Archived: Northcote House Surgery

Updated 9 February 2017

Northcote House Surgery is situated in St Ives, Cambridgeshire. The practice provides services for approximately 3800 patients. The practice dispenses medications to patients and holds a General Medical Services contract with NHS Cambridgeshire and Peterborough CCG.

According to Public Health England, the patient population has a higher than average number of patients aged 45 to 69 compared to the practice average across England. It has a lower proportion of patients aged 35 and below compared to the practice average across England. Income deprivation affecting children and older people is lower than the practice and the England average. The overall level of deprivation is in the least deprived decile nationally.

The practice team consists of a male GP lead who is supported by (regular) locum GPs, some of whom were female. The nursing team consists of a practice nurse and two health care assistants. The clinical staff are supported by a team of dispensary, secretarial and reception staff led by a practice manager.

The practice’s opening times at the time of the inspection were 8am to 6pm Monday to Friday. Extended hours appointments with the practice nurse were offered on Tuesday and Thursday mornings between 7am and 8am. Out-of-hours care was provided by Herts Urgent Care via the NHS 111 service. Appointments with GPs and nurses could be booked four weeks in advance.

Updated 9 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Northcote House Surgery on 13 December 2016. This inspection was a follow up to our previous comprehensive inspection at the practice in April 2016 where breaches of regulation had been identified. The practice was rated as inadequate for the domains of safe and well led, requires improvement in the domain of effective and good in the caring and responsive domains. The overall rating of the practice following the April 2016 inspection was inadequate and the practice was placed into special measures for a period of six months.

We also issued a warning notice to the practice to inform them where improvements were needed in relation to good governance. A visit was undertaken on 5 August 2016 where we saw that the specific improvements had been made.

At our inspection on 13 December 2016 we found that the practice had improved. The ratings for the practice have been updated to reflect our recent findings. The practice is rated as good for providing safe, effective, caring, responsive and well led services.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• 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.
• Feedback from patients about their care was positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Data from the National GP Patient Survey published in July 2016 showed that patients rated the practice in line with others for most aspects of care.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt well 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.

The area where the provider should make an improvement is:

• Proactively identify carers so that these patients receive appropriate support and care.
• Ensure that a comprehensive schedule of clinical meetings is in place.

I confirm that this practice has improved sufficiently to be rated good overall. This practice will be removed from special measures.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 February 2017

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.
• The practice used the information collected for the Quality and Outcomes Framework (QOF) to monitor outcomes for patients (QOF is a system intended to improve the quality of general practice and reward good practice). Data from 2015/2016 showed that performance for diabetes related indicators was 85%, which was 5% below the local an national averages. Exception reporting for diabetes related indicators was considerably lower (3%) than the local (13%) and national (11%) averages (exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).

• Longer appointments and home visits were available when needed.
• 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 9 February 2017

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.
• Childhood immunisation rates for the vaccinations given were overall higher than CCG and national averages.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 76%, which was above the local average of 72% and the national average of 74%. Exception reporting for this indicator was 2%, which was below the local average of 8% and the national average of 6%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• GPs were trained to child safeguarding level three.

Updated 9 February 2017

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

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice contacted patients after their discharge from hospital to address any concerns and assess if the patient needed GP involvement at that time.
• Nationally reported data from 2015/16 showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure, were generally above local and national averages.

Updated 9 February 2017

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 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.
• Practice staff carried out NHS health checks for patients between the ages of 40 and 74 years. 29 health checks had been undertaken since April 2016 from 157 invites.

Updated 9 February 2017

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

• The percentage of patients diagnosed with dementia whose care plan has been reviewed in a face-to-face review in the preceding 12 months was 95%, which was 8% above the local average and 11% above the national average.
• The practice had 26 registered patients experiencing poor mental health, of which 20 had received an annual review in the last 12 months. Six were planned for completion before April 2017.
• 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 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 9 February 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 those with a learning disability. The practice had 18 registered patients with a learning disability, of whom nine had received a review in the last 12 months, and three since April 2016. 15 were due to be completed by end of March 2017.
• 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.
• Patients who were carers were identified and signposted to local carers’ groups. The practice had 23 patients registered as carers (approximately 0.6% of the patient list). The practice acknowledged that proactive work was needed to improve this.
• 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.