Archived: Quayside Medical Centre

Updated 26 March 2015

Quayside Medical Centre, 76b Cleethorpe Road, Grimsby, North East Lincolnshire is situated in the centre of Grimsby. This is an inner city practice working with approximately 2,600 patients in the most deprived decile. The practice has 0.95 WTE GPs (three GPs, one salaried and two long term locums, covering four days a week and a locum covering Wednesdays. An additional GP joins the practice in March 2015. Nursing staff are reduced to one nurse doing five hours a week due to a recent unplanned nurse vacancy. An additional five hours of nursing time commences in February 2015. The practice also has a part time health care assistant and phlebotomist. This equates to over 2,600 patients per WTE GP.

The practice has an APMS contract.

The CQC intelligent monitoring placed the practice in band 4. The intelligent monitoring tool draws on existing national data sources and includes indicators covering a range of GP practice activity and patient experience including the Quality Outcomes Framework (QOF) and the National Patient Survey. Based on the indicators, each GP practice has been categorised into one of six priority bands, with band six representing the best performance band. This banding is not a judgement on the quality of care being given by the GP practice; this only comes after a CQC inspection has taken place.

Updated 26 March 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Quayside Medical Centre on 19 January 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well-led services. It was also good for providing services for the population groups of older people, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable, people experiencing poor mental health (including people with dementia).  It requires improvement for the population group of people with long-term conditions.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and prioritised.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Most staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Most patients said the appointment system was satisfactory, although not all patients reported continuity of care due to the use of locums on certain days. Most patients said they could be seen in an emergency but they may have to wait.
• 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.

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

Importantly the provider should:

• Ensure that full cycle clinical audits are completed.
• Ensure the safeguarding lead is trained to Level 3 in safeguarding adults and children.
• Ensure GPs are involved and aware of the practice business plan.
• Ensure that where applicable, that care plans for patients are used.
• Ensure vacant posts are filled in a timely manner so as not to impact on patient care.
• Ensure all clinical staff meet on a regular basis as a team.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 March 2015

The practice is rated as requiring improvement for the care of people with long-term conditions. The nurse and health care assistant had had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. The provision of in-house smoking cessation clinics and health trainers were available to provide lifestyle advice to patients. However, we were told by some clinical staff that use of care plans was low. The chronic disease register was reviewed monthly to ensure patients were invited to the practice for the appropriate health checks.  For those people with the most complex needs, the practice worked with relevant health and care professionals to deliver a multidisciplinary package of care. Patients could access appointments through drop-in clinics, advanced bookable appointments or telephone consultation.

Updated 26 March 2015

The practice is rated as good for the care of families, children and young people. A large percentage of the practice demographic fall within this population group. Staff recognised signs of abuse or neglect in this group and knew how to escalate or refer those concerns. The practice had good links with the Local Authority safeguarding team. 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. The practice proactively worked with the Asgard project in Grimsby, a project set up to improve the health and well-being of disadvantaged young people in the area. At the time of the inspection immunisation rates were 100%. Appointments were available outside of school hours and the premises were suitable for children and babies. On site sexual health and maternity services were not available at the practice but we were told good facilities were available in the area which patients were signposted to. We were told the practice had good access to local drug and alcohol services. We were told the practice had fractured relationships with the health visiting team following a restructure of their team. Patients could access appointments through drop-in clinics, advanced bookable appointments or telephone consultation.

Updated 26 March 2015

The practice is rated as good for the care of older people. Staff recognised signs of abuse or neglect in older people and knew how to escalate or refer those concerns. Carer status was recorded and when identified were recorded on patient notes and invited for a health check. An action plan for the care of the over 75’s was in place and 44 out of the 49 patients had a care plan in place that had been reviewed. However, we were told by some clinical staff that care plans were not being used as well as they should. Nationally reported data showed that outcomes for patients were good for conditions commonly found in 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. The practice offered mini mental tests to patients as part of dementia screening. The feedback received from patients in this population group was excellent. Patients could access appointments through drop-in clinics, advanced bookable appointments or telephone consultation.

Updated 26 March 2015

GOOD

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 and flexible. Health checks were available and promoted at the practice for patients in this group. We saw that HGV medicals were made available for heavy goods vehicle workers at weekends. The practice was proactive in offering online services. The practice used a system called MJOG which was a text based service which allowed patients to send and receive texts from the surgery using their mobile phones.  This system allowed the patient to book, cancel and change appointments via text message, as well as ordering repeat prescriptions. Patients could access appointments through drop-in clinics, advanced bookable appointments or telephone consultation.

Updated 26 March 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Data showed 100% people experiencing poor mental health had received an annual physical health check and 90.48% of patients had received an assessment for depression. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It 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 including MIND and SANE. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on the Mental Capacity Act 2005.

Updated 26 March 2015

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 and those with a learning disability. It had carried out annual health checks and longer appointments for people with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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.