Wallace House

Updated 1 June 2016

Wallace House provide primary medical services, including minor surgery, to approximately

14, 490 patients from two premises in Hertford, Hertfordshire. Services are provided on a General Medical Services (GMS) contract. The practice moved into a Grade two listed Coach House in 1983 and opened a new branch surgery in 2013. Wallace House is the main practice and Calton Court is a branch surgery located approximately one mile away.

The practice has been unable to recruit GPs to fill clinical vacancies and the practice is expecting further GP retirements in 2016 and 2017. The practice told us that their patient list size has increased by almost 7% in the last two years. NHS England accepted their application to temporarily close their list to new registrations for six months from 1 April to 1 October 2016. The practice has reduced some services to manage clinical capacity, for example the practice is currently unable to offer additional travel services.

The practice serves a lower than average population of those aged between 20 to 29 years, and higher than average population of those aged between 40 to 54 years. The population is 97% White British (2011 Census data). The area served is less deprived compared to England as a whole.

The practice team across both premises consists of seven GP Partners and one salaried GP. Five GPs are female and three are male. There are two nurse practitioners who are prescribers, one specialist diabetic nurse, two practice nurses and one health care assistant. The non-clinical team consists of a practice business manager, an assistant to the practice business manager, an operations manager, a patient services team leader, one clinical support assistant, four members of the secretarial services team, four members of the administration team and nine members of the reception team. Wallace House has been approved to train ST1 and ST2 (first and second year of speciality training) doctors who wish to undertake additional training (from four months up to one year depending on where they are in their educational process) to become general practitioners.

Wallace House is open to patients between 8am and 6.30pm Mondays to Fridays. Appointments with a GP are available from 8am to 11am and from 3.30pm to 5.30pm Mondays to Fridays. The practice offers extended opening hours between 6.30pm to 8pm every Tuesday and between 8am and 12pm every Saturday. Emergency appointments are available daily with the duty doctor. The practice offers walk in clinics every weekday between 8am and 10am and between 3pm and 5pm on Monday afternoons. The nurse practitioner runs a minor illness clinic four days a week.

Calton Court is open between 8am and 6.30pm Mondays, Wednesdays and Thursdays and between 8am and 1pm every Tuesday and Friday.

Home visits are available to those patients who are unable to attend the surgery and the practice is also able to offer home visits via the Acute In Hours Visiting Service. This is a team of doctors who work across East and North Hertfordshire to visit patients at home to provide appropriate treatment and help reduce admission to hospital. The out of hours service is provided by Hertfordshire Urgent Care and can be accessed via the NHS 111 service. Information about this is available on the practice website and telephone line.

Updated 1 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wallace House on 13 April 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 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.
• 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 and make improvements to the disabled patient toilet facilities provided in line with the requirements of the Equality Act 2010.
• Continue to monitor and ensure improvement to patient access to appointments and patient feedback.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 June 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.
• The overall performance for diabetes related indicators was in line with the CCG and national average. The practice had achieved 84% of the total number of points available, compared to 89% locally and 89% nationally.
• 78% of patients diagnosed with asthma, on the register, had received an asthma review in the last 12 months which was comparable with the national average of 75%.
• Longer appointments and home visits were available when needed.
• All patients with a long-term condition 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 1 June 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 identified as being at possible risk, for example, children and young people who had a high number of Accident and Emergency attendances. Immunisation rates were 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 81% which was in line with the national average of 82%.
• Appointments were available outside of school hours and child immunisation clinics took place at the branch surgery. Facilities at the practice were suitable for children and babies.
• We saw positive examples of joint working with midwives and health visitors.

Updated 1 June 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, this included enhanced services for avoiding unplanned admissions to hospital and end of life care.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments when required.
• Regular visits to three local nursing homes and a specialist dementia unit were carried out by named GPs for continuity of care and emergency visits were also provided when needed. Staff at the specialist dementia unit described the service provided by the practice as very good.

• The practice had completed 813 health checks for patients aged over 75 since October 2014, which was 73% of this population group.
• The practice worked closely with a local multidisciplinary team which provided a rapid response service to support people with long term or complex conditions.

Updated 1 June 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.
• It provided a health check to all new patients and carried out routine NHS health checks for patients aged 40-74 years.
• Data showed the practice had 60% of patients aged 60 to 69 years screened for bowel cancer, in the last 30 months compared to 60% locally and 58% nationally. The practice had 75% of female patients aged 50 to 70 years screened for breast cancer in the last 36 months compared to 72% locally and 72% nationally.
• The practice was proactive in offering on line services such as appointment booking and repeat prescriptions, as well as a full range of health promotion and screening that reflects the needs of this age group.
• It offered an appointment reminder text messaging service and appointment times were extended every Tuesday until 8pm and from 8am to 12pm every Saturday.
• The practice provided an electronic prescribing service (EPS) which enables GPs to send prescriptions electronically to a pharmacy of the patient’s choice.

Updated 1 June 2016

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

• 81% of patients diagnosed with dementia had their care reviewed in a face to face meeting in 2014/2015, which was in line with the national average of 84%.
• Performance for mental health related indicators was above the CCG and national average. The practice had achieved 100% of the total number of points available (with 8% exception reporting), compared to 96% locally (12% exception reporting) and 93% nationally (11% exception reporting).
• The practice carried out advanced care planning for patients with dementia.
• The practice held a register of patients experiencing poor mental health and offered regular reviews and same day contact.
• 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.

Updated 1 June 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 those with a learning disability and had completed 30 out of 66 learning disability health checks since April 2015.

• It offered longer appointments and annual health checks for people with a learning disability.
• The practice had a system in place to identify patients with a known disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• Vulnerable patients had been told how to access various support groups and voluntary organisations.
• Staff had received safeguarding training and knew how to recognise signs of abuse in vulnerable adults and children. Staff members 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.