Archived: Old Palace Medical Practice

Updated 7 January 2016

Old Palace Medical Practice is situated in Norwich in the county of Norfolk. The practice provides services for approximately 3000 patients. It is one of seven surgeries within The Coastal Partnership who look after approximately 29000 patients between their seven sites. There are seven partners managing The Coastal Partnership. They hold a Alternative Provider Medical Services (APMS) contract. They are a training practice and the practice received a Royal College of General Practitioners accreditation in March 2015 which is for individuals and organisations that have developed educational activities/resources or a programme of activities/resources relevant for Continuing Professional Development for GPs and other Primary Care Professionals.

Old Palace Medical Practice has one male GP partner on site, one female salaried GP, one female lead nurse, one female practice nurse and one female health care assistant. The practice also employs a reception lead and six reception staff. The practice manager works between all The Coastal Partnership sites.

The practice’s opening times at the time of inspection were; morning surgery from 8.30am until 1pm Monday, Wednesday, Thursday and Friday, with extended hours on a Tuesday morning from 7.30am to 8am. Afternoon surgery from 1.30pm until 5.30pm on Tuesday and Wednesday and until 6pm on Monday and Friday with extended hours on Thursdays until 7.30pm. The practice has opted out of providing GP services to patients outside of normal working hours such as nights and weekends. During these times GP services are provided by IC24.

Updated 7 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Old Palace Medical Practice on 28th October 2015. Overall the practice is rated as good.

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. Information about safety was recorded, monitored, appropriately reviewed and addressed.

• Risks to patients were assessed and well managed.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

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

• Patients said they found it easy to make an appointment with a named GP and that 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.

Outstanding elements

• The Coastal Partnership had employed a Pharmacist to ensure the practice was prescribing in line with best practice guidelines for safe prescribing.

• The practice was part of a pilot scheme led by Norwich Clinical Commissioning Group (CCG) to reduce the amount of acute bed days in both general and psychiatric admissions with positive results.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should:

• Ensure the business continuity plan is reviewed and amended with accurate up to date information

• Ensure during recruitment checks that photographic identification is kept in all personnel files

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 January 2016

The practice is rated as good for the care of people with long-term conditions. Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 7 January 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. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses.

Updated 7 January 2016

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Updated 7 January 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 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 7 January 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). 85.7% of patients with dementia had received an annual physical health check and 97.7% of mental health patients had a care plan on their records. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It 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. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

The practice was part of a pilot scheme led by Norwich Clinical Commissioning Group ( CCG) to reduce the number of days patients spent in acute beds in both general and psychiatric care.

Updated 7 January 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. It had carried out annual health checks for people with a learning disability and 95% of these patients had received a follow-up. It offered longer appointments for people with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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.