The Orchard Medical Practice Also known as The Surgery

Updated 28 April 2017

The Orchard Medical Practice is a two-site GP service and provides GP services under a General Medical Services contract. Services are provided from the following main location and the branch dispensing practice. Patients can attend either of the two locations. We visited both practices during this inspection and the branch practice is a dispensing practice:

Broughton Astley Surgery (the main practice)

Orchard Road

Broughton Astley

Leicester

LE9 6RG

Ullesthorpe Surgery (the branch and dispensing practice)

Station Road

Ullesthorpe

Leicestershire

LE17 5BT

The service has a clinical team of five partner GPs and one salaried GP, including three females and three males. There is a long-term locum GP and two locum GPs for maternity cover. GPs provide 50.5 sessions per week. The nursing team is led by an advanced nurse practitioner and includes a minor illness nurse, a practice nurse, a healthcare assistant and a phlebotomist. A practice manager, an assistant practice manager and a team of 13 non-clinical staff provide support. The dispensing practice is staffed by a practice nurse, dispensing manager, a dispenser and a receptionist. A GP is available at this site daily.

The practice is readily accessible for people who use wheelchairs and by parents with pushchairs. A portable hearing loop system is available and the reception area has recently been refurbished to offer a calmer space that more easily enables patients to speak with receptionists confidentially.

The practice services a patient list of 11,185 and is in an area of very low levels of deprivation. Of the patient list, 69% are living with a long-term condition and 58% are in paid employment or full time education. The number of patients who are unemployed (4%) is comparable to the clinical commissioning group average of 3% and the national average of 4%.

The main practice offers appointments between:

Monday 8.30am to 11.10am and 2.30pm to 5pm

Tuesday 8.30am to 11.10am and 2.30pm to 5pm

Wednesday 8.30am to 11.10am and 2.30pm to 5pm

Thursday 8.30am to 11.10am and 2.30pm to 5pm

Friday 8.30am to 11.10am and 2.30pm to 5pm

The dispensing branch practice offers a walk-in service between:

Monday 8.30am to 1pm

Tuesday 7.30am to 1pm

Wednesday 7.30am to 1pm

Thursday 8.30am to 1pm

Friday 8.30am to 1pm

The main practice offers early morning appointments from 7.30am three days per week, which change depending on demand. The practice also offers same day appointments which are available between 11.30am and 11.55am. Out of hours patients are directed to the NHS 111 service.

We had not previously inspected this provider.

Updated 28 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Orchard Medical Practice on 21 & 23 December 2016. Overall the practice is rated as good.

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

• Staff used an established system for reporting and recording significant events and the practice demonstrated an open and transparent approach to safety reporting and management.
• Risks to patients were assessed and well managed and the practice sought to continually improve processes.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had invested significant resources into improving and expanding access. This included the provision of extended opening times and facilitation of a digital clinical advice service.
• 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.
• Clinical staff proactively shared decision making with patients. This meant patients had input into their condition management plans as a strategy to help empower them to improve their health.
• The practice was proactive in providing palliative care and support for patients as part of a well-established multidisciplinary network of community specialists.
• There was a focus on continuous learning and improvement at all levels within the practice. The practice team was forward thinking and had engaged in multidisciplinary research to identify future strategies to meet the needs of the local population.

We found the following areas for improvement:

• The practice should ensure coding is consistent in the electronic records system so that tracking of children who miss scheduled hospital appointments takes place.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 April 2017

The practice is rated as good for the provision of services to 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.
• Staff used templates and registers to provide timely and structured care, including proactive reviews and scheduled annual reviews.
• The practice performed variably compared with national and Clinical Commissioning Group averages in the Quality Outcomes Framework.
• Longer appointments and home visits were provided for patients along with a range of extra services, including a virtual clinic that offered advice and guidance on condition management.
• Patients had a named GP 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.
• Performance for diabetes related indicators was similar to or better than the national average. For example the percentage of patients with diabetes in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less (01/04/2015 to 31/03/2016) was 81% compared to the CCG average of 77% and the national average of 78%. The percentage of patients in the same period in whom the last measured total cholesterol was 5mmol/l or less was 79% compared with the CCG average of 83% and national average of 80%.
• Longer appointments and home visits were available when needed.

Updated 28 April 2017

The practice is rated as good for the provision of services to 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. This included children and young people who had a high number of emergency hospital attendances and those who were known to be affected by health inequalities. However, staff did not consistently code children who had missed a scheduled hospital appointment in the electronic patient records system.
• Immunisation rates for the MMR vaccines were better than local and national averages.
• Children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. This included new mother and baby focused reviews, baby checks at 24 hours and six weeks after birth.
• A weekly midwife-led maternity service was provided in the practice.
• 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 and health visitors.
• Services included child health surveillance, antenatal care, contraception, childhood immunisation and sexual health advice.

Updated 28 April 2017

The practice is rated as good for the provision of services to 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, urgent and extended appointments.
• Staff provided advanced care plans and reviewed these at monthly multidisciplinary meetings.
• A GP and advanced nurse practitioner led the care provision for a nearby care home that included same-day appointments and continuity of care.
• Staff worked with community partners to prevent unnecessary hospital admissions. This included the use of a proactive care virtual ward coordinator and intermediate care team.

Updated 28 April 2017

The practice is rated as good for the provision of services to 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 a range of extended hours and telephone clinic access.
• The practice was proactive in offering a full range of health promotion and screening that reflected the needs for this age group. This included screening minor illness and injury clinics, smoking cessation, phlebotomy and travel health and immunisation.
• Online and remote services included electronic prescriptions, telephone consultations and health record access.

Updated 28 April 2017

The practice is rated as good for the provision of services to people experiencing poor mental health.

• 80% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was similar to the national average of 84%. The practice offered proactive dementia screening and referrals to memory assessment services.
• Patients were offered an annual review that included a physical assessment, medicine review, blood tests and a discussion with a GP or mental health facilitator.
• The practice regularly worked with multidisciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice supported patients experiencing poor mental health to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended a hospital emergency department where they may have been experiencing poor mental health.

Updated 28 April 2017

The practice is rated as good for the provision of services to people whose circumstances make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances and used advanced care planning to avoid hospital admissions.
• A lead GP for learning disabilities was in post and provided annual reviews, safeguarding reviews and health checks.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients, including independent advocates.
• The practice informed vulnerable patients about how to access various support groups and voluntary 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.
• Carers were offered an annual health check and flu vaccination and the practice facilitated a monthly carer’s clinic offered by a community health and wellbeing service.