Bottisham Medical Practice

Updated 12 April 2016

Bottisham Medical Practice provides General Medical Services to approximately 5,828 patients. The practice area comprises the town of Bottisham and the surrounding villages. The surgery is situated in a purpose built health centre and has a dispensary. Compared to other towns in Cambridgeshire, Bottisham has a high proportion of over 85 year old patients, and patients with complex needs at local nursing and residential homes.

The practice provides treatment and consultation rooms on the ground floor. Parking is available with level and ramp access and automatic doors. The practice is an accredited teaching and training practice.

The practice has a team of six GPs (one currently on maternity leave), a GP registrar and a GP returner. In addition to this, there are two associated GPs and two fixed term contract GPs covering maternity leave. Four GPs are partners, meaning they hold managerial and financial responsibility for the practice. There is a team of practice nurses, which includes two nurse prescribers, one practice nurse and one health care assistant / phlebotomist who run a variety of appointments for long term conditions, minor illness and family health.

There is a practice manager who is supported by an office manager, a dispensary manager and a practice administrator. In addition there is a team of dispensers and non-clinical administrative, secretarial and reception staff who share a range of roles, some of whom are employed on flexible working arrangements.

The practice provides a range of clinics and services, which are detailed in this report, and operates generally between the hours of 8.30am and 6pm Monday to Friday. Appointment times  are from 9am to 11.30am and 3pm to 5.10pm daily with GPs. Nurse appointments are from 9am to 11.50am and 2pm to 5pm daily. In addition to pre-bookable appointments that can be booked up to four weeks in advance, urgent appointments are also available for people that need them.

The practice does not provide GP services to patients outside of normal working hours such as nights and weekends. During these times GP services are provided by Urgent Care Cambridge via the 111 service.

Updated 12 April 2016

Letter from the Chief Inspector of General Practice.

We carried out an announced comprehensive inspection at Bottisham Medical Practice on 25 January 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• 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 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.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example referrals were made to a local outreach sexual health service, in addition a GP and the practice manager attended the local college and provided information and signposting for students at the college.

• 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. Information about how to complain was available and easy to understand.

• 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.

We saw areas of outstanding practice:

• The practice had developed an easy read pre-health review document for patients who have a learning disability. This used words and pictures in an easy read format to help patients with a learning disability to better understand and respond to questions about their health, illness, lifestyle and treatments. This ensured GPs had the basic and necessary information about the patient and their symptoms prior to their health review. The practice had identified 16 patients on the practice list with a learning disability. Face to face annual reviews were undertaken by GPs and a practice nurse.

• The practice provided support to one nursing home with 156 beds and one residential home with 56 beds. This included support for 10 patients, formerly from a secondary care establishment with complex neurological requirements. The practice had developed an emergency visit request pro forma for residential and nursing homes which ensured GPs had the basic and necessary information about the patient and their symptoms from the staff prior to a home visit. This included specific patient details, the reason for the requested visit and the time the concerns were first raised and by whom. This ensured the GP had all the information relating to the patient’s condition should the member of the staff go off duty and could then provide timely, accurate and bespoke care and treatment when required.

• The chairman of the Patient Participation Group (PPG) was a volunteer Health Walk team leader and led the practice Health Walking Group which met fortnightly under the umbrella of the County Council’s Walking for Health. With patients consent, GPs could refer patients to the group to promote activity and well-being. Some members of the group regularly joined the walking group however there was scope for patients to join the walks on an ad hoc basis.

• The practice worked with the PPG to increase links with the teenage patients. The practice had recently added a teenager page to its website which provided links to the NHS Choices live well pages for teenagers. The practice manager was working with the information technology students at the local secondary school, to review the teenager pages on the practice website with the intention to make these pages more appealing for this group of patients. This work was on-going, however the practice anticipated this would enable and encourage teenage patients to access services that would meet their needs.

• The practice worked with the local secondary school to review the annual personal, social, health and economic (PHSE) student survey, completed by students aged 16 -18 to assess where there may be gaps in the provision of care. The previous year’s PHSE survey highlighted a high incidence of self-harm amongst teenagers. The practice worked to refer such patients to support services. However, the practice had noted that local services were limited due to a lack of resources within the local mental health trust. One GP partner was the practice and local commissioning group lead for mental health, and we were told was in the process of developing appropriate mental health services for the locality.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 April 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.

• The practice undertook quarterly virtual case review meetings diabetic patients. This was organised by the CamHealth local commissioning group to aid best practice. A practice nurse had undertaken a foundation course in diabetic care, and assisted the GP lead in the CamHealth community diabetes service. The practice GP lead for diabetes worked with other practices in the support of patients with Type I and Type II diabetes.

• The lead GP for respiratory conditions worked with GPs and clinical staff to manage patients’ conditions. Additionally, another GP provided patient information evenings for patients with asthma who used maintenance therapy single inhalers.

• The practice performance for 2014/2015 QOF for chronic obstructive pulmonary disease epilepsy, heart failure and palliative care were all above or in line with CCG and national average with the practice achieving 100% across each indicator.

• The nurse prescriber provided spirometry and asthma reviews and worked closely with the GPs to highlight any concerning results. In addition to this, the practice had a process in place where they would contact any patient following an admission to hospital for an asthma exacerbation or contact with the out of hours service as a result of an asthma exacerbation.

• The practice offered in-house diagnostics to support patients with long-term conditions, such as 24 hour ambulatory blood pressure machines, electrocardiogram tests and ankle brachial index tests to read the severity of peripheral arterial disease.

• 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 multidisciplinary package of care. For example, the practice engaged with care pathways such as the psychology service and the respiratory service to further support patients with long term conditions.

• The charity Campaign for Tackling Acquired Deafness attended the practice monthly. This group provided support to patients who have a hearing impairment with the aim to enable them to retain or recover their ability to communicate with their social group and the wider world through better hearing and communication. It also supported family friends and members of the local community coming into daily contact with hard of hearing patients.

• Longer appointments and home visits were available when needed.

• The practice provided support to one nursing home with 156 beds and one residential home with 56 beds. This included support for 10 patients, formerly from a secondary care establishment with complex neurological requirements. The practice had developed an emergency visit request pro forma for residential and nursing homes which ensured GPs had the basic and necessary information about the patient and their symptoms from the staff prior to a home visit. This included specific patient details, the reason for the requested visit and the time the concerns were first raised and by whom. This ensured the GP had all the information relating to the patient’s condition should the member of the staff go off duty and could then provide timely, accurate and bespoke care and treatment when required.

Updated 12 April 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.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice liaised with the community school nurse who was based at the practice; we were told this strengthened the collaborative working between the practice and community teams.

• The health visitor and nursery nurses were based at the children’s centre in the village and worked with the practice. We saw the practice was active in advertising the children centre events.

• The practice held monthly meetings to discuss vulnerable or at risk children where the school nurse, health visitor and nursery nurse were invited. Minutes from these meetings were shared as appropriate and patient records were updated.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

• The practice worked with the local secondary school to review the annual personal, social, health and economic (PHSE) student survey, completed by students aged 16 – 18 years to assess where they may be gaps in the provision of care. The previous year’s PHSE survey highlighted a high incidence of self-harm amongst teenagers. The practice worked to refer such patients to support services. However, the practice had noted that local services were limited due to a lack of resources within the local mental health trust. One GP partner was the practice and local commissioning group lead for mental health, and we were told was in the process of developing appropriate mental health services for the locality.

• The practice offered the fitting and removal of long term contraception.

• The practice encouraged chlamydia testing for the under 24 age group. Referrals were also made to a local outreach sexual health service.

• Emergency contraception was available at the practice. In addition the practice took part in the C Card system which provided free condoms to patients between the ages of 13 -24.

• The practice worked with the PPG to increase links with the teenage patients. The practice had recently added a teenager page to its website which provided links to the NHS Choices live well pages for teenagers.

• A GP and the practice manager attended the local secondary school during a sexual health awareness week and provided information and signposting for students at the school.

• In addition to this, the practice manager was working with the information technology students at the local secondary school, to review the pages aimed at teenagers on the practice website, with the intention to make these pages more appealing for this group of patients.

Updated 12 April 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 engaged regularly with a local hospital geriatrician. Patients’ care records were reviewed annually and where required, six monthly.

• GPs undertook twice weekly ‘ward round’ visits to local nursing homes.

• GPs and dispensing staff delivered medication to patients in their own homes when unable to attend the practice.

• The East of England Ambulance coordinator met with the practice team to review patients shared care plans. In addition the practice liaised with social services and GPs arranged joint home visits to patients where support was required.

• The practice had developed an emergency visit request pro forma for care and nursing homes which ensured GPs had the basic and necessary information about the patient and their symptoms from the care staff prior to a home visit. This included specific patient details, the reason for the requested visit and the time the concerns were first raised and by whom. This ensured the GP had all the information relating to the patient’s condition should the member of the care staff go off duty.

Updated 12 April 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.

• Contraception and minor surgery clinics were held on an ad hoc basis. Patients were contacted for an appointment to the clinics when enough patients were available to fill the appointments.

• The practice’s uptake for the cervical screening programme was 82% which was comparable to the national average of 82%.

• The practice hosted annual talks or guest speakers at the PPG annual general meeting (AGM).At the previous AGM, the topic of discussion was the Mediterranean diet. There were plans in place for a talk by the Alzheimer’s Society. In addition to this, the practice hosted Saturday health education sessions organised by the PPG and run by the British Heart Foundation. We were told these sessions were well attended by the local community.

Updated 12 April 2016

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

• 96% of patients experiencing poor mental health had a comprehensive, agreed care plan documented in their record, in the preceding 12 months which is above the national average of 86%.

• The practice regularly worked with multi-disciplinary teams in the case management of people 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 worked collaboratively with community mental health services. The practice had noted that local services were limited due to a lack of resource within the local mental health trust. A GP partner was the practice and local commissioning group lead for mental health, and we were told he was developing appropriate mental health services for the locality.

• GPs had weekly agreed telephone consultation time with the locality psychiatrist to discuss care and treatment pathways.

• The practice worked with and hosted a counsellor who attended the practice weekly. Patients were able to contact the counsellor directly without requiring a referral from a GP.

• The practice provided intensive support in the care and management of a group of patients who had been in long term hospital care for chronic enduring mental illness and who now resided in a nursing home. We saw evidence of detailed care plans and systematic reviews of their health needs. The care provided by the support unit was dependent on the care and expertise provided by the GPs at Bottisham Medical Practice through regular discussion with the staff at the support unit and review of care and treatment plans. There was a regular discussion by telephone with the local Consultant Psychiatrist which enabled the practice to manage this group in a primary care setting.

• The practice worked with the local secondary school to review the annual personal, social, health and economic (PHSE) student survey, completed by students aged 16 -18 to assess where there may be gaps in the provision of care. The previous year’s PHSE survey highlighted a high incidence of self-harm amongst teenagers. The practice worked to refer such patients to support services. However, the practice had noted that local services were limited due to a lack of resources within the local mental health trust. One GP partner was the practice and local commissioning group lead for mental health, and we were told was in the process of developing appropriate mental health services for the locality.

Updated 12 April 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 had identified 16 patients with a learning disability on the practice register; annual reviews for these patients were planned for February 2016. The practice QOF achievement for the 2014/2015 learning disability indicators were 100%.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• 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 lead on the provision of care for patients with a learning disability. We were told housebound patients were visited to undertake regular health checks.

• There were systems in place to identify and follow up patients whose circumstances may make them vulnerable, for example those who had a high number of A&E attendances or out of hours contacts were flagged up to the GPs and were included on the weekly practice meeting’s agenda for discussion and to ensure the patient was followed up by their usual GP.

• The practice had developed an easy read pre-health review document for patients who have a learning disability. This used words and pictures in an easy read format to help patients with a learning disability to better understand and respond to questions about their health, illness, lifestyle and treatments. This ensured GPs had the basic and necessary information about the patient and their symptoms prior to their health review.