Archived: Marisco Medical Practice

Updated 8 January 2015

Marisco Medical Practice is located on two sites, the primary location being a purpose built medical centre. The practice moved into the building in 2008 with the vision of it being a ‘one stop shop’ to meet patients’ varying healthcare needs  including community nurses, consultant led out-patient clinics, minor surgery, health and fitness facilities and a dental surgery. It also acts as a meeting point for the local hospice day care service, Alcoholics Anonymous and Addaction drugs and alcohol addiction services.

The practice has a branch surgery at The Broadway, Sutton-on-Sea, LN12 2JN. Patients of the practice are free to use either surgery. The Sutton-on-Sea surgery was not visited during the course of this inspection.

The practice is within the area covered by Lincolnshire East Clinical Commissioning Group (CCG).

The practice holds a General Medical Services (GMS) contract. They have opted out of the requirement to provide GP consultations when the surgery is closed. The out-of-hours service is provided by Lincolnshire Community Health Services NHS Trust.

The geography of Mablethorpe dictates that patients need to travel considerable distances for hospital and other secondary care. Lincoln is 48 miles distant, Grimsby 22 miles and Boston 24 miles. Public transport links are poor.

The practice has a patient list of 14,000 but is weighted to 21,000. This reflects the very high healthcare needs of the patient population. Mablethorpe is an area of high social and economic deprivation, compared nationally. The practice population is much older than either the CCG or England average, with 40% of the practice population over the age of 65 years. Less than 50% of the working age population is in employment.

The percentage of patients with chronic long term conditions is well above the national average. This included patients with diabetes, heart disease and other chronic diseases. For example diabetes national average is 4.6%, Marisco is 12.3%. Chronic obstructive pulmonary disease nationally is 1.7%, Marisco 4.99%. Patients with heart conditions nationally is 1.5%, Marisco is 3.34%.

The area is traditionally used as holiday location for people from the midlands and south Yorkshire, some of who retire to the area. Many do not register with the practice and this results in the practice having a high and fluctuating number of temporary residents, particularly between April and September each year.  

Recruitment and retention of GPs on the east coast of Lincolnshire is an ongoing problem. In September 2012 the practice had nine GP partners (7.25 whole time equivalent - WTE) but by December 2013, due to retirements and others leaving, this had decreased to 3.25 WTE. The practice is a training practice and would normally expect to have GP registrars, but with only six of the 30 GP registrar places being filled in the Lincolnshire Vocational Training Scheme for 2014/15 the practice has only one part time GP registrar. A GP registrar is a qualified doctor who is undergoing further training to become a GP.

The spiralling costs of locum GPs to meet the shortfall in staffing has resulted in some financial concerns, and a programme of redundancy has seen six members of staff accept voluntary redundancy and  a further six on short term contracts did not have them renewed. Staff have voluntarily reduced their hours. All these factors have combined to put even further pressure on the availability of appointments.

The practice has worked hard to fill the GP vacancies and at the time of the inspection there were four full time GP partners, two part time partners and one salaried full time GP. The staffing levels equated to GPs 6.6 WTE, nursing staff 3 WTE and healthcare assistants 8.05 WTE.

The surgery in Mablethorpe is spacious and well equipped. Access for patients with restricted mobility is good and the practice provides wheelchairs in the entrance area. There is very large car park and flat and level access throughout.

Updated 8 January 2015

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of the Marisco Medical Practice on 15 October 2014.  The inspection team was led by a CQC inspector and included an additional CQC inspector, a GP specialist advisor and a practice manager.

The practice has a branch surgery located in Sutton-on-Sea which was not visited during the course of this inspection.

Our key findings were as follows:

The practice had comprehensive systems for monitoring and maintaining the care and treatment they provide to their patients. There was good use of monitoring templates for patients with long term conditions. The practice was proactive in helping people with long term conditions to manage their health and had arrangements in place to make sure their health was monitored regularly.

The practice engaged with other healthcare providers and professionals to ensure the best health outcomes for their patients.

The practice was clean and hygienic and had robust arrangements for reducing the risks from healthcare associated infections.

Patients said they were treated with dignity and respect.  They felt that their GP listened to them and treated them as individuals.

The practice had recognised that there was a lack of patient satisfaction with access to appointments particularly during the peak holiday season due to an increase in the number of temporary residents. There was evidence of on-going monitoring and initiatives to respond to the situation to increase appointment availability although it remained a problem at peak times of the holiday season due to an influx of temporary residents.

Recruitment procedures were not always adhered to, to ensure that staff were suitable to work in a healthcare environment.

Complaints and serious adverse incidents were not managed in a way that ensured learning was embedded and cascaded to staff.

There were no suitable arrangements in place to ensure that the service could continue to operate in the event of events such as fire, flood or loss of essential utilities.

Overall we rated the practice as ‘requires improvement’.

The practice must:

Take action to ensure that recruitment procedures for clinical and non-clinical staff are followed to help ensure that patients are protected from the risks associated with unsuitable staff being employed.

Embed a system for managing and learning from complaints

Ensure that learning from serious adverse events is cascaded to staff to improve learning and help prevent any re-occurrence.

Have in place a contingency and business continuity plan to ensure that patients can continue to receive care and treatment that meets their needs in the event that the practice ceases to function through foreseeable events.

In addition the practice should:

Take action to ensure that containers containing clinical waste are locked at all times when not in use.

Monitor and record refrigerator temperatures in line with the practice’s own policy to ensure the safe storage of medicines.

Have in place a system to ensure that relevant senior staff can access key documents and information held on the computer system when the practice manager was unavailable.

Ensure that patients are not put at risk, by implementing a system whereby GPs view blood test results that may potentially pose a clinical risk.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 January 2015

  The practice is rated as good for caring for patients with long-term conditions. The practice had a high number of patients with long term health conditions, many having complex, multiple morbidities. The practice responded well to the challenges of meeting the needs of this population group. The practice worked with a number of other healthcare providers to provide dietary, weight loss, smoking cessation advice and access to exercise programmes. Patients coming to the end of their lives and their relatives were able to access help and advice that was provided by the St Barnabas Hospice day therapy staff within the surgery. The practice took part in the Gold Standards Framework, a care pathway for patients coming to the end of their lives and held monthly multi agency meetings with other healthcare professionals to discuss patients’ care

Updated 8 January 2015

The practice is rated as good for caring for families, children and young people. The practice worked closely with district nurses, health visitors and the school nurse to meet the health care needs of babies and children.

Children under the age of five years of age, presenting as unwell, were added to the GP list for them to be seen that day.

A family planning service weekly was provided in the surgery by Lincolnshire Community Health Services NHS Trust.

The practice offered a full range of immunisation services for babies and children.

Updated 8 January 2015

The practice is rated as good for the care of older people. The practice had a high percentage of patients, 40%, over the age of 65. A new initiative had been instigated that provided twice weekly sessions that enabled patients to access advice on adult social care.

The GPs conducted weekly ‘ward rounds’ at three nursing homes to ensure continuity of care and to help reduce the number of unplanned admissions to hospital. GPs visited care homes as required to consult with patients.

Updated 8 January 2015

The practice was rated as good for working age people. The practice offered a range of appointment options at two locations to cater for the needs of patients who may be at work. It also offered extended surgery hours on Thursday from 6.30pm to 8pm .

All new patients were offered a health check.

The practice participated in the NHS health check scheme and offered health checks to all patients aged between 40 and 74.

The practice was pro-active in referring patients to the Heelers exercise scheme that provided 12 weeks of supervised personalised exercise free of charge and thereafter reduced price membership at a local sports centre.

Consultant led out-patient clinics were held within the practice to enable working patients who may have difficulty in getting time off work and travel long distances to hospital to receive appropriate care and treatment.

Updated 8 January 2015

The practice is rated as good for caring for people experiencing poor mental health. The practice is proactive in working with other healthcare providers to enable patients in this population group to access advice and treatment that best met their needs.

A community psychiatric nurse was based at the surgery to allow referrals of those experiencing poor mental health to specialist care including cognitive behavioural therapy.

The practice worked proactively with the community mental health team to facilitate home visits for patients with dementia.

Updated 8 January 2015

The practice is rated as good for caring for patients whose circumstances may make them vulnerable. The practice hosted weekly meetings of Alcoholics Anonymous and Addaction drugs and alcohol addiction recovery support charity.

Patients who had identified learning difficulties were invited into the practice for an annual physical health check.