East Barnwell Health Centre

Updated 16 July 2015

East Barnwell Health Centre, in the Cambridgeshire and Peterborough Clinical Commissioning Group (CCG) area, provides a range of general medical services to approximately 7000 registered patients living in East Barnwell and the East side of Cambridge.

According to Public Health England information, the patient population has a slightly higher than average number of patients aged 0 to 18 compared to the practice average across England. It has a significantly lower number of patients aged 65 and over and a slightly lower number of patients aged 75 and over and aged over 85 compared to the practice average across England. Income deprivation affecting children is slightly above average and in relation to older people is slightly lower than the practice average across England. A slightly lower percentage of patients had a caring responsibility and had a long standing health condition compared to the practice average across England.

There are four GP partners, two male and two female who hold financial and managerial responsibility for the practice. There are two salaried GPs, two practice nurses, a nurse practitioner (who is working at the practice for one year to care for people with long term conditions), a health care assistant and a phlebotomist. There are also receptionists, administration staff and a practice manager. The practice is a training practice for medical students and qualified doctors who are training to be GPs. They currently have three GP Registrars.

The practice provides a range of clinics and services, which are detailed in this report, and operates between the hours of 8.30am and 6.00pm, Monday to Friday. Outside of practice opening hours a service is provided by another health care provider Urgent Care Cambridgeshire.

Updated 16 July 2015

Letter from the Chief Inspector of General Practice

We visited East Barnwell Health Centre on the 22 June 2015 and carried out a comprehensive inspection. We found that the practice provided a safe, effective, caring, responsive and well led service. The overall rating for this practice is good.

We examined patient care across the following population groups: older people; those with long term medical conditions; families, babies, children and young people; working age people and those recently retired; people in vulnerable circumstances who may have poor access to primary care; and people experiencing poor mental health. We found that care was tailored appropriately to the individual circumstances and needs of the patients in these groups.

Our key findings were as follows:

• The practice had a GP led telephone triage service. Patients were able to get an urgent appointment the same day, if they needed to be seen urgently.
• Patients were treated with dignity, care and respect. They were involved in decisions about their care and treatment. Information was provided to help patients understand the care available to them.
• The practice was friendly, caring and responsive. It addressed patients’ needs and worked in partnership with other health and social care services to deliver individualised care.
• The practice had responded to the needs of their patient population. They had a number of initiatives which directly impacted positively on the specific needs of their patient population. These included initiatives to improve health inequalities.
• The clinical leadership at the practice was forward thinking and supportive.

However, there were also areas of practice where the provider needs to make improvements. The provider should:

• Ensure that they have documented assurance from external agencies that identified checks and work had been undertaken. This included for example cleaning records, spot checks of cleaning and Disclosure and Barring Service checks for locum staff.

• Improve the follow up of vulnerable patients who did not attend for their appointment.

• Improve arrangements for providing patients with information about the complaints process, in particular including how to escalate complaints if they remained dissatisfied.

• Ensure that all policies are dated and reviewed.
• Improve the security within the practice, so that patients do not have unauthorised access to medicines, blank prescription forms or confidential patient information.

We saw two areas of outstanding practice, which included:

• The practice had obtained funding from the Evelyn Trust for a long term condition nurse to work specifically with patients between the aged of 16 and 65 for one year. This service had been running for approximately three months and positive patients outcomes had been identified. These included  a reduction in GP time and hospital admission and verbal feedback from patients had been extremely positive.  
• The practice was proactively working with the Citizens Advice Bureau (CAB) on a one year project to test the impact of CAB advice delivered as a front line health service. The aim is to measure the impact on patients, for example, patients reporting less stress, less need to attend the GP practice and less time that health professionals spend on patients with non-medical problems. The service is funded for three days a week and is already being well used.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 July 2015

The practice is rated as good for the population group of people with long term conditions. The practice had successfully applied for funding and had a long term condition nurse for one year to focus on the needs of patients between the age of 16 and 65 years. This service had been running for approximately three months and positive patients outcomes had been identified. These included a reduction in GP time and hospital admission and verbal feedback from patients had been extremely positive. All patients with long term conditions had structured reviews, at least annually, to check their health and medication needs were being met. For those patients with the most complex needs the GPs and nurses worked with relevant health care professionals to deliver a multidisciplinary package of care. A Diabetes support group was held monthly at the practice. Emergency processes were in place and referrals made for patients in this group that had a sudden deterioration in health. When needed, longer appointments and home visits were available.

Updated 16 July 2015

The practice is rated as good for the population group of families, children and young people. Appointments were available outside of school hours and the premises were suitable for children and babies. A midwife led clinic was available for patients on a weekly basis. A health visitor clinic for babies was held weekly and for toddlers, was held monthly. Emergency processes were in place and referrals made for children and pregnant women who had a sudden deterioration in health. We saw good examples of joint working with midwives, health visitors and school nurses.

Updated 16 July 2015

The practice is rated as good for the care of older people. Nationally reported data showed the practice had good outcomes for conditions commonly found amongst older patients. Patients over the age of 75 had a named GP who was responsible for the coordination of their care. The practice offered proactive, personalised care to meet the needs of the older patients in its population. The practice was responsive to the needs of older patients, including offering home visits. Patients who had unplanned admissions to hospital were reviewed and appropriate support provided. The most vulnerable patients had a care plan in place and were reviewed every three months.

Updated 16 July 2015

The practice is rated as good for the population group of the 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. Patients who worked were offered appointments between 5pm to 6pm, but if this was not convenient the GPs told us they would see patients before and after surgery. Patients could also request a specific time for the GPs to phone them back for a telephone or telephone triage consultation. A full range of health promotion and screening which reflects the needs for this age group was also available.

Updated 16 July 2015

The practice is rated as good for the population group of people experiencing poor mental health (including people with dementia). Nationally reported data showed the practice scored above the Clinical Commissioning Group (CCG) and England average for patients with mental health needs and those with dementia. The practice had participated in a Clinical Commissioning Group and a national initiative to identify patients with dementia. Registers were held of patients with mental health needs, including those with dementia. 89% of patients with dementia had received an annual health check in the previous year. The practice worked with multi-disciplinary teams in the case management of patients experiencing poor mental health including those with dementia. Patients were referred to other mental health services as appropriate, including in house counselling held at the practice and the improving access to psychological therapy (IAPT) service.

Updated 16 July 2015

The practice is rated as good for the population group of people whose circumstances may make them vulnerable. Nationally reported data showed the practice performed above the Clinical Commissioning Group (CCG) and England average for people with a learning disability. The practice held a register of patients with a learning disability and 50% had received an annual health check in the previous year. The practice sent a letter to vulnerable patients who did not attend for their appointment. The practice manager informed us that this was an area that they would further improve. Longer appointments were given to patients who needed more time to communicate during a consultation, for example patients who needed an interpreter. There were arrangements for supporting patients whose first language was not English. They had worked with the Citizen’s Advice Bureau who were funded for three days a week, to support patients with issues that were not medical in nature and address health inequalities. 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 and out of hours.