Roman Gate Surgery

Updated 19 July 2016

The Hicks Group Practice, at the Charles Hicks Medical Centre and its branch Roman Gate Surgery are situated in Huntingdon and Godmanchester, Cambridgeshire. The practice provides services for approximately 13,650 patients. It holds a General Medical Services contract with NHS Cambridgeshire and Peterborough CCG.

According to Public Health England, the patient population has a lower number of patients aged 20 to 24, and 80+ in comparison to the practice average across England. It has a higher proportion of patients aged 50 to 59 compared to the practice average across England. Income deprivation affecting children and older people is lower than the practice average in the area and across England.

The practice has five GP partners, one female and four male, three salaried female GPs and one GP registrar. There is one advanced nurse practitioner, four practice nurses and three health care assistants. The practice also employs two practice managers, a reception manager, an administration manager and a team of reception and administration staff as well as two secretaries.

The practice is open from Monday to Friday 8.30am to 6pm. Extended hours clinics are available until 8.15pm on Monday and Thursday from the main and branch location on a rotational basis. Out-of-hours care is provided by Urgent Care Cambridge.

The practice is a training practice and teaches medical students as well as GP registrars (trainee doctors).

Updated 19 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Hicks Group Practice at Charles Hicks Medical Centre and its branch, Roman Gate Surgery, on 17 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.
• 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 that all staff receive up to date infection prevention and control training.
• Ensure that patients with a learning difficulty, those experiencing poor mental health and those with dementia receive timely annual reviews.
• Ensure that reasons for extremes in vaccine fridge temperature records are noted in a log book.
• Ensure that fire drills are undertaken.
• Continue to roll out plans to improve continuity of care for patients.

We saw one area of outstanding practice:

• The GPs undertook daily referral audits on the practice’s referrals of patients to other services from the previous day. This process ensured referrals were undertaken properly and the correct processes were followed. Patients we spoke with confirmed that they received timely and adequate referrals.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 19 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.
• 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). Performance for diabetes related indicators was higher compared to the CCG and national average. With the practice achieving 95.1%, this was 5.6% above the CCG average and 5.9% above the national average.
• Longer appointments and home visits were available when needed.
• 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 19 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 above the local averages for most 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 had a comprehensive cervical screening programme. The practice’s percentage of patients receiving the intervention according to 2014-2015 data was 80.1%, which was below the England average of 81.8%. Patients that had not attended for a screening appointment were followed up with letters and telephone calls.
• 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.

Updated 19 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.
• 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 rheumatoid arthritis and heart failure, were above local and national averages.
• The practice provided GP cover to local care homes and supported living homes; each had an allocated lead GP.

Updated 19 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 reflects the needs for this age group.
• Extended hours appointments were available until 8.15pm on Monday and Thursday from the main and branch location on a rotational basis.

Updated 19 July 2016

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

• The practice had 78 registered patients with dementia, of which 60 had received an annual review.
• The practice had 117 registered patients experiencing poor mental health, of which 82 were eligible for an annual review since April 2015. 68 of these patients had received an 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 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.

Updated 19 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 those with a learning disability. The practice had 79 registered patients with a learning disability, of which 45 had received an annual review. The practice informed us they were proactively inviting patients that were overdue a review.
• The practice offered longer appointments for patients with a learning disability. The practice managers informed us that patients with a learning disability could book appointments longer ahead and that appointment slots could be opened to allow appropriate access to an appointment for these patients.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• Patients who were carers were proactively identified and signposted to local carers’ groups. The practice had 360 patients registered as carers.
• 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.