Archived: Riverside Health Centre

Updated 12 January 2017

Riverside Health Centre provides primary care services to approximately 5591 patients in the villages of Manningtree, Lawford, Mistley, Bradfield and the surrounding areas. They hold a General Medical Service (GMS) contract for the services they provide. The practice provides a dispensing service for 2380 patients; this equates to 43% of their patient population and is available during practice opening hours daily. The deprivation score is low for this practice area in comparison with other local and national GP practices.

The practice is registered as a partnership of one male and two female GPs. The GPs are supported by one male nurse practitioner, two female practice nurses, and two female healthcare assistants. The dispensary team comprises of two part time dispensers. The management and administration team comprise of two managers and four other staff members with a range of roles; secretaries, audit clerk, administrators and receptionists. The staff members hold a combination of roles and work patterns of full and part time hours.

The practice opening hours are 8am to 1pm they close for one hour and then re-open at 2pm to 6pm Monday to Friday. The clinical sessions run from 8.30am to 11.30am and then restart at 3.30pm to 5.30pm Monday to Friday.

The practice has opted out of providing GP out of hour’s services. Patients calling the practice outside normal practice working hours are advised by the answerphone message to contact the 111 non-emergency services. Patients requiring urgent treatment are advised to contact the out of hour’s service which is provided by Care UK.

Updated 12 January 2017

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection at Riverside Health Centre on 25 October 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• Staff members knew how to raise concerns, and report safety incidents. Safety information was recorded and lessons learned were identified and shared with staff members.
• Risks to patients and staff members were assessed and documented regularly including those associated with; premises, equipment, medicines, fire safety, and infection control.
• The dispensary policies and procedures were appropriate to keep people safe
• Patient care and treatment was planned using current clinical guidance.
• Patient comments were enthusiastic and positive about the practice.
• Information regarding how to complain was available at the practice and on their website.
• Patients told us there were urgent appointments available on the day they requested.
• The practice had appropriate facilities and equipment to treat patients and meet their health and treatment needs.
• The practice patient participation group (PPG) could demonstrate their involvement with practice development.
• Staff members told us they were supported in their working roles by the practice management and the GPs.
• The leadership structure was clear and staff felt supported by management.

The area where the provider should make improvement:

• Record near misses when dispensing to minimise the chance of similar errors re-occurring.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 January 2017

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

• Nursing staff and GPs had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Personalised care plans had been created, agreed with patients, and shared to ensure continuity of care.

Diabetic quality data from 2015 to 2016 showed:

• The percentage of patients with diabetes, on the register, in whom the last IFCCHbA1c is 64 mmol/mol or less in the preceding 12 months, was 69% (local practices 75% and nationally 78%).
• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less was 63% (local practices 78% and nationally 78%). The practice realised these results were poor and worked with the local diabetes support organisation to improve their patient outcomes.

Other services provided by the practice for this population group were:

• Longer appointments and home visits when needed.
• A named GP and a structured annual review enabled patient’s health and medicine requirements to be maintained and met.
• An emergency mobile phone number was given to those patients with a greater risk of hospital admission; this gave them fast access to a clinician for advice.
• Five blood pressure machines had been purchased to loan out to patients in this population group; to monitor their blood pressure at home. This had helped with diagnosing essential hypertension and monitoring the efficacy of patient’s treatment..
• A patient’s named GP worked with relevant health and social care professionals to deliver a multidisciplinary package of care.
• The practice nurses had received specialist training in diabetes, asthma, and chronic obstructive pulmonary disease, to support the GPs manage long term condition patients.
• Clinicians used clinical templates designed to ensure patient’s received the blood tests, and diagnostic checks required before repeat prescriptions were provided.
• There was a practice based blood taking service to support patients in this population group that would struggle to access local hospitals blood taking clinics.

Regular medicine monitoring searches were undertaken for patients taking high risk medicine and medicines that require extra monitoring. This ensured patient conditions could be kept stable when taking these medicines.

Updated 12 January 2017

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

• There were systems in place to follow up children living in disadvantaged circumstances or at risk; for example, children and young people who had experienced a high number of A&E attendances. Children that ‘do not attend’ (DNA) appointments were managed promptly. GP’s had good communication with local school nurses, head teachers and "Special Educational Needs Co-ordinators" (SENCO). A SENCO is responsible for the day-to-day operation of the school's “Special Educational Needs policy; all mainstream schools must appoint a teacher to be their SENCO. The GPs found the good communication with local SENCO’s was very helpful to identify children in potentially disadvantaged circumstances, or those with behavioural or other challenging problems.
• The practice told us they saw all babies, children and young people on the day.
• On-line appointments were available for both advanced and on the day appointments.
• Immunisation rates were high for all standard childhood immunisations and flu in comparison with practices locally and nationally. The high uptake for 2015 prompted NHS England to ask the practice to share their processes to enable others to improve their uptake.
• Parents of children we spoke with told us they were treated in an age-appropriate manner; that staff members encouraged children to ask question, and the language used during consultations to explain treatment was easy to understand.
• Patients aged 25-64, attending cervical screening within the target period of 3.5 or 5.5 years coverage was 83% (compared locally 83% and nationally 82%).
• Appointments were available outside school and college hours.
• Midwives and health visitors held clinics at the practice on a weekly and monthly basis respectively. The practice nurses said there was positive joint working with their community professional colleagues.
• The GPs held weekly baby clinics to provide immunisations and perform baby & post-natal checks. Educational leaflets were provided to support parents when required.
• There was a range of contraception including fitting and removal of intrauterine contraceptive devices and other contraceptive implant devices were offered.

A clinical and administrative safeguarding lead at the practice monitored and updated the child safeguarding register, performing an audit every six months.

Updated 12 January 2017

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

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments when needed or requested.
• All older people had a named GP assigned to them and were informed who this was.
• GP’s provided a routine weekly ward round at a specialist residential care home to ensure they received continuity of care.
• The practice nurse had completed specialist dementia training which enabled opportunistic dementia screening to the most vulnerable.
• The practice provided a phlebotomy service which included home visits for frail/housebound patients for medicine monitoring.
• An agenda item at the palliative care meetings was to understand and discuss patients identified as frail that could be deteriorating.
• The practice provided a room for abdominal aortic aneurysm (AAA) screening of all males over the age of 65 years within their locality; this service provision was not only for Riverside Health Centre patients.
• The practice had a good uptake for shingles and flu vaccinations and actively campaigned across a variety of media, for example; prescription repeat forms, the auto arrival screen, posters, on their website and opportunistically during routine appointments.
• Senior health checks were booked in advance and offered, on an ad hoc basis to maximise their uptake.

The ground floor purpose built practice was wheelchair accessible.

Updated 12 January 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 at the practice and they had adjusted the services offered to ensure they were accessible, flexible and provided continuity of care.
• Although the practice did not offer extended hours they did offer on-line services to support working patients for example; appointment booking, repeat prescription management, and telephone consultations where appropriate. These services gave patients access to the practice when they needed and enabled them to arrange their time around their health needs.
• Those that had requested the service received text messages regarding appointment reminders and the results of any diagnostic tests they had received. Patients telephone details were updated with patients each time they had a verbal or face-to-face contact to check their details were correct.
• There was a full range of health promotion and patient screening that reflected the needs of this population group, for example “NHS Health Checks” for 40 - 74 year olds.

Private employment medicals and insurance reports were available, to support patients that required them for work.

Updated 12 January 2017

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

Mental health quality data from 2015 to 2016 showed, the practice performance was higher than the national and local practice averages for example:

• 94% of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (compared with 83% locally and 89% nationally).
• 87%of patients diagnosed with dementia that had their care reviewed in a face to face meeting in the last 12 months at the practice, (compared with 83% locally and 84% nationally).

Other services provided by the practice for this population group were:

• Working with multi-disciplinary teams in the case management of patients experiencing poor mental health, this included those with dementia.
• GPs visited a local dementia residential home weekly for a weekly ward round.
• Clinicians worked with other health care professionals to ensure the appropriate advice support and treatment was provided.
• GPs worked closely with the mental health trust consultants and regularly communicated by telephone or email for advice on medicine and education.
• The practice had told patients experiencing poor mental health how to access various support groups and voluntary organisations such as ‘Health in Mind’ and ‘IAPT’ services.
• The practice followed up patients who had attended accident and emergency that may have been experiencing poor mental health.
• Staff members had an understanding of how to support patients with mental health needs or dementia.
• They had worked with the ‘Alzheimer's Society’ to offer a special ‘Dementia help clinic’ for patients and their carers within the practice.
• Patients with mental health issues had an appropriate alert placed on their records; this allowed staff members to recognise any extra needs these patients may need.
• The practice told us they offered patients in this population group on the day appointments to ensure patients in mental health crisis could access a clinician and receive the support they needed.
• Practice staff members told us they would find a suitable quiet area for patients to wait if they were feeling anxious, depressed, or too unwell to wait in the busy waiting room.

Those patients at risk of medicine abuse were placed on a weekly prescription regime. The dispensary team monitored the prescriptions of patients at risk by ensuring their previous prescription had been collected before another prescription was dispensed.

Updated 12 January 2017

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

• The practice had identified patients living in vulnerable circumstances; this included those with a learning disability, homeless people, or travellers.
• The practice clinical members of staff worked with other health care professionals in the case management of vulnerable patients. They worked closely with local care homes to provide, treatment planning, and home visits when needed.
• There were 55 patients identified by the practice as living with a learning disability and they had all been offered an annual assessment and health check. The practice also offered longer appointments for patients with a learning disability.
• The practice provided information to vulnerable patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise the signs of abuse in vulnerable adults and children. They were aware of their responsibilities concerning the sharing of information and the documentation of safeguarding concerns. The practice safe guarding policy set out the details about how to contact the relevant local agencies during normal working hours and out of hours for staff members.
• The practice encouraged all patients living with a learning disability to attend their annual reviews. To enable those patients that wanted a review received one the GPs visited care homes and patients residences when needed.
• All staff had undergone safeguarding training and could recognise the signs of abuse in vulnerable adults and children. Staff members were aware of their responsibilities regarding information sharing and discussed this with leads if they were unsure.
• The GP safeguarding lead at the practice attended regular forums; this included sharing ‘lessons learned’ recently at a local level with practices concerning a case with ‘mental capacity assessments’.

GPs attended a local brain injury unit each week to provide a ward round that ensured patients received consistent care. They work alongside other allied health care professionals to deliver advice support and care.