The Linden Medical Group

Updated 6 November 2017

The Linden Medical Group provides primary medical care services to approximately 8350 patients, under a General Medical Services (GMS) contract agreed with NHS England. It is based in purpose-built premises within the Stapleford Care Centre located in Church Street, Stapleford, Nottingham, NG9 8DA. The premises are owned and managed by NHS Property Services. The practice had a branch surgery which closed in July 2016.

The practice is in the fourth less deprived decile meaning that it has a slightly lower proportion of people living there who are classed as deprived than most areas. Data shows the number of older people aged above 65 years registered at the practice is moderately higher than the local and national average.

There are six GP partners at the practice (four male and two female). One of the partners is the Registered Manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

In addition, the nursing team comprises of two practice nurses and two healthcare assistants. The clinical team are supported by a practice manager, a practice supervisor and an administrative team comprising of reception staff, an audit clerk and secretary. A pharmacist employed by another healthcare organisation is attached to the practice as part of a pilot scheme on a full time basis.

The practice is open between 8am and 6.30pm Monday to Friday. There are no closures at lunchtime except on Thursday when it is closed from 1pm until 4pm, and re-opens from 4pm until 6.30pm. Appointments start in the morning from 8.30am until 12.30pm, and in the afternoon from 3.20pm until 5.20pm. Extended opening hours are provided on Monday from 7am until 8am with GP and nurse appointments available.

Linden Medical Group has opted out of providing GP services to patients out of hours. During the evenings and at weekends an out-of-hours service is provided by Nottingham Emergency Medical Services (NEMS). Contact is via the NHS 111 telephone number.

Updated 6 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Linden Medical Group on 12 December 2016. The overall rating for the practice was rated as good, with a rating of requires improvement for providing responsive services. The full comprehensive report on 12 December 2016 can be found by selecting ‘all reports’ link for The Linden Medical Group on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 16 October 2017 to confirm that the practice had carried out improvements in relation to areas that we identified in our previous inspection on 12 December 2016 as requires improvement. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is remains rated as good.

Our key findings were as follows:

• A new telephone system was installed with a queuing system informing callers of their position in the queue before they can speak to someone. The system allowed the practice to monitor their call volumes, and it was used in resource planning to ensure there were more staff answering the telephones during busy times.

• Waiting times on the telephone had reduced significantly due to the new telephone system. This was consistent with feedback from some patients we spoke to who told us they did not wait for long on the telephone even when they were in a queue.

• Extended opening hours were now provided from 7am until 8am on Monday (four hours per week), with GPs and a nurse available, for the convenience of working age people. The practice offered a range of appointments which included telephone appointments, same day urgent and pre-bookable appointments. There were longer appointments available for patients who needed them and they were encouraged to request for longer appointments if required.

• Patients were encouraged to provide feedback about their experience using various methods. For example, the NHS friends and family test was sent to patients by text message and was available in paper format. A suggestion box was available in the practice as well as online.

• The practice offered a range of services within its premises. Patients were encouraged to self-refer to the service as well as to psychotherapy services.

• Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 February 2017

The practice is rated as good for the care of people with long-term conditions.

• The practice had a recall system for patients with long term conditions, audited on a monthly basis to identify patients who are due for a review. Patients were sent reminders in the month of their birthday to attend an annual check which incorporated a review of their long term conditions, and those who did not attend were followed up to book another appointment.

• Nursing staff had lead roles in chronic disease management with named GP leads for specific disease areas. Nurses had additional qualifications obtained in areas such as diabetes. Patients were assigned to the appropriately trained nurse to ensure they were managed effectively. Patients at risk of hospital admission were identified as a priority.

• QOF performance data for 2015/16 showed the practice achieved positive outcomes for most long term conditions, including chronic kidney disease, hypertension, and heart failure. The practice achieved 94% on rheumatoid arthritis, compared to the CCG average of 88% and the national average of 92%. The exception reporting rate was 8%, compared to the CCG average of 6% and the national average of 8%. However, performance was below average for some long term conditions such as asthma, chronic obstructive pulmonary disease and diabetes. The partners were aware of their performance and had reviewed coding inconsistencies to improving their recording of checks undertaken.

• Longer appointments and home visits were available and offered when needed.

Updated 28 February 2017

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

• The practice worked closely with midwives, health visitors and family nurses attached to the practice. 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 Accident and Emergency (A&E) attendances.

• The practice held monthly meetings with the health visitor and school nurse who were based in the same building, and also reviewed any children on a child protection plan at their clinical meetings.

• Childhood immunisations were provided on Wednesday mornings by the practice nurses. Immunisation rates were broadly in line with CCG averages for standard childhood immunisations. Vaccination rates for children under two year olds ranged from 86% to 99% (CCG range from 91% to 98%) and five year olds from 73% to 100% (CCG range from 87% to 98%).

• Appointments were available outside of school hours with urgent appointments available on the day for children and babies.

• The practice offered a full range of family planning services including fitting of intra-uterine devices (coil) and contraceptive implant fitting.

• The premises were suitable for children and babies. Baby changing facilities were available and the practice accommodated mothers who wished to breastfeed.

Updated 28 February 2017

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

• The practice had 25% of their patients aged over 65 years old, compared to a CCG average of 20% and national average of 17%. They offered proactive, personalised care to meet the needs of the older people in their population.

• GPs and nurses were responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. The practice had registered patients living in five care homes where they provided general medical services, and four of the homes sat outside their CCG boundary. Feedback from the homes was mostly positive about the care and treatment received from practice. However, some staff told us they had difficulties getting through to the practice by telephone.

• Nationally reported data showed outcomes for conditions commonly found in older people were overall good. For example, performance on heart failure indicators was 97%, compared to the CCG average of 100% and the national average of 98%. The exception reporting rate was 6%, compared to the CCG exception reporting average rate of 9% and the national average of 9%

• Shingles vaccinations were offered to eligible patients including those over 70 years old.

• All patients above 75 years old had a named GP for continuity of care.

Updated 28 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. This included access to telephone appointments.

• Flu clinics were held on Saturdays to accommodate people who would not be able to attend during the week, including working age patients and students.

• The practice was proactive in offering online services such as online prescription requests, appointments, and accessing medical records to view test results.

• There was a full range of health promotion and screening information in the practice that reflects the needs for this age group. Self-referral was encouraged for accessing services such as psychological therapies.

• The practice’s uptake for cervical screening for eligible patients was 78%, which was slightly lower than the CCG average of 84% and the national average of 82%.

• Breast and bowel cancer screening data was broadly in line with CCG and national averages. For example, the proportion of patients who were screened for bowel cancer within six months of invitation was 64%, compared with a CCG average of 64% and a national average of 58%.

Updated 28 February 2017

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

• Published data showed 79% of patients diagnosed with severe mental health conditions had a care plan documented and agreed with them in the preceding 12 months, compared to the CCG average of 91% and the national average of 89%. The exception reporting rate was 15%, in line with the CCG average of 15% and the national average of 13%.

• Published data showed 53% of patients diagnosed with dementia had a care plan reviewed in a face to face review in the preceding 12 months, compared to the CCG average of 85% and the national average of 84%. This was achieved with an exception reporting rate of 6%, in line with the CCG average of 5% and the national average of 7%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations, and encouraged them to self-refer to psychotherapy services when needed.

Updated 28 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 who were flagged on the computer system to inform staff that the patients may need extra support.

• There were 41 people on the learning disabilities register and 36 had their care reviewed in a face to face meeting 2016/17. The remaining five patients had been invited for reviews to be undertaken before the end of March 2017.

• At our previous inspection on 27 March 2015, we found the practice needed to take more proactive steps to ensure patients with learning disabilities had annual health checks. These arrangements had significantly improved when we undertook a follow up inspection on 12 December 2016. An audit carried out by the practice on learning disabilities checks showed an improvement from 56% of checks carried out in the previous year, to 70% carried out in 2015/16. Staff told us they worked closely with the community learning disabilities specialist nurse to ensure their registers were up to date and no patients were missed.

• The practice offered longer appointments and during quieter periods for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. The practice worked proactively with the multi-disciplinary healthcare team to ensure patients were supported in line with the gold standard framework for palliative care.

• 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.

• Staff told us they were aware of how to access interpreting for their patients with hearing impairment and an interpreter could be arranged for those who could not speak in English through a translation service. A hearing loop was available in the waiting room.

• The practice’s computer system alerted GPs if a patient was also a carer. There were 128 patients on the carers register (1.5% of the practice list), and 111 of them had received flu vaccinations.