Measham Medical Unit

Updated 20 April 2016

Measham Medical Unit is located in High Street, Measham, Leicestershire, DE12 7HR. Despite its post code, Measham is a large village in Leicestershire close to the borders with Derbyshire Staffordshire and Warwickshire. Many of its patients live in rural villages. The practice is housed in a purpose-built building near the centre of the village. There is parking on site, with some disabled bays. There is disabled access, with ramps and automatic doors. It has its own dispensary which can be used by those patients who lived more than a mile away from a pharmacy. It has a General Medical Services (GMS) contract and is a training practice providing placements for trainee GPs.

• The practice has five full-time GPs and four part-time GPs. Four of these are female. There are two nurse practitioners and four practice nurses, four health care assistants and a phlebotomist who are all female. There are also administrative staff including the practice manager and a reception team.
• The practice is open between 8am and 6.30pm Monday to Friday. On Wednesdays the practice opens at 7.30am. On Saturdays it is open for urgent appointments from 8am to 11.50am. Appointments are available from 8.30am to 10.30am and 11am to 12.45pm and from 2pm until 3pm and from 3.30pm to 6pm Monday to Friday. In addition, there is a ‘sit and wait’ session from 8.40am to 10.30am for patients with new problems that need same day treatment. On arrival these patients are asked to complete a simple form to describe the problem which is passed to a GP or nurse practitioner who prioritise which patients are seen first. The practice also provides minor surgery.
• Out of hours services are provided by CNCS (Central Nottinghamshire Clinical Services). Patients are directed to the correct numbers if they phone the surgery when it is closed.
• The practice has 12,840 patients registered with it. Although in an area of low deprivation it has a slightly higher proportion of patients in the 40 to 79 age groups.

The practice catchment area presents challenges in terms of providing home visits and where patients may choose to receive secondary care and community services.

Updated 20 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Measham Medical Unit on 23 September 2015. Overall the practice is rated as good.

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

• Information about safety was recorded, monitored, reviewed and any issues were addressed in a timely way. There was an effective system in place for reporting and recording significant events and complaints.
• Risks to patients were assessed and well managed.

• 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.
• Patients said they were treated with care, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• 62% of patients said they found it easy to make an appointment with a named GP and that there was continuity of care.
• Urgent appointments were available on the same day and on Saturday mornings.
• 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 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.

We saw an example of outstanding practice:

• The practice, which had a large, rural catchment area, provided a shuttle bus service paid for by charitable donations. This provided free transport to and from home to the surgery for older patients. Approximately 100 patients living in Measham and 19 other villages used this service each month. Appointment slots were blocked for the use of shuttle users and only opened up to others if not filled by bus patients. This meant that patients could have full access to services such as podiatry as well as seeing a GP or nurse. It also provided patients with an opportunity for social interaction with other passengers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 April 2016

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 worked closely with visiting specialist nurses. The practice had expanded its nursing capacity and added an extra clinical nurse room. All nurses were working towards accreditation to care for all long-term conditions in order to increase capacity and flexibility.
• The practice had been working with physiotherapists to deliver rehabilitation programs for patients with heart failure and lung disease.
• Patients were referred to local services for lifestyle advice related to their conditions.
• Patients at risk of hospital admission were identified as a priority and had a personalised care plan. An alert on their record ensured that receptionists were aware that these patients should be offered same-day contact preferably with their usual doctor.
• All 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.
• Where patients had a number of long-term conditions the practice took a holistic approach and offered them one longer appointment to review all the conditions.
• Home visits were available when needed.
• These patients could also use the shuttle bus service to get to the surgery.
• The dispensary delivered medicines free of charge to patients over 60.

Updated 20 April 2016

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify 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 (97-100%)
• Data showed that 77% of patients with asthma had an asthma review in the last 12 months.
• The practice offered a wide range of contraceptive services.
• Teenage patients had been invited to attend clinics run by nurse practitioners and the practice had arranged drop-in evening surgeries at a local youth club to make young people aware of the services available.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals. Chlamydia screening packs were available in different areas of the practice.
• Data showed 81% of eligible women had received a cervical screening test.
• Appointments were available outside of school hours and the premises were suitable for children and babies. The practice offered 24 hour and six week baby checks.
• Staff told us they had good working relationships with midwives and health visitors who were based on the practice building. We spoke with a health visitor who confirmed this.  

Updated 20 April 2016

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

• The practice offered proactive, personalised care to meet the needs of older people in its population.
• The practice had identified patients most at risk of hospital admission. Each patient had a personalised care plan and an alert was put on the patient record. Any admissions were reviewed to identify avoidable factors.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those who needed them.
• The practice provided a shuttle bus service paid for by charitable donations. This provided free transport to and from home to the surgery for older patients. Appointment slots were blocked for the use of shuttle users and only opened up to others if not filled by bus patients on the day. This meant that patients could have full access to services such as podiatry as well as seeing a GP or nurse. It also provided patients with an opportunity for social interaction with other bus passengers.
• The practice had identified a number of patients over 75 who had not been seen at the surgery for over two years and who may have become housebound. They were offered home visits with a nurse to ensure their health needs were being met. There were also given information about the shuttle bus service.
• The practice provided care for patients in the terminal phase of a life limiting illness who wished to die at home. It worked closely with district nursing teams. The GP discussed with patients and relatives what support and care the practice could provide. This included providing telephone numbers for the GP who could be contacted for advice out of normal surgery hours and when necessary visited. This helped avoid unnecessary and potentially distressing hospital admissions. During a two-year period 77% of patients who expressed a preference to die at home did so.
• The practice provided care for the residents of two nearby care homes, providing weekly visits with two GPs sharing responsibility for each home. This helped ensure continuity of care.
• The dispensary delivered medicines free of charge to patients over 60.

Updated 20 April 2016

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 offered services that were accessible, flexible and, where possible, offered continuity of care.

• Pre-bookable appointments were available from 8am to 5.55pm Monday to Friday (7.30am on Wednesdays) Pre-bookable telephone consultations were also available.
• Appointments could be pre-booked in advance. Urgent same-day appointments and telephone consultations were available.
• It was open on Saturdays from 8am to 11.50am for urgent appointments.
• The practice offered a range of online services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 20 April 2016

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

• The practice had increased its formal screening to identify patients living with dementia, working with staff in care homes and also looking at patients with long term conditions. This increased the register of patients from 47 to 100 and these patients were offered an annual check-up with a GP
• 87% of patients living with dementia had a face-to-face care review in the previous 12 months, which is slightly above the national average.
• 88% of patients with mental health problems had a comprehensive agreed care plan on their records which comparable with national figures.
• The practice regularly worked with multi-disciplinary teams in the case management of the people experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The primary mental health facilitator was based in the practice building. This helped with smooth and prompt referral of patients who needed access to psychological therapies.
• The practice had also provided patients experiencing poor mental health with information 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 when 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 20 April 2016

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 and those who were housebound.
• The practice offered longer appointments for patients with a learning disability and staff were aware of individual patient needs such as what time of day a patient might prefer their appointment.
• Patients with learning disabilities were offered annual health checks.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. Some were referred to the virtual ward to ensure that their health and social care needs were identified.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• A drug and alcohol counsellor was based on the practice building. The practice worked with the counsellor to provide a shared care scheme for drug misuse patients.
• 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.