.
• Home visits and rapid access appointments were offered for those patients with enhanced needs.
• The practice offered a range of enhanced services, for example, in dementia and end of life care.
• Monthly multi-disciplinary meetings were held and included discussions on patients receiving end of life care.
• Care plans were shared with out of hours services to ensure care was in line with patients wishes and assist in clinical decisions when the practice was closed.
• Visits to patients were made to provide flu vaccinations for those patients who were unable to attend the practice.
• Nationally reported data showed that outcomes for patients were in line with local and national standards for conditions commonly found in older patients.
• The practice was a consistently high performer for local audits of the completion of care plans and patient notes in care/nursing homes, compared with local practices.
• The practice sponsored reminiscence sessions to patients in care and nursing homes which were led by the Patient Participation Group (PPG) in conjunction with a local historical group.
• Where older patients had complex needs, the practice shared summary care records with local care services. The practice described examples where they had worked together with the district nursing team, out of hours services and care home staff to manage patient care.

Updated 28 April 2017

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

• The practice was proactive in offering a full range of health promotion and screening services that reflected the needs of this age group.
• Health promotion advice was offered such as smoking cessation and nutrition.
• The practice offered online appointment booking and the facility to request repeat prescriptions online.
• Telephone consultations were available for patients who did not feel they required a physical consultation or who had difficulty in attending the practice during opening hours.
• Extended hours appointments were available for pre-bookable appointments on Monday and Thursday evenings until 7.30pm and from 8am till 10.10am on the first Saturday of each month.

Updated 28 April 2017

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

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• Advanced care planning and annual health checks were carried out for patients with dementia and poor mental health.
• The practice was a consistently high performer for the Clinical Commissioning Group (CCG) audits on the completion of care plans and patient notes in care/nursing homes, compared with local practices.
• Performance for mental health indicators was 92% which was in line with the CCG average of 93% and above the national average of 88%. The practice exception rate was 2% which was lower than the CCG average of 11% and lower than the national average of 13%.
• The proportion of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was 90% which was above the local and national averages of 85% and 84% respectively. The practice exception rate was 2% which was lower than the CCG average of 6% and the national average of 8%.
• Patients experiencing poor mental health were advised how to access various support groups and voluntary organisations. There was a system to follow up patients who had attended accident and emergency (A&E) departments where they may have been experiencing poor mental health.
• Clinical staff had a good understanding of how to support patients with mental health needs. They were trained to recognise patients presenting with mental health conditions and to carry out comprehensive assessments.

Updated 28 April 2017

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

• Staff had been trained to recognise signs of abuse in vulnerable adults and children and the action they should take if they had concerns. There was a lead GP for safeguarding adults and children. GPs were trained to an appropriate level in safeguarding adults and children. All safeguarding concerns were discussed at the weekly GP meetings.
• The practice engaged in local initiatives to provide additional services such as the Identification and Referral to Improve Safety (IRIS) scheme (a domestic violence and abuse training support and referral programme). The project provided staff with training to help them with detecting any signs of abuse and patients were sign-posted to support agencies.
• Services were provided for all vulnerable patient groups presenting to the practice. For example, services were provided to homeless people, patients experiencing domestic violence and patients who were affected by substance misuse.
• Vulnerable patients were informed how to access various support groups and voluntary organisations.
• The practice held a register of patients living in vulnerable circumstances including those patients with a learning disability.
• Clinical staff regularly worked with multidisciplinary teams in the case management of vulnerable patients. Alerts were added to patients records for staff awareness so that longer appointments could be allocated.
• Longer appointments were available for patients with a learning disability. The practice had carried out annual health checks for 72% of the 53 patients on their register for 2016/2017.
• Sign language interpreters could be booked for face-to-face consultations for patients with hearing impairments.
• The practice offered additional services to carers such as a free annual flu vaccination and health check. There was a dedicated carer’s information board in the patient waiting area.