Background to this inspection
Updated
20 July 2016
The practice is located in the rural village of Great Massingham in Norfolk and provides primary medical care services to approximately 5,900 patients within a defined geographical area. The practice does not remove existing patients from their list if outside the practice area but abides by the boundaries for prospective new patients. There is also a branch surgery located at Docking in Norfolk, where a minimum of 10 sessions per week are offered to patients.
District nursing and health visitor services are also based within the practice. There is also a room available for use by local voluntary organisations. There is a visiting midwife service and access to a community matron.
The practice is located in a single storey building. It also offers on-site parking, disabled parking, two disabled WCs and step-free access. The practice has five GP partners, two practice nurses, two healthcare assistants, a practice manager, a dispensary manager and seven staff who carry out reception and administrative duties. Surgery opening times at Great Massingham are between 8:30am and 6:30pm every day. An extended surgery is provided at Docking Surgery on a Tuesday afternoon.
Updated
20 July 2016
Letter from the Chief Inspector of General Practice
We carried out an announced, comprehensive inspection on 2 February 2015.
Prior to our inspection we consulted with the local clinical commissioning group (CCG) and the NHS local area team about the practice. A CCG is an organisation that brings together local GPs and experienced health professionals to take on commissioning responsibilities for local health services. Neither of these organisations had any significant concerns.
We spoke with patients and staff including the management team. The inspection focussed on whether the care and treatment of patients was safe, effective, caring, responsive and well led. During the inspection we spoke with patients and carers that used the practice and met with members of the patient participation group (PPG). A PPG is a group of patients who have volunteered to represent patients' views and concerns and are seen as an effective way for patients and GP surgeries to work together to improve services and to promote health and improved quality of care.
We also reviewed comments cards that had been provided by CQC on which patients could record their views.
We looked at patient care across the following population groups: Older people; those with long term medical conditions; mothers, babies, children and young people; working age people and those recently retired; people in vulnerable circumstances who may have poor access to primary care; and people experiencing poor mental health.
Our key findings were as follows:
The practice covered a large geographical and rural area, services had been designed to meet the needs of the local population.
Feedback from patients was overwhelmingly positive, they told us staff treated them with respect and kindness.
Staff reported feeling supported and able to voice any concerns or make suggestions for improvement.
Patients were treated with compassion, dignity and respect.
Staff were able to identify and respond to changing risks to patients including deteriorating health and well-being or medical emergencies
Staff understood their responsibilities to raise concerns, and report incidents and near misses.
Patients reported good access to the practice and a named GP and continuity of care, with urgent appointments available the same day.
The overall rating for The Practice is ‘Good'.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
People with long term conditions
Updated
20 July 2016
The practice is rated as good for the population group of people with long term conditions. Emergency processes were in place and referrals made for patients in this group that had a sudden deterioration in health. When needed longer appointments and home visits were available. All these patients had a named GP and structured annual reviews to check their health and medication needs were being met. For those people with the most complex needs the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
Families, children and young people
Updated
20 July 2016
The practice is rated as good for the population group of families, children and young people. Systems were in place for identifying and following-up children living in disadvantaged circumstances and who were at risk. Immunisation rates were relatively high for all standard childhood immunisations. Patients told us and we saw evidence that children and young people were treated in an age appropriate way and recognised as individuals. There were two young people who were part of the patient participation group (PPG).
Updated
20 July 2016
The practice is rated as good for the care of older people. Nationally reported data showed the practice had good outcomes for conditions commonly found amongst older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example in dementia and end of life care. The practice was responsive to the needs of older people, including offering home visits and rapid access appointments for those with enhanced needs and home visits.
Working age people (including those recently retired and students)
Updated
20 July 2016
The practice is rated as good for the population group of the 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 offer continuity of care. The practice was proactive in offering online services as well as a full range of health promotion and screening which reflects the needs for this age group.
People experiencing poor mental health (including people with dementia)
Updated
20 July 2016
The practice is rated as good for the population group of people experiencing poor mental health (including people with dementia. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. The practice had in place advance care planning for patients with dementia.
The practice had sign-posted patients experiencing poor mental health to various support groups and third sector organisations including MIND and SANE. The practice had a system in place to follow up on patients who had attended accident and emergency where there may have been mental health needs. Staff had received training on how to care for people with mental health needs and dementia.
People whose circumstances may make them vulnerable
Updated
20 July 2016
The practice is rated as good for the population group of people whose circumstances may make them vulnerable. The practice had carried out annual health checks for people with learning disabilities. The practice offered longer appointments for people with learning disabilities.
The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. The practice had sign-posted vulnerable patients to various support groups and third sector 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 and out of hours.