Moulton Surgery

Updated 28 April 2017

Moulton Surgery provides primary medical services and dispensing facilities to approximately 11,282 patients in Moulton and surrounding villages. Services are provided on a Personal Medical Services (PMS) contract (a PMS contract is a locally agreed contract with NHS England). The practice is part of the Nene Clinical Commissioning Group (CCG).

Services are delivered to patients from one registered location, 120 Northampton Lane North, Moulton NN3 7QP. The practice has been based in a purpose built health centre since 1965, which has been extended and developed due to expansion of the practice list size over a number of years. Services have also been provided at a branch surgery, located in the campus of Northampton University since 1973.

The make-up of the practice population at Moulton Surgery is influenced by the approximate 3,500 students who register whilst they study at Northampton University and Moulton College.

The practice had fewer than average patients in the age range 55 years and under than average. The practice had 7% of patients under the age of 14 years compared to CCG and England average of 12%.

The area is recorded as being in the ’third least deprived decile’ and therefore falls in an area of the lower than average deprivation According to national data, life expectancy for male patients at the practice is 79 years, which compares to the CCG and the national England average of 79 years. For female patients life expectancy is 84 years, compared to the local CCG and the England average of 83 years.

The on-site practice team consists of five GPs (three female GPs and two male GPs), one nurse practitioner, two practice nurses, two health care assistants and phlebotomist (all female). The dispensary team compromises a supervisor and two assistants. The practice manager is supported by an administration team and patient support advisors provide reception, telephone, and administrative functions.

The practice is open from 8am to 6.30pm, Monday to Friday. Extended opening hours are available until 8pm on Thursday evenings and between 8am -11.15am each Saturday, except on bank holiday weekends. Appointments on Saturdays are generally for pre-booked appointments and are focussed for patients who are commuters or those with work commitments who are unable to attend an appointment during normal office hours.

Appointments with a GP, nurse or health care assistant are available during those times. Appointments are bookable up to four weeks in advance. Emergency appointments are available daily.

When the practice is closed, ‘out-of-hours’ services are provided via the NHS 111 service. Information about the out-of-hours services is available in the practice waiting area, on the practice website and on the practice telephone answering service.

Updated 28 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Moulton Surgery on 25 October 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, they had produced a comprehensive quality monitoring policy with positive engagement and consultation with patients, relevant local services, local Federation of GP services and Northamptonshire Clinical Commissioning Group (CCG). The policy covered all aspects of the practices work, including assisting patients in making informed plans about end of life care, cancer referrals and a proactive approach to monitoring and review of high risk medication. Implementation of the policy had been rolled out across the area at meetings with patients and other residents in the area to help raise awareness of healthy lifestyle choices.
• The practice had a branch on the campus of Northampton University since 1973. The make-up of the practice population at Moulton Surgery is influenced by the approximate 3,500 students who register whilst they study at Northampton University and Moulton College.
• Feedback from patients about their care was consistently positive. We received 46 comment cards completed by patients. All of the cards contained positive feedback about the quality of care and the compassion of staff who delivered services.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example the practice had built and maintained effective positive relationship with the parish council with representatives from the council also serving on the Practice Patient Participation Group. The practice was fully involved in consultation, planning, design and development of a new Health and Wellbeing centre to meet growing demand of the increasing population.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, feedback from local patient surveys supplemented findings from the annual national GP patient survey was presented to partners and all staff meetings.
• We saw clear evidence that patient feedback drove improvements to the practice. The practice has worked with other agencies to help address social exclusion for example they had facilitated a ‘healthy walking’ group, had obtained an allotment plot and supported a voluntary car driver scheme to help patients attend the practice or for other health related needs.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had produced a comprehensive vision for the development and implementation of a Health and Wellbeing strategy for the residents of the village and surrounding area.
• The practice had strong and visible clinical and managerial leadership and governance arrangements. A three year business plan and strategic development plan had been developed and produced to guide the direction and growth of the practice as it prepared to move in to new purpose centre.
• Strategic planning was at the core of development work for the delivery of excellence to patients by staff who were encouraged and supported to embrace opportunities for their own personal improvement.

We saw one area of outstanding practice;

• The practice had created a Proactive Care Scheme for patients entering the palliative care phase of their illness and for patients resident in a local nursing care home. This scheme encouraged a multidisciplinary and collaborative approach and evidence showed this had a positive impact on the care patients received.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 April 2017

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

• All these patients had a named GP and a structured annual review to check their needs were being met. For those patients with the most complex needs, the named GP worked closely with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice had clear protocols in place to support the treatment of patients with long term conditions. The practice held records of the number of patients with long term conditions. These patients were seen at the surgery on a regular basis and invited to attend specialist nurse-led clinics as appropriate.
• The practice offered longer appointments to these patients and home visits were available when needed.
• Effective arrangements were in place to ensure patients with diabetes were invited for a review of their condition, with dedicated clinics provided by trained staff. For example, 98% of the patients on the diabetes register had an influenza immunization in the preceding 01 August 2015 to 31 March 2016, compared to local CCG average of 96% and national average of 95%.
• Nurse led clinics ensured annual reviews and regular checks for patients with asthma and chronic obstructive pulmonary disorder (COPD) were in place. The practice had clear objectives to reduce hospital admissions for respiratory conditions. 122 patients on the COPD register of which 117 patients had received an annual review. The practice had taken part in the formation and supported a COPD choir for patients.
• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The practice had 20 patients on its Proactive Care Scheme, under which all patients entering the palliative care phase of their illness are designated on the practice system so that all staff are aware of their ‘Special Patient’ status and services are prioritised for their care.

Updated 28 April 2017

The practice is rated as good for the care of 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, for example, children and young people who had a high number of A&E attendances.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals and we saw evidence to confirm this.
• The practice provided appointments outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• The practice delivered health talks at local schools and university student to raise awareness of lifestyle choices.
• Chlamydia screening was offered to all patients under 25 years of age. Take up of this reflected an appropriate focus on sexual health for a practice with a high student population with Moutlon surgery completing 320 screens during 2015-16.
• Immunisation rates for standard childhood immunisations were higher than local CCG and national averages. The practice provided flexible immunisation appointments.
• The practice supported a number of initiatives for families with children and young people, for example the practice offered a range of family planning services.
• Baby vaccination clinics and ante-natal clinics were held at the practice on a regular basis. Positive links with the community midwife team and liaison with health visitors formed a positive and collaborative approach.

• 82% of women aged between 25 - 64 years of age whose notes record that a cervical screening test has been performed in the preceding five years, was in line with the local CCG and the national average of 81%.

Updated 28 April 2017

The practice is rated as good for the care of 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. GPs were able to offer home visits to those patients who were unable to travel into the surgery. On-the-day or emergency appointments were available to those patients with complex or urgent needs.
• The practice had clear objectives to avoid hospital admissions where possible. Performance was regularly monitored and there was a Bereavement Protocol.
• GPs made home visits to elderly patients and ensured that patients’ medicines were reviewed regularly and where possible other routine tests were undertaken without the need for patient admission to hospital.
• Patients in this group had access to a dedicated telephone number at the practice, for use in an emergency.
• The practice undertook weekly ward rounds at a local care home for 60 residents. The practice worked with pharmacists and care home staff to create integrated services between health and social care.

Updated 28 April 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice had adjusted the services it offered to ensure that appointments were accessible, flexible and offered continuity of care. Extended opening hours are available until 8pm on Thursday evenings and between 8am and 11.15am each Saturday.
• The practice provided a health check to all new patients and carried out routine NHS health checks for patients aged 40 - 74 years.
• A full range of health promotion and screening that reflected the needs of this age group, for example smoking cessation and weight management.
• 68% of patients aged 60 to 69 years had been screened for bowel cancer in the last 30 months compared to 60% locally and 58% nationally.
• 83% of female patients aged 50 to 70 years had been screened for breast cancer in the last three years compared to 77% locally and 73% nationally.

Updated 28 April 2017

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

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. The practice carried out advance care planning for patients with dementia.
• The practice provided dedicated GP services to two specialist mental health units in the county.
• Staff had a good understanding of how to support patients with mental health needs and dementia and had received training in dementia awareness.
• 78% of patients diagnosed with dementia had their care reviewed in a face-to-face meeting in the last 12 months, compared to the local CCG average of 87% and the national average of 84%.
• For patients on the dementia register, the practice had a lead member of staff with responsibility for developing and improving delivery of services for patients with mental health and health promotion. Staff had received dementia awareness training.
• The patient participation group was leading plans for a local initiative to raise awareness of ‘dementia friendly’ options, within the practice and externally with community leaders.
• The practice had supported patients experiencing poor mental health about how to access support groups and voluntary organisations, with links to support services, such as counselling and referrals to the Improving Access to Psychological Therapies service (IAPT).
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01 April 2015 to 31 March 2016) was 92%, compared against the local CCG average of 91% and the national average of 89%.
• The practice had a system in place to follow up patients who had attended A&E where they may have been experiencing poor mental health.

Updated 28 April 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. For example, a number of patients registered at the practice were homeless people and the practice was able to recognise how services should be adapted to support the patient’s lifestyle. The practice provided dedicated GP services to residents at a homeless hostel.
• The practice offered longer appointments for patients with a learning disability. The practice had 32 patients registered with learning difficulties and 20 of these patients (66%) had received a health check in 2015/2016. The practice had made regular and repeated attempts to contact the remainder of the patients and had offered additional support to enable them to attend.

• The practice had recorded 207 carers on their register, which was approximately 2% of the total patient list, and had generated positive links with carers and community groups. A member of staff had taken on the role of carers champion. The practice held the Northamptonshire Carers Bronze Award since 2015 and further development work was planned, including an application for the Carers Silver Award.
• The practice regularly worked collaboratively with other health care professionals in the case management of vulnerable patients.
• The practice had a system in place to identify patients with a known disability, with staff able to create a ‘flag’ on the patient’s record. This ensured appropriate consideration was given to decisions about the patients circumstances.
• The practice informed vulnerable patients about how to access support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children and the protocol to follow for reporting concerns.
• 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. For example, the practice held weekly meetings to discuss patients who had not attended their appointment to follow up on any concerns as a result.