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Archived: Marisco Medical Practice

Overall: Good read more about inspection ratings

Stanley Avenue, Mablethorpe, Lincolnshire, LN12 1DP

Provided and run by:
Dr Simon Lowe

Latest inspection summary

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Background to this inspection

Updated 12 July 2019

Marisco Medical Practice provides primary medical services from two surgeries situated at Stanley Road, Mablethorpe and Sutton on Sea. On the day of inspection 14,037 patients were registered at the practice.

It is the only GP practice in Mablethorpe and surrounding villages and is not a dispensing practice.

Marisco Medical Practice is a single-handed GP practice and is registered to provide the regulated activities of;

Diagnostic and screening procedures

Family planning

Maternity and midwifery services

Surgical procedures

Treatment of disease, disorder or injury

It has a main surgery at Stanley Avenue, Mablethorpe LN12 1DP and a branch surgery at Broadway, Sutton on Sea. LN12 2JN. Patients are free to use either surgery. The branch surgery at Sutton on Sea was not visited during this inspection.

Public transport links in the area are extremely limited and road transport links are poor.

The nearest urgent care facilities are in Louth (16 miles), Skegness (17 miles) and Grimsby (30 miles). There is no provision for GP out-of-hours services or other urgent care in the Mablethorpe area. Patients in need of urgent care, out of hours or minor injuries services must travel to one of the locations listed.

The practice sits in the most deprived decile of practices in England. 39% of people are in full time employment compared to the national average of 63%.

The practice has a particularly high number of older patients. 40% are aged 65 or over compared to the national average of 17%. There are significantly fewer numbers of younger people. 22% are aged between 15 and 44 compared to the national average of 41%.

The practice has a higher number of patients with long standing health conditions, 76%, compared to the national average of 53%.

Disease prevalence is exceptionally high for all common long-term conditions compared to the national average. For example; heart failure 2.8% compared to the national average of 0.7%, diabetes 14.5% compared to the national average of 6.2% and chronic obstructive pulmonary disease 5.2% compared to the national average of 1.8%.

The practice list is Carr Hill weighted to 20,597 indicating the enhanced needs of the patient population.

Life expectancy is lower than the national average for both men and women, at 76 and 80 years compared to the national average of 79 and 83 years respectively.

The index of multiple deprivation is the official measure of deprivation in England, where one is the most deprived and ten the least deprived centile. The practice lies in the most deprived decile, one.

The practice experiences high numbers of temporary residents, especially between April and September who occupy the some estimated 27,000 caravan and mobile homes along the 17mile stretch of coastline between Skegness and Mablethorpe.

At the time of our inspection healthcare was provided by one male provider GP, two salaried

and five regular locum GPs. (whole time equivalent 5.5). There are five nurse practitioners (WTE 4), five practice nurses, nine health care assistants and a pharmacist. They are supported by a team of management, administration, reception and housekeeping staff.

The practice is located within the area covered by NHS Lincolnshire East Clinical Commissioning Group (CCG). The practice has General Medical Services (GMS) contract which is a contract with the CCG under delegated responsibilities from NHS England.

The Mablethorpe surgery is open from 8am to 6.30pm Monday to Friday.

The Sutton on Sea branch surgery is open from 8am to 6.30 pm daily, except on Wednesdays when it closes at 12.30pm.

Pre-bookable extended hours appointments are available at the extended hours hub which is hosted by Marisco Medical Practice and commenced on 8 April 2019. Appointments are available from 6.30pm to 8pm Monday to Friday and 8.30am to 1pm Saturday and Sunday.

The practice has opted out of providing out-of-hours services to their own patients. The out-of-hours service is provided by Lincolnshire Community Health Services NHS Trust and is accessed by NHS111.

Overall inspection

Good

Updated 12 July 2019

We had previously carried out an announced comprehensive inspection at Marisco Medical Practice on 28 March 2018. We rated the practice as requires improvement in safe, and responsive, good in effective and caring and inadequate in well-led. Overall the practice was rated as requires improvement. We rated all the population groups as requires improvement as the identified areas of concern affected all population groups.

This inspection, on 11 April 2019, was conducted to ensure that concerns that we had identified at our previous inspection on 28 March 2018 had been resolved.

At the inspection on 28 March 2018 the areas where the provider was required to make improvements were;

  • The complaints system was not effective and did not provide a mechanism for capturing all complaints or facilitate learning from complaints to be cascaded to staff.
  • There was no effective infection prevention and control process in place.
  • The practice had not acted upon the advice of independent health and safety advisors and had failed to address and rectify a potentially serious patient safety issue.
  • The systems in place to monitor and ensure staff received essential and training relative to their job role was ineffective.
  • The temperature of refrigerators was not effectively monitored to ensure the efficacy of medicines stored within.
  • Blank prescription stationary was not kept securely.
  • Patient group directions did not meet the standard to allow nurses to administer medicines in line with the legal requirements.
  • Feedback from patients showed that appointment systems were not working well.

In addition, we identified areas where the provider should make improvements;

  • Improve the availability of non-urgent appointments.
  • Undertake pro-active engagement with patients as a means of assessing patient satisfaction with the service with reference to access to clinicians.
  • Update health and safety posters to show the correct contact details.
  • Update the whistleblowing policy.
  • Cease the practice of recording complaints in patient’s clinical notes.

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At this inspection on 11 April 2019 we found that the provider had satisfactorily addressed these concerns and the practice is now rated as good in the safe, caring, responsive and well-led key questions. It is rated as requires improvement in the effective key question. It is rated as good overall. All population groups are rated as good.

However, the practice should;

  • Review and embed the process of recording patient consent to surgical procedures, and the system in place for dealing with tissue samples sent for histology.
  • Ensure that medicines are prescribed in line with the latest guidance.
  • Continue to monitor and assess patient satisfaction in respect of appointment availability and type.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care