Archived: Mount Gould GP Practice

Updated 25 July 2017

Mount Gould Medical Centre is a GP practice for approximately 10,058 patients.

The practice has an Alternative Provider Medical Services (APMS) contract under a NHS framework agreement. This means NHS England have asked the organisation to manage services for a period of time. This contract had commenced on 1 April 2016. The practice is operated by Access Health Care; a social enterprise organisation owned by Exeter based Devon Doctors. The clinical governance, complaints and human resources management are conducted at this headquarters. This meant there were no GP partners at the practices.

The practice comprises of three separate medical centres located within three separate areas of the city of Plymouth, Devon. The patient population group of 10,058 was divided as 2795 patients at Mount Gould, 4231 patients at Ernesettle branch and 3032 at the Trelawny branch. Although patients could be seen at any of the three sites patients often choose to see GPs and nurses at the practice closest to their home. Staff also occasionally work across all three practices but tended to work at the same practices to improve continuity of care for patients.

The aim at all three sites is to provide 50-54 GP/nurse practitioner sessions per week. Across the three practices there are four salaried GPs (all male) providing 23 sessions. The salaried GPs are supported by one male agency GP providing 10 sessions and five long term locum GPs (three female and two male) providing 18 sessions. The GP received support from two advanced nurse practitioners (one male and one female) providing eight sessions. In total the clinical team provided 59 sessions per week.

There were five practice nurses and three health care assistants across all three sites who together provided 6.23 whole time equivalent.

Each site has an office manager responsible for the 17 business intelligence, administration and reception staff. This team were managed by an overall operations manager and practice manager.

The practice is open Monday to Friday between 8.30am until 1pm and between 2pm until 6pm. There is a contracted agreement that the out of hours provider (NHS 111) responded to calls between 1pm and 2pm and between 6pm and 8.30am.

There was no published collated information regarding the demographics of the practice and two branches. However, neighbourhood demographic information provided by the organisation showed that the majority of patients registered were white British.

The practice is registered to provide regulated activities which include:

Treatment of disease, disorder or injury, surgical procedures, maternity and midwifery services and Diagnostic and screening procedures and operate from the main site of:

Mount Gould Medical Centre based at 200 Mount Gould Road, Plymouth, PL4 7PY

And from the two other sites at:

Ernesettle branch surgery, Ernesettle green, Plymouth, PL5 2ST

Trelawny branch surgery, 45 Ham Drive, Plymouth, PL2 2NJ

Updated 25 July 2017

Letter from the Chief Inspector of General Practice

Mount Gould Medical Centre is operated by Access Health Care, a social enterprise organisation owned by Exeter based Devon Doctors. The practice comprises of three separate medical centres located within three separate areas of the city of Plymouth, Devon. The patient population group of 10,058 was divided as 2795 patients at Mount Gould, 4231 patients at Ernesettle branch and 3032 at the Trelawny branch. (Collectively referred to as sites)

The clinical governance, complaints and human resources management are conducted at the Devon Doctors headquarters in Exeter. There were no GP partners at the practices.

We carried out an announced comprehensive inspection at Mount Gould Medical Centre on 27, 28 and 29 June 2017. 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 a system in place for reporting and recording significant events.

• The practice had clearly defined and embedded systems to minimise risks to patient safety. For example, the practice management teams were open about the shortfalls identified since Access Healthcare had taken over the leadership. Action plans were in place for these issues and timescales had often been met. We saw evidence that action plans demonstrated assessment of risk and priority.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Not all patients we spoke with said they found it easy to get through on the telephone or make an appointment with a GP and added that there was not always continuity of care, but said urgent appointments were available the same day. This had been identified by the management who were in the process of introducing a new telephone system, employing additional staff (clinical pharmacist), and improving ways of how patients could access and cancel routine appointments.
• All three practices had good facilities and were well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. Staff said Access Healthcare were a ‘structured’ and ‘supportive’ employer and added that the practices were good places to work. Staff said they had received detailed inductions, supervision, and support and had access to sufficient training and education.
• The practice proactively sought feedback from staff and patients, which it acted on. For example, changes in appointment processes, introduction of additional car park spaces and drinking water dispensers in waiting areas.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvement are:

• Ensure systems are in place to demonstrate that patients, in addition to an apology, are informed on any delay in response to complaints.

• Ensure systems are in place to ensure the overview and monitoring of clinical roles are consistent and completed across all three sites, and managed by staff with appropriate skills

• Ensure systems continue to ensure the coding (Recording and identification of specific screening tests, conditions and illnesses) are consistently recorded over all three sites to ensure the patient record is accurate and clearly show past and present medical conditions.

• Ensure patient access to GP appointments is monitored following the introduction of new telephone system.

• Continue with the monitoring and audit of the quality of the patient summary record

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 July 2017

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

• Nursing staff managed Chronic Disease Management/Monitoring with support from the GPs and healthcare assistants. This involved interim checks and annual checks. Patients at risk of hospital admission were discussed at clinical meetings.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs. Discharge summaries were reviewed by the duty GP who completed medicine reconciliation. Any concerns or changes were raised at the clinical meetings.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health. Urgent appointments or home visits could be requested as required. Those under care of long term condition team are discussed at multi-disciplinary team meetings.
• All these patients had a named GP and there was a system to recall patients for 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. All patients had a named GP and were informed by text/letter as well as patients notices in waiting areas. New patients were informed of named GP upon registration.
• Recall processes were in place. Patients were invited in on interim and annual basis by the Business Intelligence Team.

Updated 25 July 2017

The practice is rated as good for the care of families, children and young people.

• There were systems 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 accident and emergency (A&E) attendances. All A&E visits were coded on the computer system and regular searches took place to identify any children frequently missing appointments or screening. All emergency department attendances by children were highlighted and discussed at clinical meetings.
• Immunisation rates were average for all standard childhood immunisations. The lead nurse had identified a group of patients who had missed immunisations. A full search of children under the age of 18 years was performed. The cause of the error had been addressed and babies and children recalled for immunisation updates.
• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
• The practice provided support for premature babies and their families following discharge from hospital. Any discharge summary involving premature birth of new patients was reviewed and actioned by GP.

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

Premises were fit for purpose and included a private room for breast feeding and baby change facilities.

• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics. The health visitor worked on site at Mount Gould. Midwives held clinics at all three sites. Midwives, health visitors and school nurses were invited to clinical meetings and received minutes of all clinical meetings held.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications. Urgent appointments were offered and emergency protocols including how to escalate a potentially septic child.

Updated 25 July 2017

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

• Staff were able to recognise and report the signs of abuse in older patients and knew how to escalate any concerns. Staff had received the appropriate level of safeguarding training and any safeguarding incidents were shared in review meetings.

• 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, and offered home visits and urgent appointments for those with enhanced needs. Elderly frail patients were prioritised for home visits. Patients with mobility issues or hearing impairment were offered support by our reception staff upon arrival.

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life.End of life care plans and treatment escalation plans were completed for all palliative care patients. Practice staff, with patient consent, shared details with out of hours (OOH) GP service via special patient messages on Adastra (computer patient record system).Palliative care patients were discussed at clinical meetings which take place weekly or monthly depending on sites.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs. Discharge summaries were reviewed by the duty GP who completed medicine reconciliation (updating an accurate list of medicines being taken).Any concerns or changes were raised at the clinical meeting.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 25 July 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, appointments early and late in the day were offered for working patients. Online booking and prescription ordering was available. Patients were able to book into any of the three practices as one site may be nearer to work than home.
• 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. Online registration was encouraged as part of new patient questionnaire. Patient summary care records, prescription ordering and appointment booking were available online.

Updated 25 July 2017

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

• The practice carried out advance care planning for patients living with dementia including patients over the age of 60 years old living in a local care home.
• All patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs. GPs followed a protocol for reviewing repeat prescriptions. This was monitored by the practice manager at each site. Any concerns are raised at the clinical meeting.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia. For example, ward rounds at the local dementia care home were offered by the nurse practitioner and GP. Mental health nurses were invited to attend clinical meetings.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 25 July 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 (LD). A LD register was held on each site. Homeless patients and traveller patients were coded on the computer system and could be searched to ensure they were receiving the care appropriate to their needs. These patients were discussed at clinical meetings and the lead nurse developed rapport with parents to encourage the uptake of immunisations. The local LD lead met regularly with the nursing team to discuss patient’s needs.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable. The practice offered longer appointments for patients with a learning disability. Staff made efforts to prioritise appointments for patients with a learning disability at the start of clinics so they did not become anxious in waiting area.
• The practice regularly worked with other health care professionals and invited them to the clinical meetings to discuss the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations. There were carer’s notice boards with appropriate information signposted and leaflets available.
• 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.