Priory Fields Partnership

Updated 6 February 2017

The practice is situated in the town of Huntingdon. The practice offers health care services to approximately 11,800 patients and offers consultation space for GPs, nurses and extended attached professionals including community nurses, a health trainer, and a mental health worker.

The practice holds a General Medical Services (GMS) contract and is a training practice with two GP trainers. A training practice has trainee GPs (Registrars) working in the practice; a registrar is a qualified doctor who is undertaking further training to become a GP. A trainer is a GP who is qualified to teach, support, and assess trainee GPs. The practice has one registrar working in the surgery. The practice also teaches medical students and foundation year doctors.

• There are three (two male and one female) GP partners who hold managerial responsibilities for the practice and four salaried GPs (three female and one male). There are four practice nurses and four healthcare assistants.
• A team of 17 administration and reception staff led by the practice manager support the clinical team.
• The practice is open between 8am and 6.30pm Monday to Friday. With extended hours to 8pm on Monday evenings and from 7.30am on Friday mornings.
• If the practice is closed, Herts Urgent Care provides emergency treatment, patients are asked to call the NHS111 service or to dial 999 in the event of a life threatening emergency.
• The practice has slightly lower number of patients aged under 20 years and slightly higher number of patients aged over 75 years than the practice average across England. The deprivation score is above the England average.

Male and female life expectancy in this area is 78 years for males and 82 years for females compared with the England average at 79 years for men and 83 years for women.

Updated 6 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Priory Fields Partnership on 15 December 2016. Overall the practice is rated as good.

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

• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with practice staff and was regularly reviewed.

• The practice had strong and visible clinical, managerial leadership and governance arrangements.

• We found that there was an open and transparent approach to safety and a system was in place for reporting and recording significant events.
• The practice demonstrated they valued education for all practice staff and patients. One GP had been awarded a certificate for excellent teaching from the NHS Health Education England.
• The practice used a range of assessments to manage the risks to patients.
• Practice 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.
• Data from the Quality and Outcome framework 2015/ 2016 showed the practice performance was above the CCG and national average. Data showed the practice had significantly higher exception reporting in some indicators when compared to the CCG and National average. However, the practice shared with us a written report detailing the finding from a NHS England investigation. This confirmed the practice did not have high exception reporting but that IT issues were the problem. We reviewed the practice clinical system and we were assured that the practice did not have high exception reporting.
• 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.
• 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.

Areas of outstanding;

• The practice recognised they served a population of patients whose first language was Polish and not English. In addition to using translation services, the practice had a GP and staff member who could interpret for them. With the PPG support the practice held a health education for this group of patients, the complete evening was conducted in Polish and 30 patients attended. The practice had invited other health professionals to attend, including a local dentist who provided NHS treatment and Camquit, the smoking cessation service. The practice was proactive in supplying information for patients in both verbal and easy read formats in other languages.

• The practice worked with charities, third sector, and voluntary agencies to maximise benefits for their patients. For example, they collected donations for the local food bank and encouraged patients who would have given food gifts to staff to donate to the food bank instead.

• The partners gave all staff an extra day’s leave for their birthday as an additional way to show they valued their team.

The areas where the provider should make improvement are:

• Ensure that the formal and overarching fire risk assessment is reviewed annually and ensure practice staff always complete the record of the fire alarm tests that are undertaken weekly.

• Review the methods used to encourage carers to register ensuring they receive support and care.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 February 2017

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.
• Patients were invited for an annual review in their birthday month. The practice system and processes for managing the recall systems were robust. This ensured patients received appropriate and timely care with the minimum number of appointments.
• Where appropriate the practice undertook reviews by telephone with the patient or virtually. The practice offered the option for patients to receive the test results relating to long term conditions via email.
• The practice had a health trainer available to offer healthy lifestyle advice and support with exercise and weight loss.
• Longer appointments and home visits were available, including for long term condition reviews when needed for all patients unable to attend the practice or with a learning disability.
• 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.

Updated 6 February 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 and who were at risk. For example, children and young people who had a high number of A&E attendances. Immunisation rates were in line with the national average for the standard childhood immunisations.

• Unwell children were seen as soon as possible and convenient to the parent or carer.

• 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.

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

• The practice offered full contraceptive services including long-acting reversible contraceptives (LARC).

Updated 6 February 2017

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.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including hypertension, dementia, and heart failure were above or in line with the local and national averages.

• The practice provided care to patients in five care homes; each home had a designated GP and weekly visits to ensure proactive care.

• Information for support groups such as Age UK was available.

• The practice tried where possible to bring services closer to patients, for example the practice offered in-house phlebotomy services.

Updated 6 February 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. The practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• Extended hours appointments were available on Monday evenings or early Friday mornings.

• The practice offered telephone consultations for those patients that wished to seek advice in this way. Test results for patients with long term conditions could be sent via email, if the patient wished.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

• The practice offered early appointments with nurses and GPs. Flu clinics were held on Saturdays enabling patients to obtain their immunisation without having to take time off work.

• Patients who were working and experienced poor mental health were referred to the Richmond foundation and could be seen in the practice.

• Travel clinics appointments including Yellow Fever were available in the evening.

Updated 6 February 2017

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

• The practice and practice team were dementia friendly with good signage throughout the building. Clinicians collected patients from the waiting areas; patients we spoke with valued this.

• A mental health professional attended the practice every two weeks to see patients with complex needs. This professional was available to the practice staff for advice.

• The practice had 179 patients diagnosed with dementia on the register. 115 of these patients had received an annual review with the practice nurse with a special interest in mental health. Many of the remaining patients lived in care homes, received on going health reviews through the year with the GPs, and did not have a formal annual review.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those 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 A&E where they may have been experiencing poor mental health.

• Practice staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 6 February 2017

The practice is rated as good overall for the care of people whose circumstances may make them vulnerable. The practice is rated as outstanding for responsive services to patients whose circumstances may make them vulnerable.

• The practice had a GP who was the mental health lead and a designated nurse.

• The practice held a register of patients living in vulnerable circumstances including the transiently homeless and those with a learning disability.
• The practice offered longer appointments with the named doctor 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.
• Practice 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.
• One GP worked at a local prison, had expertise in offenders’ health and wellbeing, and gave support to patients with forensic history.
• The practice recognised they served a population of patients whose first language was Polish and not English. In addition to using translation services, the practice had a GP and staff member who could interpret for them . With the PPG support the practice held a health education for this group of patients, the complete evening was conducted in Polish. The practice had invited other health professionals to attend, including a local dentist who provided NHS treatment. The practice was proactive in supplying information for patients in both verbal and easy read formats in other languages.
• The practice worked with charities, third sector, and voluntary agencies to maximise benefits for their patients. For example, they collected donations for the local food bank and encouraged patients who would have given food gifts to staff to donate to the food bank instead .