Lensfield Medical Practice

Updated 6 September 2016

Lensfield Medical Practice is situated in Cambridge, Cambridgeshire. The practice provides services for approximately 11000 patients. It holds a General Medical Services contract. The practice has two male and four female GP partners who are all part time, two specialist GPs and one retainer GP. The team also includes three female practice nurses and one female health care assistant. They also employ a practice manager, an assistant practice manager, an office manager and a team of reception/administration/secretarial staff. The practice is a teaching and training practice and had one registrar at the time of the inspection.

The practice is open between 8am and 6pm Monday, Tuesday and Friday, 7am to 6pm Wednesday and 8am to 8pm Thursday. During out-of-hours GP services are provided by Urgent Care Cambridge via the 111 service.

We reviewed the most recent data available to us from Public Health England which showed that the practice had a lower than average practice population aged between 0-14 and between 40-84 but a higher than average practice population between 15-39 compared with the national England average. The deprivation score was lower than the average across England.

Updated 6 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lensfield Medical Practice on 2 August 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. Improvements were made to the quality of care as a result of complaints and concerns.
• 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.
• 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 annual appraisals are completed in a timely way.
• Ensure infection control audits are completed when due.
• Ensure that on-going mandatory training is completed when due.
• Ensure that children who fail to attend a hospital appointment are appropriately coded on the practice’s computer system.
• Ensure repeat reviews of patient safety alerts searches are regularly conducted to ensure that medicines that are subject to safety alerts continue to be adequately monitored.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 September 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). Data from 2014/2015 showed that performance for diabetes related indicators was 90%, which was the same as the CCG average and the national average. The practice exception reporting for the clinical domain was 17% which was above the CCG average of 13% and the England average of 11%. The practice had an international expert in primary care management of diabetes leading their diabetic clinic.
• Longer appointments and home visits were available when needed.
• 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. The practice ran an annual review clinic which ensured patients were recalled in for review on their birthday month and served as a memorable prompt.

Updated 6 September 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 however the practice did not read code children who fail to attend a hospital appointment on their clinical system. 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.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 6 September 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 had 49 patients on their palliative care register and the practice worked closely with the multi-disciplinary team, out-of-hours and the nursing team to ensure proactive palliative care planning.
• 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 looked after patients living in local nursing homes. GPs undertook regular visits and visited patients as and when required.
• The practice had in house phlebotomy appointments and a community phlebotomy team to attend patients in the community if necessary.

Updated 6 September 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.
• The practice’s uptake for the cervical screening programme was 81% which compared to the CCG and England averages of 82%. The practice exception reporting for the clinical domain was 17% which was above the CCG average of 8% and the England average of 6%.
• The practice website included information on signs of stress, counselling services available to help students with stress and a depression questionnaire. The practice also had in house counsellors on site.
• The practice worked with the local colleges in order to a give a co-ordinated approach to care for their registered students.

Updated 6 September 2016

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

• 99% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is better than the CCG average by 14% and the England average by 15%. The exception reporting was 1% which was below the CCG average by 9% and the England average by 7%.
• The practice achieved 97% for mental health related indicators in QOF, which was above with CCG averages and England averages by 4%. The rate of exception reporting for these indicators was generally lower than both the CCG and England averages.
• 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.
• The practice website had information on various services and charities available to patients with poor mental health and worked closely with the Psychological Wellbeing Service (Improving Access to Psychological Therapies (IAPT) is an NHS initiative designed to make psychological or talking therapies more accessible to people experiencing common mental health problems).

Updated 6 September 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 offered longer appointments 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.
• 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.
• The practice worked closely with YMCA keyworkers and held meetings to offer proactive and educational assistance with contraceptive needs for vulnerable patients.