Monkfield Medical Practice

Updated 16 March 2017

Monkfield Medical Practice is located in Cambourne, Cambridgeshire. The practice is run by three female GP partners (one partner is currently on maternity leave). The practice employs three salaried GPs, one male and one female nurse practitioners, one female practice nurse supervisor, two female practice nurses, two minor illness practice nurses, one female health care assistant, a female phlebotomist and a clinical pharmacist. Four of the nursing team are qualified to prescribe medicines. The clinical team is supported by a practice manager, a business manager, an assistant practice manager and a team of administrative, secretarial and reception staff.

According to Public Health England information, the practice age profile has higher percentages of patients 0 to 14 years and 25 to 44 years compared to the practice average across England. It has lower percentages of patients aged 15 to 24 years and 50 to 85+ years. Income deprivation affecting children and older people is below both the local area and national average.

The practice is open between 8am to 6pm Monday to Friday. Appointments with GPs are on average from 8.40am to 12.20 every morning nurse practitioners appointments are from 8.35am to 12.30am. Afternoon appointments are from 3pm/3.30pm to 5.20 daily. The practice does not offer an extended hours service, however we were told patients are seen when required with additional appointments made available each day. In addition to pre-bookable appointments that can be booked up to five weeks in advance, urgent appointments are also available for people that need them. The practice runs a duty GP pre-appointment assessment offering telephone advice and where required appointments, nurse practitioner appointments, minor illness nurse appointments, on-line appointments, telephone appointments and face to face appointments. With older patients given priority for urgent appointments. The practice provides 15 minute morning appointments with GPs and nurses.

The practice is located in a County Council owned building and is shared with other services such as the library and a children’s services centre.

The practice holds a Personal Medical Service (PMS) contract to provide GP services to approximately 10,486 registered patients, which is commissioned by NHS England. A PMS contract is a nationally negotiated contract to provide care to patients. In addition, the practice also offers a range of enhanced services commissioned by their local CCG: facilitating timely diagnosis and support for people with dementia and extended hours access. The practice has seen a rapid growth and a high turnover in patient population due to the patient population demographic and local closure of practice lists. For example the practice has seen an increase in new registrations from 12% to 15 % per annum, above both local and national averages.

Out of hours care is provided via the NHS 111 service by Herts Urgent Care

Updated 16 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Monkfield Medical Practice on 17 November 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice provides 15 minute morning appointments with GPs and nurses.
• 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 found it easy to make an appointment. However not always with a named GP. We were told there was continuity of care, with urgent appointments available the same day.
• 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. All treatment room doors displayed the name of the clinician and their registration number. For example all GPs names displayed their General Medical Council (GMC) registration number beneath.

The areas where the provider should make improvement are:

• Ensure patients waiting for their appointments (and whose health might deteriorate) in all areas of the practice can be clearly seen by reception staff.
• There was scope to improve the recording of actions implemented as a result of national patient safety alerts such as MHRA.
• The practice should ensure they continue to proactively encourage patients to attend national screening programmes, such as for bowel and breast cancer screening.
• Ensure regular fire drills are undertaken to ensure staff are aware of their responsibilities.
• The practice should ensure they continue to extend and prioritise work to ensure that patients (including working patients) can access appointments in a timely manner. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 March 2017

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.

• The practice used the information collected for the Quality and Outcomes Framework (QOF) and performance against national screening programmes to monitor outcomes for patients. (QOF is a system intended to improve the quality of general practice and reward good practice). The most recent published results for 2015 to 2016 the practice achieved 97% of the total number of points available with a an 18% exception reporting rate which was seven percentage points above the CCG average and eight percentage point above the national average, (exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).
• Longer appointments and home visits were available when needed.
• 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.
• The practice had administered flu vaccinations 86% of patients on the practice at risk register during the 2016 to 2017 flu vaccination clinics at the time of the inspection.

Updated 16 March 2017

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. Childhood immunisation rates for the vaccinations given were comparable to CCG/national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 91% to 99% which is comparable to the CCG average of 70% to 95% and five year olds from 89% to 98% which is comparable to the CCG average of 88% to 95%.

• 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 76%, which was comparable to the CCG average of 72% and the national average of 74%. There was a policy to offer telephone reminders for patients who did not attend for their cervical screening test.
• 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 16 March 2017

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.
• The practice worked closely with the multi-disciplinary team, out-of-hours and the nursing team to ensure proactive palliative care planning.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure were above local and national averages.
• The practice had administered flu vaccinations to 63% of patients aged over 65 years old during the 2016 to 2017 flu vaccination clinics at the time of the inspection.

Updated 16 March 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 was working to adjust the services it offered to ensure these were accessible, flexible and offered continuity of care.
• Results from the national GP patient survey published July 2016 showed that patient’s satisfaction with how they could access care and treatment was below local and national averages. For example; 53% of patients were satisfied with the practice’s opening hours compared to the CCG and the national average of 76% and 60% of patients said they could get through easily to the practice by phone compared to the CCG average of 75% and the national average of 73%. The practice were aware of the negative feedback for access from the patient survey and continued to review and adjust the appointment system to improve this.
• 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.
• Patients attending national screening programmes, such as for bowel and breast cancer screening were below local and national averages. For example; Patients aged 60-69 screened for bowel cancer in the last 30 months was 56% of the target population, which was below the CCG average of 59% and the national average of 58%. Females aged 50-70 screened for breast cancer in the last 36 months was 67% of the target population, which was also below the CCG average of 74% and the national average of 72%.
• Patients had access to appropriate health assessments and checks. These included health checks for new patients and NHS health checks for patients aged 40–74. The practice had undertaken 411 NHS health checks last year. Appropriate follow-ups for the outcomes of health assessments and checks were made, where abnormalities or risk factors were identified

Updated 16 March 2017

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

• The percentage of patients experiencing poor mental health who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2015 to 31/03/2016) was 94% this was above the CCG average of 87% and the national average of 88%.
• The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months (01/04/2015 to 31/03/2016) was 94% this was above the CCG 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.
• 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 hosted councillor services from the practice.

Updated 16 March 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• Of the ten patients identified on the practice register with a learning disability, eight had been invited for a health review with five attending and two scheduled for a review. The practice referred patients to various support services as required and continued to encourage those patients who did not attend.
• 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.