Archived: Lakeside Healthcare Stamford

Updated 12 October 2017

The Sheepmarket Surgery provides primary medical services to approximately 14,200 patients.

The Sheepmarket Surgery is purpose built with consultation rooms on the ground floor. Administration and meeting rooms were on the upper floor. The practice offered a full range of primary medical services and was able to provide dispensary services to those patients on the practice list who lived more than one mile (1.6km) from their nearest pharmacy.

At the time of our inspection the practice employed eight GP partners, two salaried GP and one locum GP. Five GPs were full time (four male and one female) and six part-time (four female and two male). The surgery also employed a practice manager, four practice nurses, two health care assistants and assistant practice manager, finance manager, seven receptionists, five dispensers and five administration staff.

The practice has a General Medical Services Contract (GMS). The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities.

The practice is located within the area covered by South Lincolnshire Clinical Commissioning Group (CCG). The CCG is responsible for commissioning services from the practice. A CCG is an organisation that brings together local GP’s and experienced health professionals to take on commissioning responsibilities for local health services.

We inspected the following location where regulated activities are provided:-

The Sheepmarket Surgery, Ryhall Road, Stamford, Lincs. PE9 1YA

The practice was open from 8am until 6.30pm Monday to Friday. The practice had extended hours on Tuesday and Thursday 6.30pm to 8pm and Saturday’s 8am until 11am.

Patients can book appointments in advance and the practice also offer book on the day appointments. Patients who do not have an appointment but feel they need to be seen will be triaged by the on-call team (one GP and one minor illness nurse) and given advice by telephone, brought to the surgery to be seen on the day or given an appointments where appropriate

The practice had a website which we found had an easy layout for patients to use. It enabled patients to find out a wealth of information about the healthcare services provided by the practice. Information on the website could be translated in many different languages. This enabled patients whose first language was not English to read the information provided by the practice.

The Sheepmarket Surgery had opted out of providing out-of-hours services (OOH) to their own patients. The OOH service is provided by Lincolnshire Community Health Services NHS Trust.

The Sheepmarket Surgery is one of three surgeries in Stamford who merged with Lakeside Healthcare on 1 July 2016. The three practices are now known as Lakeside Stamford. At the time of the inspection the Care Quality Commission continued to have further discussions with Lakeside Healthcare in regard to their  registration with the Care Quality Commission following the merger in 2016.

Updated 12 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Sheepmarket Surgery on 2 February 2015 followed by a further comprehensive inspection on 6 April 2017.

The overall rating for the practice was Good but we rated the Safe domain as requires improvement. The full comprehensive report from 2 February 2015 and focussed follow-up inspection from 6 April 2017 can be found by selecting the ‘all reports’ link for The Sheepmarket Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection on 19 September 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspections of 2 February 2015 and 6 April 2017. This report covers our findings in relation to those requirements.

The rating for the Safe Domain is good and the overall rating for the practice remains as Good.

Our key findings were as follows:

• We found that the practice had made considerable improvements since the last inspection.

• An effective system was in place for safeguarding service users from abuse.

• We found the practice had made significant improvements to its system for significant events, near misses and incidents. Some further improvement was required to ensure that all events were captured and investigations were detailed and actions identified and implemented.
• The practice now had systems in place to minimise risks to patient safety which included fire safety and monitoring of Disclosure and Barring Checks for all staff including the medicine delivery drivers.

• A review of some of the processes in the dispensary had taken place to minimise the risk to patients. For example, regular checks to ensure that dispensary stock is within expiry date and maintain appropriate records and implemented a system to ensure dispensary fridge temperatures were recorded daily in line with national guidance.

• Quality Improvement had taken place but in relation to clinical audit, further information was required to evidence the actions, outcomes and shared learning achieved as a result of the audits.

• We saw a more formalised process had been put in place for meetings that took place in the practice. Most minutes of meetings we reviewed were structured and followed a fixed agenda.

• The practice now had a governance framework in place which supported the delivery of their strategy and good quality care.

The provider should:

• Continue to review the system in place for significant events to ensure all events are captured , investigations are detailed, actions are identified and implemented

• To strengthen the system for clinical audits to demonstrate the evidence, actions, outcomes and shared learning achieved.

• Review the process in place for prescriptions that remain uncollected in the dispensary to ensure patient safety.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 June 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• The practice had utilised a number of administration tools which had helped the practice to identify patients, previously unidentified, with a long term condition. This process had increased the number of patients on the long term register, for example, COPD, Diabetes, Heart failure.

• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 150/90 mmHg or less was 93.9% which was 0.4% above the CCG average and 2.6% above the national average. Exception reporting was 2.7% which was 1.8% below the CCG average and 2.8% below national average.

• The percentage of patients with asthma, on the register, who had an asthma review in the preceding 12 months that included an assessment of asthma was 80.9% which was 2.9% above the CCG average and 5.3% above the national average. Exception reporting was 0.9% which was 2.2% below the CCG average and 7% below national average.

• The percentage of patients with COPD who had a review undertaken by a healthcare professional in the preceding 12 months was 93.8% which was 0.2% above CCG average and 4.2% above the national average.

• The percentage of patients with hypertension in whom the last blood pressure reading (measured in the preceding 12 months) was 150/90 mmHg or less was 86.5% which was same as CCG average and 5% above the national average. Exception reporting was 2.2% which was 0.9% above the CCG average and 1.7% below national average.

• The practice provided a blood pressure machine in one of the waiting areas so that patients could take their own blood pressure and present the readings at reception to be entered on their record.

• Longer appointments and home visits were available when needed. Home visits are carried out for patients who are unable to attend the practice for routine blood tests.

• Patients had a named GP and the practice had a system in place for recalling patients for a structured annual review to check their health and medicines needs were being met.

• The practice had a number of GPs with special interests (GPwSI’s), for example, dermatology, neurology, gynaecology, minor surgery and diabetes. This meant that the practice could refer to GPs within the practice and reduce the number of patients referred to secondary care.

Updated 5 June 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.

• The practice’s uptake for the cervical screening programme was 85% which was above the CCG average of 81% and the same as the national average of 86%.

• Childhood immunisations were carried out in line with the national childhood vaccination programme. Uptake rates for the vaccines given were comparable to CCG/national averages. For example, rates for the vaccines given to under two year olds ranged from 89% to 100% and five year olds from 91.5% to 98%.

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

• We saw positive examples of joint working with school nurses.

Updated 5 June 2017

The practice is rated as good for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

• 9.59% of the practice population are older people.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• 2.2% of patients who had been assessed as being at risk had a care plan in place which was above the required national target of 2%.

• Each of the five care homes in the area had a lead GP who visited regularly to maintain continuity.

• The practice provides a medicine delivery service to patient’s homes twice a week.

Updated 5 June 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours and Saturday appointments.

• 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.

• Health promotion advice and material were available throughout the practice.

Updated 5 June 2017

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

• The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was 94% which was 6.6% above the CCG average and 10.4% above the national average. Exception reporting was 2.4% which was 1.4% below the CCG average and 4.4% below the national average.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 95.1% which was 0.7% above CCG average and 6.3% above the national average.

• The percentage of patients 18 or over with a new diagnosis of depression who had been reviewed not earlier than 10 days but not later than 56 days after the date of diagnosis was 87.9%. This was 3.6% above the CCG average and 4.9% above the national average.

• 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. For example, referrals to Addaction for patients who experience alcohol and substance misuse problems. Staff had a good understanding of how to support patients with mental health needs and dementia. All staff had received mental capacity and dementia awareness training.
• The practice PPG in conjunction with two other Stamford PPGs held a dementia educational event in 2016. The event was well received by newly diagnosed patients and carers.

Updated 5 June 2017

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.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable

• 100% of patients on the palliative care register had had their care reviewed in the last 12 months.

• Only 45% of patients registered with the practice with a learning disability had had their care reviewed in the last 12 months. The practice told us as the inspection that nine patients had recently been added to the register and not had the opportunity to be invited for a review of their care.

• 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.