Dr Lindsay Mackenzie Also known as Wootton Vale Healthy Living Centre

Updated 3 November 2016

Wootton Vale Healthy Living Centre; led by Dr Lindsay MacKenzie provide primary medical services; including minor surgery, to approximately 5,000 patients from a modular building in Wootton, Bedfordshire. Services are provided on a General Medical Services (GMS) contract which is a nationally agreed contract between general practices and NHS England for delivering general medical services to local communities.

The practice has operated from these temporary facilities since its establishment in 2006. The building serves patients on one level with sufficient consultation and treatment rooms available. Access for patients with reduced mobility and parents and/or carers using pushchairs is adequate.

The practice team serve both practices and consist of one female GP Partner, two salaried GPs; one male and one female, and several regular locum GPs. Additional clinical staff include one advanced nurse practitioner who is an independent prescriber, two practice nurses, a regular nurse locum, two health care co-ordinators; (one currently in training), a phlebotomist (currently undergoing training to become a health care assistant, an assistant practitioner who is a trainee student nurse and a clinical manager. The non-clinical team is made of a business director and an administration manager supported by 10 administrative staff.

The practice serves a lower than average population of those aged 75 years and over; approximately 4% of the practice population and higher than average population of those aged between 0 to 18 years; approximately 28% of the practice population. Approximately 10% of the population is aged below 5 years. The population is predominately white British (2013 Census data) and the area served is less deprived compared to England as a whole.

The Wootton Vale Healthy Living Centre is open between 8.15am and 12.30pm and between 2pm and 6.30pm Monday to Friday. Patients can contact reception by telephone between 8am and 6.30pm. The practice offers extended hours appointments until 8pm on Tuesdays and Thursdays. In addition, pre-bookable appointments are available between 8.30am and 11.30am Monday to Friday and between 3pm and 6pm on Monday, Tuesdays, Thursdays and Fridays. The practice offers additional clinic appointments on Tuesdays from 6.30pm until 7.40pm and on Thursdays from 6.30pm until 8pm.

The services provided at this location include midwifery, childhood immunisations, childhood surveillance, minor surgery, travel clinics, joint injections, cryotherapy, family planning, antenatal/postnatal care, sexual health, diagnostic and screening procedures, cervical screening, immunisations and minor illness.

Patients who require the services of a GP when practice is closed, are advised to contact the surgery and a recorded message gives details of how to contact the clinician on call or the ‘out of hours’ service. The out of hours service is provided by Bedford Doctors on Call (BEDOC). Information about this is available in the practice and on the practice website and telephone line.

Updated 3 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wootton Vale Healthy Living Centre; Dr Lindsay Mackenzie on 27 April 2016. Overall the practice is rated as Good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• 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.
• Feedback from patients about their care was consistently positive.
• 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
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs.
• The practice had good facilities and was well equipped to treat patients.
• The practice actively reviewed complaints and assessed how they were managed. They responded to complaints, ensuring improvements and changes took place 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 provider was aware of and complied with the requirements of the duty of candour.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw several areas of outstanding practice including:

The practice employed two healthcare coordinators. This role provided the link between clinicians and patients to offer support and advice in areas such as smoking cessation, support for patients diagnosed with cancer, referring patients to secondary care and identifying and supporting carers.

The practice‘s vision is to facilitate provision of care and services in a community setting. We saw numerous examples of how it has achieved this including the following:

• The lead GP had undertaken a redesign of the clinical team to ensure a quality service was provided and had developed a Women’s Health Practitioner role to support women’s health and provide sexual health advice to men and women.
• The practice managed an integrated gynaecology service, commissioned by Bedfordshire Clinical Commissioning Group (BCCG) for surrounding practices. This service allows women to receive treatment and tests in a primary care setting, reducing the need for hospital attendance with the exception of surgical procedures.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 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 for example, diabetes, asthma and chronic obstructive pulmonary disease (COPD) and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was higher than local and national averages. For example, the percentage of patients with diabetes, on the practice register, in whom the last HbA1c was 64mmol/mol or less in the preceding 12 months was 87% compared to local CCG average of 76% and national average of 78%.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with more complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• Asthma care audits were used to identify patients who would benefit from additional support and more frequent reviews.
• The practice was keen to offer support for patients suffering from neurological conditions such as, multiple sclerosis and Parkinson’s disease. They liaised with specialist nurses and provided dedicated clinical space. This service was offered to patients from the practice as well as patients from the surrounding area.
• There was a robust recall system in place to monitor patients in this group.
• Patients benefitted from access to on-site specialist services. For example, access to a dedicated respiratory nurse, dermatology GP and a Women’s health nurse specialist.
• NHS Health checks were used to identify patients at risk of developing long term conditions. These patients were then provided with further treatment and support as necessary.
• Dementia assessments were performed at annual reviews for patients suffering from long term conditions.

Updated 3 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 higher number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• 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 88%, which was higher than the CCG average of 83% and the national average of 82%.
• 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 and health visitors, including clinics held on site and attending meetings.
• The practice frequently undertook safeguarding audits, attended monthly meetings and worked with other agencies to support children and families at risk.

Updated 3 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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Monthly combined palliative care and unplanned hospital admission meetings were held with community services to provide a multidisciplinary package of care to these patients.
• The practice worked closely with community matron to provide care for patients in this group.
• An information sheet was available signposting older patients to services available both in the practice and externally.

• The local pharmacist provided a same day medication delivery service for patients unable to collect their medicines from the pharmacy.
• A hearing advisory service was available at the practice.

Updated 3 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.
• The practice had developed a women’s health practitioner role to support women's health and provide sexual health advice to men and women.
• 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.
• Late appointments and telephone advice were available for patients unable to attend the practice in normal working hours.
• In addition the practice offered the Electronic Prescription Service (EPS) and SMS text message reminders.

Updated 3 November 2016

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

• The practice held registers of patients suffering from poor mental health and those with dementia.
• 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the 12 months preceding our inspection. This was above the CCG average of 84% and the national average of 84%.
• Performance for mental health related indicators was also above local and national averages. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in their patient record in the preceding 12 months was 100%;
• 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, including MIND, SEND and local advocacy services.
• 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. The practice had developed a family orientated approach to mental health problems in children and parents. Safeguarding meetings were held every 6 weeks, attended by health visitors to ensure families were given support, especially in cases where women were showing signs of post-natal depression.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• Mental health reviews were completed and medication monitoring systems were in place and facilitated through corroborative working with local mental health services.
• Patients could be referred to external support services for example, the lifestyle hub, cognitive behavioural therapy and addiction support services.
• The practice offered space for mental health professionals to see patients who needed to be seen in a more local environment including CALS (alcohol workers) and Changing Faces (disfigurement camouflage).
• A project was planned to screen patients for early signs of dementia and refer to services for diagnosis.

Updated 3 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. They adapted services where possible to facilitate the needs of these vulnerable groups. Where appropriate used the health care coordinators to support and sign post patients.
• The practice offered longer appointments, annual reviews and personalised care plans 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.
• Patients who required additional support with drug and alcohol addictions and were unable to travel to specialist clinics were seen in the practice by local support groups for example, the Pathway 2 Recovery service.
• 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.
• Priority appointments were available for patients registered as carers, who were also offered regular health assessments.
• Electronic alerts on the clinical system ensured vulnerable patients were quickly identifiable.
• Translation services and British Sign Language (BSL) interpretation was available through an external agency.
• The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 127 patients as carers (2.4% of the practice list) whose ages ranged from 17 to 93 years of age.
• The practice provided support to carers including offering flexible appointments and assistance with carers assessments, applying for benefits and advice on advanced care plans.