Archived: St Augustines Medical Practice

Updated 2 September 2016

Letter from the Chief Inspector of General Practice

In January 2016 a comprehensive inspection of St Augustines Medical Practice was conducted. The practice was rated as requires improvement for safe and good for effective, caring, responsive and well led. Overall the practice was rated as good. During that inspection we found concerns related to the management of blank prescription security and the systems in place to monitor this risk. The practice also needed to ensure all action was taken to mitigate risks in relation to fire evacuation procedures. The report setting out the findings of the inspection was published in April 2016. Following the inspection we asked the practice to provide an action plan detailing how they would improve on the areas of concern.

We visited the practice and carried out an announced focused inspection of St Augustines Medical Practice on 10 August 2016 to ensure the changes the practice told us they would make had been implemented and to apply an updated rating.

We found the practice had made significant improvement since our last inspection on 27 January 2016. At this inspection we rated the practice as good for providing safe services. The overall rating for the practice remains good. For this reason we have only rated the location for the key question to which this related. This report should be read in conjunction with the full inspection report of 27 January 2016.

At this inspection we found:

• Risks to patients were assessed and well managed.

• Systems were in place to monitor and ensure the security of blank prescriptions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 April 2016

The practice is rated as goodfor the care of patients with long-term conditions.

• The practice had a very high prevalence of chronic diseases 63.4% compared to the national average of 54%, for example 70% more than the national average of patients with heart failure, 20% more than the national average of patients with a atrial fibrillation (a heart condition) which for the majority of patients requires regular blood monitoring and 60% more than the national average of patients who have experienced a stroke.

• Nursing staff had lead roles in chronic disease management and led clinics for patients with lung disease, asthma and diabetes.

• Patients at risk of hospital admission were identified as a priority and the practice had developed care plans for those at risk of admission for just over 2.2% of their population over the age of 18. One example we saw was a care plan with steps to manage a patient’s chronic lung condition which had helped the patient manage their condition through the winter avoiding a hospital admission.

• The practice offered an in house test for the diagnosis and monitoring of respiratory conditions (spirometry) at both practice locations which reduced the need for those patients to travel to a hospital. This was also taken to housebound patients to monitor their condition.

• The percentage of patients with diabetes on the register whose blood sugar level targets were within the target range (2014 to 2015) was 84% which was higher than the national average of 78%.

• The percentage of patients with diabetes on the register whose blood pressure was in the target range (2014 to 2015) was 81% which was higher than the national average of 78%.

• The percentage of patients with diabetes on the register who had their flu immunisation (2014 to 2015) was 98% which was higher than the national average of 94%.

• The percentage of patients with diabetes on the register whose cholesterol was in the target range was 87% which was higher than the national average of 81%.

• Longer appointments and home visits were available when needed.

• All these 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. This included weekly meetings with the community and specialist teams including community matrons, health visitors for the actively ageing. The practice met daily with the palliative care nurses and district nurses for those at the end of life.

Updated 26 April 2016

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

• 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 patients who had a high number of A&E attendances. Immunisation rates were high for all standard childhood immunisations.

• The percentage of patients with asthma who had their asthma reviewed in the last 12 months (2014 to 2015) was 76% in line with the national average of 75%.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

• The percentage of patients aged 25 to 64 who had their cervical screening within the last five years was 82% in line with the national average of 82%.

• 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.

• The practice offered an additional 24 week antenatal check for women to improve continuity of care.

Updated 26 April 2016

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

• 27% of the registered practice population were aged over 65 (national average 17%). They also had the highest number of patients in the local clinical commissioning group of patients prescribed anticoagulant medicines which required regular blood tests. The practice had kept 94% of these patients in the target range by testing at the surgery which was significantly higher than the expected standard of 80%.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population. 15% of all those aged over 75 had a personalised care plan.

• The practice looked after approximately 150 patients in local nursing homes, and conducted weekly ward rounds to monitor and review the patient’s needs. In one local nursing home all the patients looked after by the practice had a personalised care plan.

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

Updated 26 April 2016

The practice is rated as good for the care of working-age patients (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 offered a 7.45am blood test appointment for patients who were unable to attend during the traditional working day.

• The practice offered extended hours on a Monday evening until 8pm and alternate Saturday mornings to increase access outside of traditional working hours.

• The practice offered a daily triage service so those at work could access care by phone when urgently needed.

Updated 26 April 2016

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

• The practice looked after approximately 170 patients with dementia and worked closely with the older persons psychiatric services to care for this group of patients. All the patients with dementia in a nursing home had a personalised care plan to avoid unnecessary hospital admissions as they recognised these patients are distressed by an unfamiliar environment. One of the GPs had specialist knowledge and could undertake memory tests which meant some of these patients did not have to attend a hospital.

• The practice had developed an electronic template which provided information, on local support groups, support for carers, dementia advice websites, information on lasting power of attorney and prompts to ensure all the appropriate blood tests had been completed.

• 80% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84%.

• The percentage of patients with a serious mental health problem who have a comprehensive, agreed care plan (2014 to 2015) was 91% which was higher than the national average of 88%. Patients with a serious mental health problem are all invited to an annual health check.

• The percentage of patients with a serious mental health problem whose alcohol consumption has been recorded in the preceding 12 months (2014 to 2015) was 94% which was higher than the national average of 90%.

• 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 arranged for the local eating disorder service based at a local hospital to use a room at the practice to see a patient. The practice had a talking therapies service counsellor based at the practice. The practice had seen one patient on a weekly basis when they would not engage with the specialist mental health team to ensure continued care.

• The practice would see patients on an opportunistic basis with mental health needs and dementia as they recognised these patients may be unable to engage with the appointment system.

• 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 26 April 2016

The practice is rated as good for the care of patients whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including those socially isolated, who were dependant on others and those with a learning disability.

• The practice offered longer appointments and yearly health checks for patients with a learning disability, and last year completed 84%. All these patients had a care plan with a copy kept in their home.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations and held food bank vouchers.

• 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 had been proactive in undertaking training in increasing awareness and skills for identifying domestic violence in their patients.

• The practice had set up a system to refer patients who may be socially isolated to groups and local activities which had been shared across the local clinical commissioning group due to its success.