Archived: Rainbow Surgery

Updated 28 March 2017

Rainbow Surgery is semi-rural practice situated in Ramsey, Cambridgeshire and serves the population of Ramsey as well as some of its surrounding villages. The practice provides an on-site dispensing service for any of its patients living more than one mile away from a pharmacy / chemist.

The practice is run by two GP partners (one male and one female). The practice employs four regular male locum GPs, two practice nurses and two health care assistants/receptionists as well as the practice manager, an information technology manager, medical secretaries and a team of reception /administration staff. The practice holds a General Medical Service (GMS) contract to provide GP services to a population of 4,633 patients, which is commissioned by NHS England. A GMS contract is a nationally negotiated contract to provide care to patients. In addition, the practice also offers a range of enhanced services commissioned by their local CCG: facilitating timely diagnosis and support for people with dementia and extended hours access.

According to Public Health England information, the practice age profile has higher percentages of patients from 0 to 19 years and 40 to 59 years compared to the practice average across England. It has lower percentages of patients aged 20 to 39 years and 75 years and over.

The practice is open between 8am and 6pm Monday to Friday. Extended hours appointments are offered from 7am to 8am Thursday mornings. In addition to pre-bookable appointments that can be booked up to six weeks in advance, urgent appointments are also available for people that need them. Where patients request an appointment on the day, contact details are transferred to the GPs. The patient is then contacted that morning and where required an appointment is allocated with the most appropriate clinician. Telephone consultations are available for patients that wish to use this service.

Out-of-hours care is provided via the NHS111 service. The practice has undergone a period of change in the past year. The practice was a three GP partner practice. Following the relocation of one GP partner in spring 2016, the patient list at the practice was closed in September 2016 with permission from NHS England, due to high demand in the area and low doctor-patient ratio. The practice is part of a sustainability initiative from local CCG managers, to see how to support practices through GP recruitment issues.

Updated 28 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rainbow Surgery on 13 September 2016. The overall rating for the practice was good, with requires improvement for the safe domain. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Rainbow Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 21 February 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 13 September 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• The practice had obtained a new medicine refrigerator. Records of medicine refrigerator temperatures were being appropriately completed. Written procedures were amended to reflect the correct temperature range for the storage of medicines requiring refrigeration.

• Controlled drugs (medicines that require extra checks and special storage arrangements because of their potential for misuse) were being monitored weekly in line with published guidance. However, the provider informed us that the practice no longer intended to keep higher scheduled controlled drugs.

• The practice had considered the risks around the open-plan nature of the dispensary and taken action to the raise awareness of staff about the risks of non-authorised access to medicines. This was to be reviewed annually. Medicine stock-takes were in place which would highlight medicine discrepancies if they occurred.

• The practice had put in place systems which included a written procedure to ensure there was written authorisation in place for the administration of medicines such as injectable vitamin B12 and influenza vaccines by nursing and healthcare staff.

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

The provider should:

• Continue to risk assess and monitor arrangements in place for the security of medicines in the dispensary area.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 December 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 practice used the information collected for the Quality and Outcomes Framework (QOF) to monitor outcomes for patients (QOF is a system intended to improve the quality of general practice and reward good practice). Data from 2014/2015 showed that the performance for diabetes related indicators was also better than local and national averages with the practice achieving 96%; this was 6 percentage points above both the local and national averages. The rate of exception reporting was also in line with the local and national averages.

• Longer appointments and home visits were available when needed.

• Patients had a named GP and a structured annual review to 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.

• The practice had set up stroke, dementia and Parkinson’s support groups, an armchair exercise group and a men’s weight reduction group. The men’s weight group had six members at the time of our inspection with a reported average of seven pounds in weight loss per member since December 2015. The practice provided these groups for the whole community in addition to their own patients.

• The practice had administered flu vaccinations to 74% of patients on the practice at risk register during the 2015 to 2016 flu vaccination clinics.

Updated 9 December 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 in-line for all standard childhood immunisations. Childhood immunisation rates for the vaccinations given were comparable to local/national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 69% to 98%, which was comparable to the CCG average of 52% to 96% and five year olds from 92% to 94%, which was comparable to the CCG average of 88% to 95%.

• 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’s uptake for the cervical screening programme was 93%, which was above the local average and the national average of 82%. There were failsafe systems in place to ensure results were received for all samples sent for the cervical screening programme and the practice followed up women who were referred as a result of abnormal results.

• 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, health visitors and school nurses.

Updated 9 December 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.

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

• The practice worked closely with the multi-disciplinary team, out-of-hours and the nursing team to ensure proactive palliative care planning.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure were above local and national averages.

• The practice looked after patients living in local nursing homes. GPs undertook regular visits and visited patients as and when required.

• The practice provided rooms for many specialist consultations, this was to bring care closer to the patient’s home and allow them to be seen in the practice. These included a weekly Parkinson’s specialist nurse clinic, a weekly anti-coagulation clinic, and an ultrasound clinic and diabetic eye screening clinic twice a month. This saved patients having to attend the community clinic or hospital.

• The practice had administered flu vaccination to 90% of patients aged over 65 years old during the 2015 to 2016 flu vaccination clinics.

Updated 9 December 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.

• 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.

• The practice encouraged its patients to attend national screening programmes for bowel and breast cancer screening. The bowel cancer screening rate for the past 30 months was 62% of the target population, which was above the CCG average of 59% and the national average of 58%.The breast cancer screening rate for the past 36 months was 58% of the target population, which was below the CCG and the national average of 72%. Following the inspection the practice submitted data which had not been validated, but demonstrated the practice breast screening rates had improved.

• The practice supported a number of self help and support groups. The practice encouraged patients with high blood pressure and thyroid conditions to self-manage and patients submitted regular recordings of their results for the GPs to review. This saved patients having to attend for unnecessary appointments.

Updated 9 December 2016

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

• 34 of the 36 patients diagnosed with dementia on the practice dementia register had a care plan in place. 35 had their care reviewed in a face to face meeting in the last 12 months.

• 15 of the 20 patients identified on the practice mental health register had received a health check in the past twelve months with one patient excepted and four patients scheduled to be seen. The practice referred patients to various support services as required.

• 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 had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 9 December 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 had identified 17 patients with a learning disability on the practice register, and all 17 patients had received a health check. The practice referred patients to various support services as required.

• 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.

• 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.