Archived: Moakes Medical Centre

Updated 26 August 2016

Moakes Medical Centre provides primary medical services, including minor surgery, to approximately 2,757 patients in Luton and surrounding areas. Services are provided on an Alternate Provider Medical Services (APMS) contract (a nationally agreed contract).

Services are delivered to patients from one registered location;

Moakes Medical Centre,

Marsh Farm Health Centre,

The Moakes, Luton, LU3 3SR.

The practice forms part of the Network Healthcare Solutions Limited (NHS Limited), a corporate group which provided primary medical services at eight locations across England. Executive management oversight is provided by NHS Limited, which include corporate business planning, performance monitoring and central functions such as human resource management, payroll and regular review and update of policies and processes.

The practice serves a population group with a noticeably different profile to the England average. For example, the practice had almost double the number of young people aged 0 - 4 years than the national average, with 14% compared to 8%.

Similarly, the practice had 37% of its practice population less than 18 years of age, compared to the England average of 26%.

For patients in the older age ranges, the practice had 5.4% of patients over 65 years of age, compared to the England average of 11.5%.

The population group served by the practice is recorded as being 82% White British (2011 Census data), with the level of deprivation of people living within the area being in the most deprived decile. Male life expectancy for the area is 75 years, which was lower than the CCG average of 78 years and the national England average of 79 years. For female patients life expectancy is 79 years, compared to the local CCG average of 82 years and the England average of 83 years.

The on-site practice team consists of two GPs, one male and one female, two, part-time, long-term locum nurses and one health care assistant. The practice manager is supported by a team of three staff who provide all reception and administrative functions.

The practice is open between 8am and 8pm Monday to Friday.

Appointments with a GP, nurse or health care assistant are available as follows;

• Monday, Wednesday and Friday 9am - 12pm and 3am - 6pm.
• Tuesday from 9am -12pm and 5pm - 8pm.
• Thursday from 9am - 12pm and 3pm - 8pm.

The practice offers extended hours for additional, pre-booked, appointments between 8am to 12pm Saturday morning.

Emergency appointments are available daily. A telephone consultation and call-back service is also available for those who need urgent advice.

Home visits are available to those patients who are unable to attend the surgery and the out-of-hours service is provided by Care UK, which can be accessed via the NHS 111 service. Information about the out-of-hours services was available in the practice waiting area, on the practice website and on the practice telephone answering service.

Updated 26 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Moakes Medical Centre on 05 July 2016. Overall the practice is rated as good.

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

• The practice had a clear vision and had recognised the particular needs of patients in the community it served.

• The practice had worked to create an open and transparent approach to safety. A clear system, which was made known to all staff, was in place for reporting and recording significant events.
• Risks to patients were identified, assessed and appropriately managed. For example, the practice implemented appropriate recruitment checks for new staff, undertook regular clinical reviews and followed up-to-date medicines management protocols. However, systems for processing deliveries of medicines should be improved. Additionally, thorough records for fire drills and building evacuation should be maintained.
• We saw that the staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff were supported to access development learning and routine training was provided to ensure they had the skills, knowledge and experience to deliver effective care and treatment.
• Feedback from patients was consistently positive. Patients we spoke with told us they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Comments from patients on the 27 completed CQC comment cards confirmed these views.
• Results from the GP Patient Survey January 2016 were generally positive, with some outcomes higher than local and national outcomes. For example, 79% of patients described their experience of the surgery as good.
• Information about services and how to complain or provide feedback was available in the waiting area and published on the practice website. Where appropriate improvements were made to the quality of care as a result of complaints and concerns. Outcomes from complaints were shared and learning opportunities identified as appropriate.
• The practice had only 0.5% of carers recorded from its patient list and should look to increase this number.
• Appointments were readily available. Urgent appointments were available the same day, although not always with the patients named or usual GP. For example, 72% of patients described their experience of making an appointment as good.
• The practice shared a purpose built, modern building with other care providers. They had access to good facilities and modern equipment in order to treat patients and meet their needs.

• There was a clear leadership structure and we noted there was positive outlook among the staff, with good levels of moral in the practice. Staff said they felt supported by management. The practice business plan should be updated to reflect local objectives.

• The practice proactively sought feedback from staff and patients in a variety of ways, which it acted on.

• The social prescribing project had enabled the practice to reach out to patients and offer support and advice to improve health and non-clinical elements of their lives.

• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvements are as follows:

• To implement a system to ensure that deliveries of medicines and vaccinations are refrigerated in accordance with appropriate guidelines and to maintain a written record of action taken.
• Records of fire drills and building evacuation arrangements should be maintained.
• The business development plan in place at the practice was corporately produced by the provider and would benefit from review and evaluation of progress against specific local objectives.
• The developmental outreach work, designed to identify and support patients with caring responsibilities should continue.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 August 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.

• 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 the most complex needs, the named GP worked constructively with relevant health and care professionals to deliver a multidisciplinary package of care.

• The practice had clear protocols in place to support the treatment of patients with long term conditions. The practice held records of the number of patients with long term conditions. These patients were seen at the surgery on a regular basis and invited to attend specialist, nurse-led clinics.

• The practice offered longer appointments to these patients and home visits were available when needed.

• Arrangements were in place to ensure patients with diabetes were invited for a review of their condition twice yearly.

• 96% of the patients on the diabetes register had influenza immunization in the preceding 01 August 2014 to 31 March 2015.

• Nurse led clinics ensured annual reviews and regular checks for patients with asthma and COPD were in place. The practice had clear objectives to reduce hospital admissions for respiratory conditions. All patients who were admitted to hospital were reviewed by the practice respiratory nurse after discharge.

Updated 26 August 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.

• 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.

• 81% of women aged between 25 - 64 years of age whose notes record that a cervical screening test has been performed in the preceding five years, was in line with the local CCG average of 80% and the national average of 82%.

• The practice provided appointments 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.

• Immunisation rates for all standard childhood immunisations were broadly similar to local CCG performance averages. The practice provided flexible immunisation appointments.

• The practice supported a number of initiatives for families with children and young people, for example the practice offered a range of family planning services. Baby vaccination clinics and ante-natal clinics were held at the practice on a regular basis. A community midwife held a clinic at the practice on a weekly basis.

Updated 26 August 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. GPs were able to offer home visits to those patients who are unable to travel into the surgery. On-the-day or emergency appointments were available to those patients with complex or urgent needs.

• The practice had clear objectives to avoid hospital admissions where possible. For example, when GPs visited patients who lived in residential care homes they ensured that patient medication was reviewed regularly and other routine tests were undertaken without the need for patient admission to hospital.

Updated 26 August 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• As the practice had a high percentage of working age patients, they focused on their needs through analysis of patient surveys and feedback from the Patient Participation Group (PPG). 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 on line services as well as a full range of health promotion and screening that reflects the needs for this age group.
• The practice offered easy access to telephone appointments and telephone consultations.
• The practice provided a health check to all new patients and carried out routine NHS health checks for patients aged 40 - 74 years.
• The practice was proactive in offering on line services such as appointment booking, an appointment reminder text messaging service and repeat prescriptions, as well as a full range of health promotion and screening that reflects the needs of this age group.
• The practice offered extended opening hours, from 8am until 8pm Monday to Friday and from 8am until 12pm midday on Saturday morning.
• The practice provided an electronic prescribing service (EPS) which enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.

Updated 26 August 2016

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

• 75% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was slightly below the local CCG average of 81% and the national average of 84%.
• 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, including access to a counsellor, who held regular appointments at the practice.
• Patients were actively referred to the Improving Access to Psychological Therapies service (IAPT) and the practice encouraged patients to self-refer.
• The practice had supported 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 26 August 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, such as homeless people, travellers and those with a learning disability. The practice recorded 134 patients on its register and had completed health reviews for 56 patients in 2015/2016.
• The practice offered longer appointments for patients with a learning disability. GPs also visited patients who lived at local care homes when they were unable to travel to the practice for an appointment.
• The practice had recorded only 14 carers recorded on their register, which represented 0.5% of the total patient list. To address this low recorded figure the practice had recently supported a member of staff to be trained as a carers ‘champion’, in order to raise awareness of the issues faced by carers and improve services available to them.

• The practice regularly worked positively and collaboratively 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.