Merridale Medical Centre - RP Tew

Updated 7 December 2016

Merridale Medical Centre – RP Tew provides primary medical services to approximately 14,848 patients within Leicester City and is located within a spacious, purpose built health centre. The practice also provides services to patients residing in 14 nursing and residential homes in the surrounding area.

The practice is registered with the Care Quality Commission to provide the regulated activities of; the treatment of disease, disorder and injury; diagnostic and screening procedures; family planning and surgical procedures.

At the time of our inspection the practice consisted of two GP partners and two salaried GPs, three locum GPs, an advanced care practitioner, nurse practitioner, locum nurse practitioner, admission avoidance practitioner, practice nurse, two health care assistants (HCAs) a practice manager, assistant practice manager, admin team leader, reception team leader and a reception, administration and secretarial team. Three members of the administration team were dedicated prescription administrators who coordinated all repeat prescription requests.

Merridale Medical Centre – RP Tew is open from 8am to 6.30pm Monday to Friday. The practice provides extended opening hours on a Monday and Tuesday evening until 8pm and from 8.30am until 12.30pm each Saturday. The practice is part of a pilot scheme within Leicester City which offers patients an evening and weekend appointment with either a GP or advanced nurse practitioner at one of four healthcare hub centres. Appointments are available from 6.30pm until 10pm Monday to Friday and from 9am until 10pm on weekends and bank holidays. Appointments are available by walk in, telephone booking or direct referral from NHS 111.

The practice has a General Medical Services (GMS) contract. The GMS contract is a contract between the GP partners and the CCG under delegated responsibilities from NHS England.

The practice has a higher population of patients between the ages of 25-44 years of age and a higher than average level of deprivation.

The practice has an active patient participation group (PPG) who meet on a regular basis.

The practice offers on-line services for patients including ordering repeat prescriptions and booking routine appointments.

The practice lies within the NHS Leicester City Clinical 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.

Updated 7 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Merridale Medical Centre – RP Tew on 14 July 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 been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.

• Patients said they did not always find it easy to understand the appointments system or make an appointment with a named GP or that there was continuity of care, with urgent appointments available the same day. However, the practice was pro-active in improving the availability of appointments for patients and had successfully recruited additional clinicians to improve access to appointments.

• The practice employed an admissions avoidance practitioner who carried out visits to patients who resided in care and nursing home patients and housebound patients and acted as a care coordinator.

• Performance for mental health related indicators was 100% which was better than the national average of 93%. This included an exception reporting rate of 6% which was better than the national average of 11%.

• The practice employed a mental health practitioner and provided 30 minute pre-bookable appointments and 15 minute crisis appointments which were bookable on the day. Patients were able to book appointments directly with the mental health practitioner. Home visits were also provided and carried out care plan reviews in the community for patients who suffered with dementia.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

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

The areas where the provider should make improvement are:

• Review process and methods for identification of carers and the system for recording this. To enable support and advice to be offered to those that require it.

• Address the issues highlighted in the national GP survey in order to improve patient satisfaction, including in respect of satisfaction on access to appointments and use of the appointments system and also in respect of consultations with GPs and nurses.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 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.

• Performance for diabetes related indicators was 92% which was better than the national average of 89%. This included an exception reporting rate of 11% which was comparable to the national average of 11%.

• The practice provided midwifery led clinics three times a week.

• 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 7 December 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. 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 70%, which was comparable to the CCG average of 69% and the national average of 74%.

• The practice offered dedicated appointment slots with a GP for acute cases for young children and babies under the age of two years.

• 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.

Updated 7 December 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.

• Those at high risk of hospital admission and end of life care needs were identified and reviewed regularly, this included working with other health professionals to provide co-ordinated care.

• The practice employed an admissions avoidance practitioner who carried out visits to patients who resided in care and nursing home patients and housebound patients and acted as a care coordinator.

• Patients received personalised care plans from a named GP to support continuity of care.

• The premises were accessible to patients with mobility difficulties.

Updated 7 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 and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• The practice offered extended hours appointments on a Monday and Tuesday evening until 8pm and on a Saturday morning from 8.30am until 12.30pm.

• 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.

• The practice participated in an electronic prescribing service.

Updated 7 December 2016

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

• Performance for mental health related indicators was 100% which was better than the national average of 93%. This included an exception reporting rate of 6% which was better than the national average of 11%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. The practice had a dementia lead.

• 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.

• The practice employed a mental health practitioner who was also the dementia lead. Patients were able to book appointments directly with the mental health practitioner who also provided home visits and carried out care plan reviews in the community for patients who suffered with dementia.

Updated 7 December 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.

• 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.