Horncastle Medical Group

Updated 19 July 2016

Horncastle Medical Group provides primary medical care for 9,000 patients living in the small market town of Horncastle and the surrounding villages.

The town is located equidistantly between Lincoln, Louth, Skegness and Boston where there are hospitals providing a range of acute, out-patient and associated healthcare services including out-of-hours GP services.

The practice is located within a spacious and well maintained former vicarage, set in its own extensive grounds. A community pharmacy is located within the grounds. All consultation, clinical and treatment rooms are on the ground floor as is the spacious reception and waiting area and dispensary. The building is well adapted and equipped to meet the needs of people using wheelchairs.

The service is provided under a General Medical Services contract with Lincolnshire East Clinical Commissioning Group.

It is a dispensing practice, providing the service to 2,497 of its patients.

Care and treatment is provided by four partner GPs (WTE 2.75), three nurse practitioners, four practice nurses, an over 75’s case manager and a phlebotomist. They are supported by a team of dispensers, receptionists, administration and housekeeping staff.

The practice has a larger number of older patients and 62% of patients have a long standing health condition compared to the national average of 54%.

The reception is open between 8am and 6.30pm Monday to Friday.

When the surgery is closed GP out-of- hours services are provided by provided by Lincolnshire Community Health Services NHS Trust which can be contacted via NHS111

Updated 19 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Horncastle Medical Group on 5 May and 13 May 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.
• 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.
• The practice responded to patient needs, for example through its arrangements to meet the healthcare needs of older people.
• 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 July 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.

• Diabetes indicators were comparable to CCG and national averages with low exception reporting.

• 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.

Updated 19 July 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. Immunisation rates were relatively high for all standard childhood immunisations.

• The practice was a ’yellow fever centre’ and offered vaccines for patients travelling to high risk areas.

• 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.

• The practice was signed up to the contraception and chlamydia enhanced services

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

• We saw positive examples of joint working with other agencies although we were aware that the practice had found it difficult to maintain good and close working relationships with health visitors and school nurses as a result of re-organisation and the shortage of staff in community nursing services.

Updated 19 July 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 had identified 163 patients who were on the register of avoiding unplanned admissions and whose status was identifiable to staff on their patient record.

• The practice was part of theclinical commissioning group (CCG) funded initiative to help improve the care, treatment and outcomes for patients aged 75 and over. The service had been running for two years across the CCG and had now been extended and re-named the ‘Older Peoples Service’ to include vulnerable patients who had not reached their 75th birthday but who had been identified as potentially benefitting from the service. Whilst it had proved very difficult to quantify or demonstrate the effects of the service, anecdotal evidence and the response from patients, families and carers indicated that the service was highly regarded and valued and made a positive impact on people’s lives.

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

Updated 19 July 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 and appointment times 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.

• NHS health checks were offered to patients between the ages of 40 and 74.

Updated 19 July 2016

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

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  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.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 19 July 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 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.