Archived: Lakeside Healthcare at Bourne

Updated 8 June 2018

Hereward Group Practice (www.herewardgp.co.uk) provides primary medical services to approximately 12,600 patients.

The practice has a General Medical Services Contract (GMS). The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities.

Hereward Group Practice is a two storey building situated in Bourne, Lincolnshire. It has car-parking facilities with spaces for patients with a disability. The practice has automatic doors at the entrance. Toilet facilities are available which includes disabled access.

The practice provides dispensary services to 29% of those patients on the practice list who live more than one mile (1.6km) from their nearest pharmacy. The practice also provides a delivery service and has four medicine collection points where patients can collect their medicines.

The practice team consists of five GP partners (one female and four male), two salaried female GPs, and one GP registrar. The practice employed three nurses, two paramedics and two-advanced nurse practitioners working with five health care assistants. The clinical team work alongside a practice manager, an assistant practice manager and a team of administration and reception staff.

The practice is located within the area covered by South Lincolnshire Clinical Commissioning Group (CCG). The CCG is responsible for commissioning services from the practice. A CCG is an organisation that brings together local GP’s and experienced health professionals to take on commissioning responsibilities for local health services.

We inspected the following location where regulated activities are provided:-

Hereward Group Practice, Exeter Street, Bourne, Lincs. PE10 9XR

The practice is open between 8am and 6.30pm Monday to Friday. A range of GP appointments are available from 8.40am to 5.40pm Monday to Friday. Nurse Appointments from 8.40am to 6pm Monday to Friday and Health Care Assistant from 8am to 4.30pm Monday to Friday.

Extended hours appointments are offered on a Saturday morning from 8am to 12 midday. In addition to pre-bookable appointments that could be booked up to four weeks in advance, urgent appointments were also available for people that needed them.

Hereward Group Practice had opted out of providing out-of-hours services (OOH) to their own patients. The OOH service is provided by Lincolnshire Community Health Services NHS Trust.

Updated 8 June 2018

This practice is rated as good overall (at the previous inspection undertaken in 12 October 2016, the practice received a good overall rating).

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Hereward Group Practice on 28 February 2018 and 27 March 2018. This inspection was carried out under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• There was a structured approach to risk within the practice and this was well managed by the leadership team.
• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• GPs and practice staff worked effectively as a cohesive team and provided personalised and responsive care to their patients.
• There was a walk in surgery on Monday mornings and extended hours every Saturday morning to alloy for flexibility in the way appointments were available.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• In response to some GPs leaving employment with the practice, there was the introduction of an ‘Acute Illness team’, which increased the number of appointments and allowed for the reception team to book the most appropriate clinician for the patients need.
• There was a clear leadership structure and staff told us they felt well supported by the partners and practice manager. We observed the positive impact this had in establishing a well-integrated practice team.

We saw the following areas of outstanding practice:

• The practice had implemented a quality management system to ensure each part of the practice was achieving the required standards.

However there were areas of practice where the provider should make improvements:

• Review the levels of patient satisfaction, and continue to improve in relation to access to the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 November 2016

The practice is rated as good for the care of 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.

• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 150/90 mmHg or less was 93.5% which was same as the CCG average and 2.2% above the national average. Exception reporting was 2.7% which was 1.8% below the CCG average and 2.8% below national average.

• The percentage of patients with asthma, on the register, who had an asthma review in the preceding 12 months that included an assessment of asthma was 83.5% which was 5.5% above the CCG average and 8% above the national average. Exception reporting was 2.3% which was 0.8% below the CCG average and 5.6% below national average.

• The percentage of patients with hypertension in whom the last blood pressure reading (measured in the preceding 12 months) was 150/90 mmHg or less was 87% which was 0.5% above the CCG average and 4.1% above the national average. Exception reporting was 3.6% which was 0.5% above the CCG average and 0.3% below national average.

• The practice provided a blood pressure machine in one of the waiting areas so that patients could take their own blood pressure and present the readings at reception to be entered on their record.

• Longer appointments and home visits were available when needed. Home visits are carried out for patients who are unable to attend the practice for routine blood tests.

• Patients had a named GP and the practice had a system in place for recalling patients for a structure annual review to check their health and medicines needs were being met.

Updated 24 November 2016

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.

• Immunisation rates were relatively high for all standard childhood immunisations.

• The practice were signed up to the C-Card Scheme and all staff had been trained. This scheme enables the practice to give free contraception, for example, condoms to young people aged 13-24.

• The practice’s uptake for the cervical screening programme was 82% which was slightly below the CCG average of 84 % and the same as the national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice had an Under 12 walk in clinic on a Monday morning which is run in conjunction with a walk-in surgery.

• We saw positive examples of joint working with health visitors and school nurses.

Updated 24 November 2016

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.

• 10% of the practice population were older people (age 65 and over).

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• 1.53% of patients who had been assessed as being at risk had a care plan in place which was below the required national target of 2%.

• Each GP partner had responsibility for a local care home. The practice had eight care homes with patients registered with the practice. A GP partner was lead for intermediate care. The practice had joint responsibility for intermediate care beds used for hospital discharges. A MDT meeting took place weekly to review the patients.

• The practice provide a medicine delivery service to patient’s homes twice a week.

Updated 24 November 2016

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. For example extended hours on a Monday evening and Saturday morning. A minor injury service was available during practice opening hours.

• Health care assistants offer early morning appointments for blood tests for those patients who work.

• The Hereward Group practice prescription service offers patients who work the option to have their medicines delivered to their home by post.

• Minor surgery clinics are held at the practice to reduce the need for patients to be referred to secondary care.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 24 November 2016

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

• The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was 92.5% which was 4.8% above the CCG average and 8.7% above the national average. Exception reporting was 2.2% which was 2.3% below the CCG average and 5.3% below the national average.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 94% compared to a national average of 88%.

• The percentage of patients 18 or over with a new diagnosis of depression who had been reviewed not earlier than 10days but not later than 56 days after the date of diagnosis was 86.5%. This was 2.1% above the CCG average and 3.5% above the national average.

• 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. For example, In house counsellors and referrals to Addaction for patients who experience alcohol and substance misuse problems.

• Staff had a good understanding of how to support patients with mental health needs and dementia. All staff had received mental capacity and dementia awareness training.

Updated 24 November 2016

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 including homeless people, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• 59% of patients on the palliative care register had had their care reviewed in the last 12 months. We found that the system in place for palliative care monitoring had been reviewed over the past two months by a new lead GP. The lead GP had identified that further work needed to be carried out to patients on the palliative care register were reviewed at least yearly and ensure that all care plans were routinely reviewed and updated for patients with complex needs.

• 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 in normal working hours and out of hours.