Archived: Metheringham Surgery

Updated 23 May 2016

Metheringham Surgery provides primary medical services to approximately 1,718 patients in Metheringham.

Metheringham Surgery is a member of a group of four GP practices run by Universal Health Ltd who are a venture between Lincolnshire and District Medical Services and Lincolnshire Partnership NHS Foundation Trust. Universal Health Ltd took over the contract for this location on 1 April 2015. At the time of our inspection, Universal Health Ltd had recently completed a full workforce review and re-structure of the practice management structure and administrative and reception roles.

The practice has a higher distribution of patients between the ages of 25-49 years and an even distribution of male/female patients.

At the time of our inspection the practice employed: three salaried GPs, a primary care manager, two practice nurses, two receptionists, a health care support worker, a lead administrator, and a healthcare administrator. The primary care manager was also supported by an interim practice manager.

The practice has an Alternative Provider Medical Services (APMS) contract. The APMS contract is the contract between general practices and NHS England for delivering care services to local communities.

The practice is one of four locations of which the provider is Universal Health Ltd, each location is registered separately with the Care Quality Commission (CQC), the address for this location is Metheringham Surgery, High Street, Metheringham, Lincoln, LN4 3DZ.

The practice is open from 8am to 6.30pm Monday to Friday. Pre-bookable appointments and on the day ’urgent’ appointments are available. Pre-bookable appointments can be booked up to two weeks in advance. The practice provides telephone consultations for patients and a home visit service from GPs. The practice offers on-line services for patients such as on-line appointment booking, ordering repeat prescriptions, access to summary care record and electronic prescription service (EPS).

The practice lies within the NHS Lincolnshire West Commissioning Group (CCG). A CCG is an organisation that brings together local GPs and experienced health professionals to take on commissioning responsibilities for local health services. There are significant health inequalities in Lincolnshire West, linked to a mix of lifestyle factors, deprivation, access and use of healthcare.

The practice has opted out of the requirement to provide GP consultations when the surgery is closed. The out-of-hours service is provided by Lincolnshire Community Health Services NHS Trust.

Updated 23 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Metheringham Surgery on 15 December 2015. Overall the practice is rated as requires improvement.

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. Incidents and near misses were discussed in monthly practice meetings.

• Risks to patients were assessed and well managed, the provider had a risk register in place to identify risk and an action plan to address risks identified.

• Information about services and how to complain was available and easy to understand.

• The practice encouraged patient feedback using different methods to ensure the practice provided high quality services for patients and planned to make improvements for the benefit of its patients. The practice did not have an active patient participation group (PPG).

• Data showed patient outcomes were low compared to the locality and nationally. As the provider had taken over the contract for this practice on 1 April 2015, a key objective was to improve patient outcomes and improve the quality and provision of services for patients.

• Results from the national GP patient survey showed patients responded negatively to questions about their involvement in planning and making decisions about their care and treatment. Results were below local and national averages.

• Patient Group Directions (PGDs) had been adopted by the practice to allow nurses to administer medicines in line with legislation. A practice nurse was responsible for the coordination of all PGDs.

• Not all staff acting as a chaperone had completed the relevant training to fulfil the role.

• Urgent appointments were usually available on the day they were requested.

• The practice had a number of policies and procedures in place to govern activity.

The areas where the provider must make improvements are:

• Ensure all staff who act as a chaperone are competent to fulfil the role.

In addition the provider should:

• Carry out a disability access audit to assess disabled access for patients and identify reasonable adjustment measures to be taken.
• Ensure infection control lead receives an appropriate level of infection control training.
• Ensure members of staff who act as a chaperone receive an appropriate level of training.
• Improve the frequency of multi-disciplinary meetings to discuss patients care and needs.
• Ensure all significant events reported are reviewed in a timely manner, ensuring lessons learned and actions to be taken are recorded following review.
• Ensure appropriate records and evidence of staff training are held by the practice.
• Ensure there is a clinical leadership structure in place within the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 May 2016

The practice is rated as requires improvement for the care of people with long term conditions. The provider was rated as good for providing safe care and being responsive. However it was rated as requires improvement for being caring, effective and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• Nursing staff did not have lead roles in chronic disease management however members of the nursing team were undergoing training in chronic disease management at the time of our inspection.

• The percentage of patients with diabetes having regular blood pressure tests was 78.7% which was lower than the CCG average of 85.2% and national average of 89.2%.

• Longer appointments and home visits were available when needed.

• The practice held regular multi-disciplinary meetings and worked with relevant health and care professionals to deliver a multi-disciplinary package of care for those patients with the most complex needs such as patients at end of life.

Updated 23 May 2016

The practice is rated as requires improvement for the care of families, children and young people. The provider was rated as good for providing safe care and being responsive. However it was rated as requires improvement for being caring, effective and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• Appointments were not available outside of school hours.

• 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 we saw evidence to confirm this.

• There was a weekly health visitor clinic held at the practice.

Updated 23 May 2016

The practice is rated as requires improvement for the care of older people. The provider was rated as good for providing safe care and being responsive. However it was rated as requires improvement for being caring, effective and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• Longer appointments were available for older people when needed.

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

Updated 23 May 2016

The practice is rated as requires improvement for the care of working age people (including those recently retired and students). The provider was rated as good for providing safe care and being responsive. However it was rated as requires improvement for being caring, effective and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 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 including appointment booking and cancellation, ordering repeat prescriptions and ability to view summary care record.

• The practice offered a range of health promotion and screening that reflects the needs for this age group.

Updated 23 May 2016

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). The provider was rated as good for providing safe care and being responsive. However it was rated as requires improvement for being caring, effective and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• Performance for mental health related indicators was 53.84% which was lower than the CCG of 90.5% and national average of 92.8%.

• 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 23 May 2016

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. The provider was rated as good for providing safe care and being responsive. However it was rated as requires improvement for being caring, effective and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice held a register of patients living in vulnerable circumstances including patients with a learning disability and offered longer appointments for these 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.