Preston Grove Medical Centre - Yeovil

Updated 10 August 2017

Preston Grove Medical Centre is located in the town of Yeovil. The practice serves a local population of approximately 12,360 patients from the town and the surrounding area. The report relates to the Regulated Activities carried out at:

Preston Grove Medical Centre

Preston Grove

Yeovil

Somerset

BA20 2BQ

There is parking on site including spaces for patients with a disability.

The practice has eight GPs, seven of which are partners. Between them they provide forty nine GP sessions each week and are equivalent to 5.8 whole time employees (WTE). Four GPs are female and four are male. There are ten practice nurses, whose working hours are equivalent to 5.25 WTE, including five non-medical prescribers who offer nineteen sessions per week.

Three health care assistants (known as health technicians) are also employed by the practice with combined hours of 1.7 WTE. The GPs and nurses are supported by twenty three management and administrative staff including business, performance and office managers and department managers and team leaders for clinical systems, reception and administration.

The practices patient population is expanding and has slightly fewer patients between the age of 25 and 39 years than the national average. Approximately 21% of the patients are over the age of 65 years compared to a national average of 17%; and 3% of patients are over the age of 85 years, compared with a national average of 2%.

The practice supports patients in eighteen nursing and residential homes. Approximately 47% of patients have a long standing health condition compared to a national average of 54%. The general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in the seventh least deprivation decile. (An area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score. It is important to remember that not everyone living in a deprived area is deprived and that not all deprived people live in deprived areas).

Average male and female life expectancy for the area is the same as the national average of 79 and 83 years respectively and one year less than the Clinical Commissioning Group average.

The practice is open between 8.30am and 6.30pm Monday to Friday. Appointments are available from 8:30am until 11.30am and between 3pm and 6pm. The practice operates a mixed appointments system with some appointments available to pre-book and others available to book on the day. Extended hours appointments are offered on Tuesdays, Wednesdays and Thursdays from 6.30pm until 7pm and on Saturdays from 8.30am until 11.30am. The practice also offers telephone consultations. At evenings and weekends, when the practice is closed patients are directed to the NHS 111 and out of hours service operated by another provider.

The practice offers online booking facilities for non-urgent appointments and an online repeat prescription service.

The practice has a Personal Medical Services (PMS) contract to deliver health care services; the contract includes enhanced services such as childhood vaccination and immunisation scheme, facilitating timely diagnosis and support for patients with dementia and minor surgery services. An influenza and pneumococcal immunisations enhanced service is also provided. These contracts act as the basis for arrangements between the NHS Commissioning Board and providers of general medical services in England.

The practice is a teaching practice and two registrar GPs placed with them at the time of our inspection. The practice also hosts placements for medical students. Three of the GPs are GP trainers.

Updated 10 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Preston Grove Medical Centre on 3 November 2016. The overall rating for the practice was good. The practice was rated as good for providing effective, caring, responsive and well-led services and requires improvement for providing safe services. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Preston Grove Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 17July 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 3 November 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. The practice is rated as good for providing safe services.

At our previous inspection on 3 November 2016, we rated the practice as requires improvement for providing safe services. This was because the arrangements in respect of infection prevention and control, management of medicines and the management of staff training were not adequate.

At this inspection on 17 July 2017 our key findings were as follows:

• The practice had an induction programme for newly appointed staff which now included mandatory training in respect of infection prevention and control, safeguarding adults and the Mental Capacity Act (2015).

• The staff training matrix evidenced that all staff had undertaken appropriate training to their role including; safeguarding adults training, infection prevention and control training and Mental Capacity Act training. We saw training records showed that staff who supported patients with long term conditions had received relevant refresher training including updates in asthma and diabetes.

• There were arrangements in place to assess and monitor the risk, prevention, detection and control of the spread of infections.

• Medicines, including the required arrangements for temperature control of vaccine storage, were managed appropriately.

• The practice had made improvements in arrangements to support patients with diabetes.

• Medicines including the required arrangements for temperature control of vaccine storage, were managed appropriately.

• The practice had made improvements in arrangements to identify and support patients who were also carers.

• Telephone access arrangements to the practice had improved for patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 April 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• We saw evidence of patient centred care for patients with diabetes provided via ‘virtual clinics’ involving a specialist diabetes nurse and hospital consultant.
• The practice proactively identified patients at risk of developing long-term conditions and took action to monitor their health and help them improve their lifestyle. For example, patients could access support from health coaches.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• 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 the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 20 April 2017

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

• There were systems 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 accident and emergency (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 provided support for premature babies and their families following discharge from hospital. For example, patients were able to access support from health coaches.
• The practice’s uptake for the cervical screening programme was above local and national averages.
• 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.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 20 April 2017

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

• Staff were able to recognise the signs of abuse in older people and knew how to escalate any concerns.
• 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 identified at an early stage older people who may be approaching the end of life and used the gold standard framework to coordinate care. It involved older people in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Where older patients had complex needs, the practice shared summary care records with local care services. For example, the practice contributed to joint work with other local GP practices and local nursing and residential homes to co-ordinate and improve patient care.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. We saw examples of older patients being supported with health and social care issues, including evidence of a reduction in demand for GP appointments from these patients.

Updated 20 April 2017

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.

Updated 20 April 2017

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

• Quality Outcomes Framework data for 2014/15 indicated variable performance compared to clinical commissioning group (CCG) and national averages. For example, 30% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is below the CCG average of 53%; however, 76% of patients diagnosed with a mental health condition had a comprehensive, agreed care plan documented in the last 12 months, which is above the CCG average of 60%. Data for 2015/16, published after the inspection, indicated some improvement to 37% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, compared with the CCG average of 47%.
• However, evidence from the local quality and outcomes framework, Somerset Practice Quality Scheme (SPQS), showed evidence of positive outcomes for patients experiencing poor mental health. For example, health coaches had supported patients with anxiety, agoraphobia and depression to achieve a better quality of life.
• The practice specifically considered the physical health needs of people with poor mental health. For example, we saw evidence of patients experiencing poor mental health benefiting from support to lose weight.
• The practice had a system for monitoring repeat prescribing for people receiving medication for mental health needs.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• People at risk of dementia were identified and offered an assessment.
• 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 20 April 2017

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.
• End of life care was delivered in a coordinated way, using the gold standard framework, which took into account the needs of those whose circumstances may make them vulnerable.
• 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.