Archived: Gorleston Medical Centre

Updated 22 January 2015

Gorleston Medical Centre, in the Great Yarmouth and Waveney clinical commissioning group (CCG) area, provides a range of general medical services to approximately 7100 registered patients living in Gorleston and the surrounding villages.

There are three GP partners who hold financial and managerial responsibility for the practice. There is a salaried GP, two practice nurses and a health care assistant. There are also receptionists, administration staff and a practice manager. The practice is a training practice for medical students and qualified doctors who are training to be GPs.

Gorleston Medical Centre has a slightly higher proportion of patients under 18 and a slightly higher proportion of patients aged over 65, 75 and 85 compared to the practice average across England.

Income deprivation affecting children and older people is slightly higher than the practice average across England.

The practice has a branch surgery at Hopton –on-sea, Station Road, Hopton-on-sea, Great Yarmouth, Norfolk, NR31 9BE. We did not visit the branch surgery as part of this inspection.

Outside of practice opening hours a service is provided by another health care provider (South East Health) by patients dialling the national 111 service.

Updated 22 January 2015

Letter from the Chief Inspector of General Practice

We visited Gorleston Medical Centre on the 16 October 2014 and carried out a comprehensive inspection.

The overall rating for this practice is good. We found that the practice provided a safe, effective, caring and responsive service. There were areas for improvement in relation to leadership at the practice. We examined 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. We found that care was tailored appropriately to the individual circumstances and needs of the patients in these groups.

Our key findings were as follows:

• The practice was friendly, caring and responsive. It addressed patients’ needs and worked in partnership with other health and social care services to deliver individualised care.

• Patients were satisfied with the appointment system and felt they were treated with dignity, care and respect. They were involved in decisions about their care and treatment and were happy with the care that they received from the practice.
• The needs of the practice population were understood and services were offered to meet these.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Ensure that all clinical staff are aware of their responsibilities in relation to the Mental Capacity Act (2005).

• Ensure that there are robust systems for feedback of lessons learnt to the non-clinical staff team following significant events.
• Ensure that there are effective systems of support in place for non-clinical staff.
• Follow their recruitment procedure by ensuring that employment references are documented. 
• Ensure that staff who act as chaperones receive appropriate training to undertake this role.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 January 2015

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 structured reviews at least annually to check their health and medication needs were being met and were led by a GP. These reviews were undertaken for patients who lived in residential care. 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. There was a Diabetic Specialist Nurse Clinic held on site to review patients with complex diabetes.

Updated 22 January 2015

Information and advice was available to promote health to women before, during and after pregnancy. Expectant mothers had access to a community midwife who held an antenatal clinic every week at the practice. The physical and developmental progress of babies and young children was monitored and the practice had regular meetings with the health visitors. 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. Appointments were available outside of school hours and the premises were suitable for children and babies. There was a private room which was available for mothers to breast feed. We were provided with good examples of joint working with midwives, health visitors and school nurses. The practice visited the local high school once every year to discuss sexual health awareness.

There were two GP partners involved in teaching medical students maternity and child healthcare. This led to better learning and dissemination of good practice in this area.

Updated 22 January 2015

The practice is rated as good for the care of older people. Patients over the age of 75 had a named GP who was responsible for the coordination of their care. 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. There was evidence of effective multidisciplinary working to optimise their health care and also reduce unplanned admissions to hospital

The practice was responsive to the needs of older people, including offering rapid access appointments for those with enhanced needs. The practice also undertook home visits. This included visits to administer the influenza vaccination to patients who were housebound and the elderly. The practice undertook welfare checks on the elderly, especially if they missed clinic appointments.

Updated 22 January 2015

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 offered continuity of care. The practice was open from 8am to 6:30pm Monday to Friday and pre bookable appointments were available on Thursday evening from until 8pm. Early morning appointments with GPs and nurses were available, as well as the health care assistant for blood tests. Patients could book appointments over the telephone, in person or online. Repeat prescription could also be requested online. The practice was proactive in offering a full range of health promotion and screening which reflects the needs for this age group.

Updated 22 January 2015

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

The practice worked closely with Norfolk Mental Health Services. A drug and alcohol clinic was held at the practice. This was led by a nurse from the Norfolk Recovery Partnership. We saw evidence of shared care between the GPs at the practice and the nurse. The practice had sign-posted patients experiencing poor mental health to various support groups and third sector organisations A mental health and counselling link worker was available at the practice every week. The GPs had the necessary skills and information to treat or refer patients with poor mental health.

One of the GP partners was the mental health lead with the Clinical Commissioning Group and had advocated guidelines and health services for patients with mental health needs. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. The GPs recognised that some patients with mental health needs expressed a strong preference for their usual doctor and so the practice made arrangements to facilitate access to the same treating GP.

Updated 22 January 2015

There was a system to highlight vulnerable patients on the practice’s electronic records. This included information so staff were aware of any relevant issues when patients contacted the practice or attended appointments. 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.