5 May 2016
Drs Irwin, Goodwin and Fargnoli is a dual sited surgery with purpose built practices situated at both Buckden, Cambridgeshire, and at the branch surgery in Little Paxton, Cambridgeshire. Between the two sites, the practice provides services for approximately 8,464 patients. It holds a General Medical Services contract with Cambridgeshire and Peterborough CCG.
According to information taken from Public Health England, the patient population has a higher than average number of patients aged over 45 years old in comparison to the practice average across England. The practice is in an area with a low level of deprivation. There are currently new housing developments being built in the area.
The practice team consists of three GP partners, two salaried GPs, two GP registrars (GPs in training), a practice manager, a nurse practitioner, three practice nurses, a lymphedema nurse, a health visitor and four phlebotomists. It also has teams of reception, administration, secretarial, dispensary and courier staff. The practice is an accredited training and research practice.
Buckden Surgery is open from Monday to Friday. It offers appointments between 8am and 7.30pm on Mondays, 8am to 6pm on Tuesdays and Wednesdays, 8am to 2pm on Thursdays and 8am to 5pm on Fridays. The practice also has a branch surgery in the neighbouring village of Little Paxton. It offers appointments between 8am and 6pm on Mondays and Wednesdays, 8am to 12.30pm on Tuesdays and Thursdays, and 8am to 5pm on Fridays. Little Paxton Surgery was not inspected as part of this inspection. Out of hours care is provided by Urgent Care Cambridge via the 111 service.
Drs Irwin, Goodwin and Fargnoli was inspected in 2014 using previous CQC methodology, and was found to be compliant with the legal requirements and regulations associated with the Health and Social Care Act 2008. The practice did not receive a rating following this inspection under CQC’s previous methodology.
5 May 2016
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Drs Irwin, Goodwin and Fargnoli on 17 March 2016. Overall the practice is rated as outstanding.
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.
- The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.
- Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
- Feedback from patients about their care was consistently and strongly positive.
- Information about services and how to complain was available and easy to understand.
- Patients said they found it easy to make an appointment with a named GP and that 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 had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
- The practice had strong and visible clinical and managerial leadership and governance arrangements.
We saw several areas of outstanding practice:
- The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients. For example, the practice implemented a lymphoedema clinic following patient request. This meant that patients requiring this service did not have to travel to secondary care providers.
- The practice recognised the lack of public transport for patients to get to the practice, and organised a patient led transport scheme. This service was promoted to new patients in the practice newsletter and on the patient participation group (PPG) notice board.
- The practice worked alongside the PPG to develop education events for patients. They organised a ‘Dementia Day’ held at the practice, which was well attended and well received by patients. Furthermore, the PPG were in contact with local schools and had a plan in place to present health education sessions. The practice recognised the barriers to engaging with younger patients, and was keen to build positive relationships and promote good health.
- The practice was innovative and proactive in setting up new services in the area. For instance, the practice promoted exercise programmes to patients identified as at risk of cardiovascular disease at NHS health checks. The senior partner at the practice had organised for a weekly parkrun to take place nearby after recognising the need for local, free of cost exercise groups in the area. We received positive feedback from patients about these services.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
5 May 2016
The practice is rated as outstanding 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 implemented a lymphoedema clinic following patient request. This meant that the patient requiring this service did not have to travel to secondary care providers.
- 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 2014/2015 showed that performance for diabetes related indicators was 100%, which was above the CCG average by 10.5% and above the national average by 10.8%. Exception reporting for these indicators was 13.7%, which was comparable to local and national averages.
- Longer appointments and home visits were available when needed.
- All of 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.
5 May 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.
- 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 percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding 5 years was 82%, which was in line with the national average.
- Appointments were available outside of school hours and the premises were suitable for children and babies.
- We saw positive examples of joint working with midwives, health visitors and school nurses.
- The PPG had a plan in place to hold education events at local schools.
5 May 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 was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
- The practice looked after older adults living in two local residential homes, with a dedicated doctor assigned to each home to maintain continuity of care.
- Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure, were above local and national averages.
- The practice was at or below the CCG average for emergency admissions, accident and emergency presentations and outpatient referrals.
5 May 2016
The practice is rated as outstanding 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. The senior partner at the practice organised a local parkrun event to promote exercise to patients identified at NHS health checks.
- Extended hours appointments were available between 6.30pm and 8pm on Mondays.
- The practice offered in house minor surgery, vasectomy services and dermatology clinics.
- The practice offered email contact to patients.
- The practice offered pre-bookable telephone appointments on certain days from 7.30am and from 6.30pm.
5 May 2016
The practice is rated as outstanding for the care of people experiencing poor mental health (including people with dementia).
- 92% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was above both local and national averages.
- 95% of patients experiencing poor mental health had a comprehensive care plan, which was above the CCG and national averages.
- The practice regularly worked with multi-disciplinary teams in the case management of people 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 might have been experiencing poor mental health.
- Staff had a good understanding of how to support patients with mental health needs and dementia.
5 May 2016
The practice is rated as good for the outstanding 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 offered longer appointments for patients with a learning disability.
- The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
- The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
- The practice was engaged with the Carers’ Prescription Service and had a carers champion within the team, who regularly communicated with the service on behalf of patients who were carers. There was a plan in place for the Carers’ Prescription Service to present at the practice’s clinical governance meeting in April 2016.
- The practice recognised the lack of public transport for patients to get to the practice, and organised a patient led transport scheme. This service was promoted to new patients in the practice newsletter and on the PPG notice board.
- Local drug and alcohol services held regular clinics at the practice for patients with substance misuse issues.
- 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.