Hoveton and Wroxham Medical Centre

Updated 24 March 2017

The practice is situated in the village of Hoveton in North Norfolk and offers health care services to approximately 9000 patients. The practice dispenses medicines and offers consultation space for GPs, nurses and attached professionals including community nurses, a specialist continence nurse, and a mental health worker.

The practice holds a General Medical Services (GMS) contract and is a training practice with two GP trainers and an associate trainer. There are three tutors who are Honorary Senior Lecturers at the University of East Anglia and GP trainees with Year 4 medical students from Norwich Medical School. The medical student training at the practice is on Obstetrics, Gynaecology, Paediatrics, General Practice, Emergency Care and Clinical Audit.

A training practice has trainee GPs (registrars) working in the practice; a registrar is a qualified doctor who is undertaking further training to become a GP. A trainer is a GP who is qualified to teach, support, and assess registrars. The practice has two registrars currently working in the surgery. The practice also teaches medical students and foundation year doctors.

• There are five (three male and two female) GP partners who hold managerial responsibilities for the practice and one salaried GP (male). There are three nurse practitioners, two practice nurses, and two healthcare assistants.
• A team of 16 administration and reception staff led by the practice manager, business manager and assistant practice manager support the clinical team. A team of seven dispensers support the dispensary lead.
• The practice is open between 8.30am and 6pm Monday to Friday. With phlebotomy and NHS health checks available from 7am on Thursday mornings.
• If the practice is closed, patients are asked to call the NHS111 service, provided by IC24, or to dial 999 in the event of a life threatening emergency.
• The practice has significantly lower number of patients aged 20 to 50 years and a significantly higher number of patients aged over 60 years than the practice average across England. The deprivation score is above the England average.

Male and female life expectancy in this area is 80 years for males and 84 years for females compared with the England average at 79 years for men and 83 years for women.

Updated 24 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hoveton and Wroxham Medical Centre on 10 January 2017. Overall the practice is rated as good.

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

• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with practice staff and was regularly reviewed.

• The practice had a relatively new management team in place and we saw that the practice had a cohesive team approach to ensure that systems and processes were in place.

• We found that there was an open and transparent approach to safety and a system was in place for reporting and recording significant events.
• The practice used a range of assessments to manage the risks to patients.
• Practice staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Practice 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.
• Information about services and how to complain was available and easy to understand.
• 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. For example, a member of the PPG assessed and advised the practice on access around the building for wheel chair users.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw several areas of outstanding practice:

• We saw many positive examples of care provided to patients. For example, the practice had staff who were named and identified as the carers’ champion. A practice leaflet detailed the carers’ group monthly meeting and the champion’s name and contact details.

  The practice had two named dementia champions. These staff members had attended external training and recognised adjustments that could be made to best support people with dementia. The dementia leads had made significant changes to the environment to ensure that patients who may be confused were put at ease. For example, the chairs and waiting room used a colour scheme known to be helpful to dementia patients and the black mat had been removed from the inside of the entrance door.

  • The practice demonstrated they valued education for all staff. They had supported their staff to be involved in a practice nurse course which had been accredited by Middlesex University, approved by the Royal College of General Practitioners and to run study evenings and weekends for local nurse practitioners, these included external speakers, prescribing updates and other professional issues. The nurses were also proactive in delivering patient education and had run several successful events. These events included topics such as men’s and women’s health and they had been well attended. Expert patients had attended and spoken about their experience and external speakers such as the chairman of the of the prostate society were able to add to the event.

The areas where the provider should make improvement are:

• The practice should audit the processing of incoming correspondence to ensure that protocols are being followed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 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.
• Patients were invited for an annual review. The practice system and processes for managing the recall systems ensured patients received appropriate and timely care with the minimum number of appointments.
• Where appropriate the practice undertook reviews by telephone with the patient or virtually.
• The practice had access to other agencies such as health trainers who gave advice on weight management and supported patients with lifestyle changes.
• Longer appointments and home visits were available, including for long term condition reviews when needed for all patients unable to attend the practice or with a learning disability.
• 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 24 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 or failed to attend appointments. Immunisation rates were in line with the national average for the standard childhood immunisations.

• Unwell children were seen as soon as possible and convenient to the parent or carer.

• 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 nurses worked actively with a local school. Surveys had been conducted with the young people to ensure the practice was offering services that young people wanted to access.

• The practice produced a regular newsletter which included such topics as sexual health and immunisation updates. The practice nurse attended meetings a local school and had undertaken a survey, this included asking the young people the information they would like to have more access to for example, managing stress, personal safety and bullying.

• The practice had open access appointments with a nurse practitioner each lunchtime for young patients who attended the local schools.

• 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 24 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 offered 12 minute appointments as standard, with longer appointments available if required.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including hypertension, dementia, and heart failure were above or in line with the local and national averages.

• The practice provided care to patients in three large care homes and ten smaller facilities; these included a home with a speciality in dementia care and small homes where patients with learning disabilities lived with 24 hour care. Designated GPs conducted weekly visits to the larger homes to ensure proactive care.

• Information for support groups such as Age UK and was available.

• The practice tried where possible to bring services closer to patients, for example the practice offered in-house phlebotomy services.

Updated 24 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. The practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• The practice offered early morning appointments for phlebotomy and for patients to attend a NHS health check appointment. The practice stopped offering extended hours for GP and nurses because the uptake had been low.

• The practice offered telephone consultations for those patients that wished to seek advice in this way.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 24 March 2017

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

• The practice had a dementia champion and practice team were dementia friendly with good signage throughout the building. Clinicians collected patients from the waiting areas; patients we spoke with valued this.

• A mental health professional attended the practice regularly to see patients with complex needs. This professional was available to the practice staff for advice.

• The practice had 131 patients diagnosed with dementia on the register. 65 of these patients had received an annual review with the practice nurse. Some of the remaining patients lived in care homes, and as these patients generally had more complex needs they received on going health reviews through the year with the GPs.

• 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 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 A&E or had failed to attend appointments where they may have been experiencing poor mental health.

• Practice staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 24 March 2017

The practice is rated as good overall for the care of people whose circumstances may make them vulnerable. The practice is rated as outstanding for providing responsive services to people whose circumstances may make them vulnerable.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice clinical team met every day to discuss visits and patients who may need support. Members of the community team such as the community link nurse, and the palliative care nurse regularly attended.

• The practice had both dementia and carers champions. These staff member encourage the practice team to be dementia friendly.

• The practice held a register of patients living in vulnerable circumstances including the patients staying in the end of life care home and those with a learning disability.

• The practice offered longer appointments with the named doctor for patients with a learning disability.

• The practice, with the support of a PPG member had undertaken an audit of the premises to ensure that patients with special needs could be safely accommodated. Results from this audit had led to improvements for patients who are not so mobile.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Practice 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.