Village Health Group, East Leake

Updated 18 May 2018

East Leake Medical Group is registered with the CQC as a GP partnership with six GP partners. The practice is based at East Leake Health Centre, Gotham Road, East Leake, Loughborough, Leicestershire LE12 6JG. There are also two branch sites in the nearby villages of Sutton Bonnington and Ruddington. We visited East Leake Health Centre and the Sutton Bonnington and Ruddington branch sites during our inspection.

The practice has a population of 13,608 patients and is in one of the least deprived areas of England. 3.5% of patients are from black and minority ethnic groups.

The Sutton Bonnington branch is able to offer dispensing service to patients who live more than one mile (1.6km) from their nearest pharmacy.

The practice is open from 8am until 6.30pm Monday to Friday with appointments available at varying times across the three sites. Extended hours appointments are available at the practice from 7am three mornings per week.

Patients can also access extended hours appointments between 6.30pm and 8pm in the evening on weekdays and between 8.30am and 12.30pm at weekends via the Rushcliffe area extended hours service.

When the practice is closed patients are advised to contact the NHS 111 service if they require urgent medical advice.

The practice has a range of clinical staff available to support patients. Alongside the six GP partners the practice employs two salaried GPs. (In total six male and two female GPs.) The practice is a teaching practice and accommodates placements for GP registrars. At the time of this inspection there were three GP registrars working at the practice. (A registrar is a qualified doctor who is training to become a GP). The practice is also a training practice providing training sessions to medical students on a rotational basis. The practice employs a nurse practitioner, two practice nurses and three health care assistants.

Further information about the practice can be found on their website; www.elmgroupsurgeries.com

This inspection is a comprehensive ratings inspection as part of our sample of locations previously rated Good or Outstanding. There are no specific concerns or known risks.

The practice was previously inspected in February 2015 and rated Outstanding. That report can be found on the CQC website at;

http://www.cqc.org.uk/location/1-582137422

Updated 18 May 2018

This practice is rated as Outstanding overall. (Previous inspection February 2015 – Outstanding)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Outstanding

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? - Outstanding

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Outstanding

People with long-term conditions – Outstanding

Families, children and young people – Outstanding

Working age people (including those recently retired and students – Outstanding

People whose circumstances may make them vulnerable – Outstanding

People experiencing poor mental health (including people with dementia) - Outstanding

We carried out an announced comprehensive inspection at East Leake Medical Group on 16 and 21 March 2018 as part of our inspection programme.

At this inspection we found:

• There were safety policies including adult and child safeguarding policies in place and staff were familiar with these. Staff received safety information as part of their induction and refresher training and knew how to raise concerns.

• The practice identified vulnerable patients and worked with other agencies to support and protect them from neglect and abuse.

• Care records gave the information needed to deliver safe care and treatment and were accessible to relevant staff in an accessible way, including for extended hours appointments.

• Arrangements for the storage of medicines and the operation of the dispensary kept patients safe.

• Patients participated in national screening programmes and health initiatives with encouragement and support from the practice.

• The most recent published QOF results were 100% of the total number of points available compared with the clinical commissioning group (CCG) average of 99% and national average of 96%. The overall exception reporting rate was 6% compared with a CCG and national average of 10%.

• Patients could access services in ways that were convenient to them, including using online services and accessing routine appointments with GPs and nurses outside of usual surgery hours.

• The practice collaborated with stakeholders and played a key role in developing services across the whole CCG area.

• Staff were respected and valued. They felt proud to work for the practice.

• The patient participation group (PPG) played an active role in representing patient views and developing services.

• The practice was open to innovation and developed new ways to improve services for patients.

We saw areas of outstanding practice:

• The practice had initiated, piloted and participated in the development of an innovative and comprehensive electronic system to guide clinicians along appropriate care pathways and aid their decision making. This was known as ‘F12 Pathfinder’ and meant clinicians pressed one key to access all the templates and protocols they needed when considering the health needs of patients. The F12 Pathfinder system was built into the electronic record system and templates were automatically pre-populated with individual information from patient records. There were templates for a broad range of health issues including for example, heart failure and cancer, which meant clinicians were confident they were following relevant up to date guidance and pathways and had support for their decision making. In each case, the template guided clinicians through the relevant pathway, ensuring accurate information was gathered, basic investigations completed, tests carried out and referrals made. The templates were personalised to the Rushcliffe area and reflected the services that were available to the practice, for example giving details of local clinics and their referral criteria.

• The practice collaborated with stakeholders and played a key role in developing services in the practice and across the whole CCG area, including the ‘Let’s Live Well in Rushcliffe’ scheme and the extended hours service. They had developed a programme to identify patients with undiagnosed atrial fibrillation (AF) and this had been successful in increasing the numbers of patients identified and treated for this long term condition. Their development of a multi-agency CCG wide model of enhanced care home support for older people had improved care for these patients and resulted in a reduced number of emergency admissions to hospital. The practice were active in the GP Federation and GPs from East Leake Medical Group took lead roles in the development of services across the local health community.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 June 2016

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

• The management of patients with long term conditions was based on evidence based guidance and relevant assessment tools to ensure good care for patients.

• The GPs and nursing staff had lead roles in chronic disease management and the review of patients’ health and medicine needs was facilitated by a robust recall system.

• Patients at risk of hospital admission were identified as a priority.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.

• Nationally reported data showed patient outcomes for long term conditions were comparable to the local and national averages.

• The practice was signed up to the Rushcliffe GP enhanced specification for long term conditions monitoring and management. This covered clinical areas such as shared care for monitoring prescribed medicines, diabetes, prostate cancer testing and anticoagulation therapy.

• A total of 149 patients had been provided with an anticoagulation service including warfarin monitoring since 2015. This included home visits for patients that were unable to attend the practice.

• The practice provided a home delivery service and dossette boxes for patients registered with the dispensary service.

• The appointment system was flexible and allowed patients to choose an appointment that suited them.

• The practice website had a comprehensive range of self-help and health promotion information.

Updated 15 June 2016

The practice is rated as outstanding 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 those at risk of ill-health or abuse. For example, the practice held regular meetings with the health visitor and school nurse to discuss vulnerable children and families.

• A flexible appointment system was in place and this ensured children and young people could be seen on the same day when this was needed. Appointments were also available outside of school hours.

• The premises were suitable for mothers, children and babies. This included baby changing and breast feeding facilities, and a range of toys and books for children.

• One of the GPs had specialist paediatric experience and offered advice and support to colleagues.

• The practice provided a full range of contraceptive services and routine health checks for expectant and new mothers. This included: preconception advice and care during pregnancy, post-natal checks and eight week baby checks.

• Immunisation rates were in line with local averages for all standard childhood immunisations.

Updated 15 June 2016

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

• The practice was committed to working collaboratively with other stakeholders in the development and implementation of efficient ways to deliver more joined up care. For example:

• The practice was engaged in the Rushcliffe health care of older people “in- reach” pilot, to facilitate appropriate and timely hospital discharges. The senior GP partner worked alongside four local GPs, a community matron, hospital consultants and staff working in the older people’s wards at Nottingham University Hospital. Benefits to older people included a coordinated and holistic approach to the management of their care and reduced lengths of inpatient stay.

• The practice provided a GP service to residents living in two care homes as part of an enhanced support service which aimed to improve the quality of care for older people by reducing unplanned admissions, emergency department attendances and risk of falls for example. Data reviewed reflected these aims were being achieved.

• We received positive and complimentary feedback from a care home provider in respect of continuity of care, responsiveness to urgent requests for home visits and the caring nature of staff.

• The GPs, clinical commissioning group pharmacist and care home staff met regularly to undertaken medicine reviews for patients and discuss any changes required.

• Nationally reported data showed patient outcomes for conditions commonly found in older people were comparable to local and national averages. We however noted high exception reporting rates for conditions such as osteoporosis and rheumatoid arthritis at 25% and 45.6% respectively. The practice accessed the consultant led Rushcliffe virtual osteoporosis service to obtain management advice for patients following scans

• Patients aged 75 and over had a named GP and a range of enhanced services were offered. For example shingles and immunisations.

• The practice offered proactive and personalised care to meet the needs of older people. This included identification and care planning for frail and vulnerable patients, and those at risk of hospital admission. Monthly multi-disciplinary meetings were held to plan and deliver care appropriate to their needs.

• The practice was responsive to the needs of older people, and offered urgent appointments for those who needed them and home visits from GPs, nurses (long term condition reviews) and healthcare assistants (phlebotomy and blood pressure monitoring). The practice’s home visit checklist included identifying carers, checking medication compliance and stockpiling, and obtaining consent for information sharing.

Updated 15 June 2016

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

• An outstanding feature of the practice included the development and delivery of community clinics for gynaecology and dermatology in response to the specific needs of its community. This enabled patients within the wider Rushcliffe area to receive care closer to home.

• The practice and patient participation group were consistent in supporting people to live healthier lives through a targeted and proactive approach to health promotion and prevention of ill-health. This included hosting an annual event where over 2000 patients received a flu jab and educational talks on specific health needs.

• 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 and flexible. For example, 90 patients were registered with the practice under the out of area registration scheme in line with their preferences and to ensure continuity of care.

• The virtual patient participation group comprised of 120 patients and this enabled them to inform service delivery through their preferred correspondence (email).

• The practice offered good access to clinical appointments and this included face to face and telephone consultations. Patients gave positive feedback about their experience in obtaining an appointment at a time that was convenient to them.

• An early morning extended hours surgery was provided each week by the GPs, nurses and health care assistants.

• The practice was proactive in offering online services and this included appointment booking and signing up to prescribing services.

• A text messaging service was used to remind patients of their appointments and patients could also cancel their appointments. This was used to help reduce non-attendance for appointments.

Updated 15 June 2016

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

• The practice was signed up to the enhanced service specification for facilitating timely diagnosis and support for people with dementia. It had the third highest number of patients diagnosed with dementia within the CCG and the diagnosis rate was 77.4% as at September 2015. Staff also made appropriate referrals to the older age mental health team after a cognitive test was undertaken.

• Comparative data showed:

  - 81% of people diagnosed with dementia had their care reviewed in a face to face meeting in 2014/15 compared to a CCG average of 88.5% and national average of 84%.

  - 96.6% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan in place compared to a CCG average of 93.3% and national average of 88.3%

• Practice supplied data for 2015/16 showed improvement although this was yet to be verified. For example a total of:

  - 23 out of 25 (92%) patients listed on the mental health register had received a face to face review and had a care plan in place.

  - 116 out of 135 (85.93%) patients on the dementia register had received a face to face review.

• The practice worked with multi-disciplinary teams in the management of people experiencing poor mental health, including those with dementia. This included the mental health crisis team to ensure patients experiencing acute difficulties received urgent assistance to manage their condition, the dementia outreach team, care home staff and the county alcohol service.

• The practice told patients experiencing poor mental health and patients with dementia about how to access services including talking therapies, counselling services and various support groups and voluntary organisations.

Updated 15 June 2016

The practice is rated as outstanding for the care of people who circumstances may make them vulnerable.

• The practice offered a range of services to support people whose circumstances may make them vulnerable. This included:

• Hosting a monthly bereavement self-help group for people experiencing grief and loss. This group was facilitated by the patient participation group and was open to the whole community. Meetings were held every last Tuesday of the month between 10.30am and 12pm in the Keyworth primary care centre.

• A total of 2% of the practice population were carers and they were signposted to relevant services.A representative from the Carers Federation attended the practice on the first Monday of every month to provide information and support to patients and unpaid carers.

• The practice identified patients requiring end of life care and used the electronic palliative care co-ordination system (EPaCCS) to record and share people’s care preferences.

• We received positive patient feedback in respect of advance care planning, prescribing of anticipatory medications; and some of the GPs were described as offering a caring and personalised service. Feedback from one care home provider showed the GPs provided good quality end of life care and were proactive in ensuring the needs of patients were regularly reviewed and met.

• Staff worked with multi-disciplinary teams in the case management of vulnerable people and they knew how to recognise signs of abuse in vulnerable adults and children.

• The practice had carried out cervical cytology screening for women with learning disabilities, were consent had been obtained.

• A total of 24 out of 27 patients with a learning disability had received an annual health check and review. Three patients were under the age of 16 years and their reviews are carried out by a paediatrician.

• Reasonable adjustments had been made to ensure ease of access for these patients. This included access to interpreting services, longer appointments and home visits where needed.