Colne Medical Centre

Updated 23 December 2016

Colne Medical Centre has a main surgery in Brightlingsea and a branch surgery in Alresford to approximately 10168 patients. The practice population live in the Brightlingsea, Alresford and surrounding rural areas. They hold a General Medical Service (GMS) contract for the services they provide. The practice provides a dispensing service open daily from their branch practice to 912 patients this equates to 9% of their patient population. They are well-established and have been a training practice for 23 years, helping qualified doctors, known as registrars, complete the final stages of their GP Training. Deprivation is low in the practice area in comparison with other local and national GP practices.

The practice is registered as a partnership of four male GPs. The GPs are supported by two female nurse practitioners, two female practice nurses, three female healthcare assistants and one female Phlebotomist. The dispensary team comprises two part time dispensers. The management and administration staff comprised a practice manager and twelve other staff with a range of roles, secretaries, scanners, audit clerks, administrators and receptionists. The staff members work a combination of full and part time hours.

The main practice opening hours are from 8am to 12.30pm closed for lunch and then open again from 1.30pm to 6pm. There is an open surgery each morning from 8.30am to 10am and some bookable appointments for the GP registrar’s each morning. There are pre-bookable appointments, with some urgent appointments available on the day. There are also emergency and telephone call appointments available by request. The branch practice opens Monday, Tuesday, Thursday and Friday from 3pm to 5pm and on Wednesday from 8.30am to 10.30am.

The practice has opted out of providing GP out of hour’s services. Patients calling the practice outside normal practice working hours are advised by the answerphone message to contact the 111 non-emergency services. Patients requiring urgent treatment are advised to contact the out of hour’s service which is provided by Care UK.

Updated 23 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Colne Medical Centre on 11 October 2016. Overall the practice is rated as good.

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

• Staff members knew how to raise concerns, and report safety incidents. Safety information was recorded and any learning identified was shared with staff members.
• Risks to patients and staff members were assessed and documented regularly including those associated with; premises, equipment, medicines, fire safety, and infection control.
• Patient care and treatment was planned using recommended current clinical guidance.
• Patient comments were enthusiastic and positive about the practice.
• The practice patient participation group (PPG) could demonstrate their involvement with practice development.
• Information regarding how to complain was available at the practice and on their website.
• Patients told us there were urgent appointments available on the day they requested.
• The practice had appropriate facilities and equipment to treat patients and meet their health and treatment needs.
• Staff members told us they were supported in their working roles by the practice management and the GPs.
• Prescriptions waiting to be collected were not stored securely.
• The dispensary processes and procedures were suitable to keep people safe. However staff members including the four nurses we spoke with could not tell us what to do if the refrigerators they were monitoring were found outside the limits of cold storage medicines.
• The leadership structure was clear and staff felt supported by management.

The areas where the provider should make improvements:

• Ensure prescriptions waiting to be collected are stored securely.
• Ensure all staff members recording the temperature of refrigerators know what to do if they find them outside the limits for cold storage of medicine.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 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.

Diabetic quality data from 2015 to 2016 showed:

• The percentage of patients with diabetes, on the register, in whom the last IFCCHbA1c is 64 mmol/mol or less in the preceding 12 months, was 73% (local practices 75% and nationally 79%).
• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less was 82% (local practices 78% and nationally 77%).

Other services provided by the practice for this population group were:

• Longer appointments and home visits when needed.
• A named GP and a structured annual review to check their health and medicine requirements were being maintained and met.
• A patient’s named GP worked with relevant health and social care professionals to deliver a multidisciplinary package of care.
• The practice nurses had received specialist training in diabetes, asthma, and chronic obstructive pulmonary disease, to support the GPs manage long term condition patients.
• GP written alerts were designed to ensure patient’s received the blood tests, and diagnostic checks required before repeat prescriptions were provided.
• There was a practice based blood taking service to support patients in this population group that would struggle to access local hospital blood taking clinics.

Regular drug monitoring searches were undertaken for patients taking high risk medicine and medicines that required extra monitoring. This ensured patients’ conditions could be kept stable when taking these medicines.

Updated 23 December 2016

The practice is rated as good for the care of families, children and young people.

• There were systems in place to follow up children living in disadvantaged circumstances or at risk; for example, children and young people who had experienced a high number of A&E attendances.
• Immunisation rates were high for all standard childhood immunisations in comparison with practices locally and nationally.
• Parents of children we spoke with told us they were treated in an age-appropriate manner; that questions were encouraged, and easy to understand language was used during consultations to explain treatment.
• Patients aged 25-64, attending cervical screening within the target period of 3.5 or 5.5 years coverage was .
• Appointments were accessible outside school hours.
• We were told by the practice nurses there was positive joint working with community professionals; for example space for the community midwives providing regular clinics. The GPs provided post-natal and six week baby checks.
• On-line appointments were available for both advanced and on the day appointments.

The practice told us they ensured all babies, children and young people were seen on the day, this included a number of urgent appointments available each afternoon.

Updated 23 December 2016

The practice is rated as good for the care of older people.

• The practice was responsive to the needs of older people, and offered them home visits and urgent appointments when needed or requested. The practice employed a senior nurse to specifically provide home visiting to frail elderly patients to provide blood pressure check, dementia reviews, flu vaccinations, ear syringing, diabetes reviews and hospital admission avoidance reviews to this population group.
• All older people had a named GP assigned to them and informed who this was.
• GP written alerts ensured patient treatment reviews were not missed.
• A standing agenda item during the palliative care meetings was to discuss frail patients to understand patients that could be deteriorating. These discussions ensured patients in the final year of their life had agreed treatment plans recorded with patients’ wishes.
• Senior health checks were booked and offered to patients, on an ad hoc basis to maximise the uptake.
• The premises were wheelchair accessible, there were downstairs clinical rooms and there was a lift to access the first floor clinical rooms.

The branch surgery building was all on one level.

Updated 23 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 at the practice and they had adjusted the services offered to ensure they were accessible, flexible and provided continuity of care.
• Although the practice did not offer extended hours they did offer on-line services to support working patients and telephone consultations both morning and afternoon. Those that had requested the service received text messages regarding the results of any tests they had received. These telephone details were checked with patients when they received their test to check they were correct.
• There was a full range of health promotion and patient screening that reflected the needs of this population group.
• Private employment medicals and insurance reports were available, to support patients that required them for work.

The ability to book on-line appointments and request repeat prescription services gave patients access when needed so they could arrange their time around their health requirements.

Updated 23 December 2016

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

Mental health quality data from 2015 to 2016 showed, the practice performance was higher than the national and local practice averages for example:

• 87% 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 (compared with 76% locally and 78% nationally).
• 83% of patients diagnosed with dementia that had their care reviewed in a face to face meeting in the last 12 months at the practice, (compared with 73% locally and 72% nationally).

Other services provided by the practice for this population group were

• Working with multi-disciplinary teams in the case management of patients experiencing poor mental health, and included those with dementia.
• The practice had told patients experiencing poor mental health how to access various support groups and voluntary organisations such as ‘Health in Mind’ and ‘IAPT’ services.
• The practice followed up patients who had attended accident and emergency that may have been experiencing poor mental health.
• Staff had an understanding of how to support patients with mental health needs and dementia.
• Patients with mental health issues had an appropriate GP written alert placed on their records; this allowed staff members to recognise any extra needs these patients needed.
• The practice told us they offered patients in this population group on the day appointments to ensure patients in mental health crisis could access a clinician and receive the support they needed.

Practice staff members told us they would find a suitable quiet area for patients to wait if they were feeling anxious, depressed, or too unwell to wait in a busy waiting room.

Updated 23 December 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice clinical members of staff worked with other health care professionals in the case management of vulnerable patients. They worked closely with local care homes to provide, treatment planning, and home visits when needed.
• The practice had identified 109 patients living in vulnerable circumstances this included those with a learning disability, homeless people or travellers.
• There were 46 patients identified by the practice as living with a learning disability and they had all been offered an annual assessment and health check. The practice also offered longer appointments for patients with a learning disability.
• The practice provided information to vulnerable patients about how to access various support groups and voluntary organisations.

Staff knew how to recognise the signs of abuse in vulnerable adults and children. They were aware of their responsibilities concerning the sharing of information and the documentation of safeguarding concerns. The practice safe guarding policy set out the details about how to contact the relevant local agencies during normal working hours and out of hours for staff members.