Wrafton House Surgery

Updated 13 April 2016

Wrafton House Surgery (the main practice) situated in Wellfield Road, provides primary medical care for approximately 9400 patients living in Hatfield, Hertfordshire. A branch of the main practice is located at 2 Northdown Road, Hatfield. The practice maintains one patient list and patients can access either practice for primary medical services. We did not inspect the Northdown Road branch at this time.

Wrafton House Surgery provides services under a General Medical Services (GMS) contract agreed nationally. The practice population is made up of predominantly white British but the practice also serves a small ethnic population mostly of Asian and Eastern European origin.

The practice has six GPs partners (two males and four females). The practice also employs three practice nurses and a health care assistant who are managed by a practice nurse manager. There is a practice manager who is supported by a team of administrative and reception staff. A health visitor a community midwife, a community matron, a palliative care nurse specialist and a phlebotomist from local NHS trusts support patients at this practice. The practice also trains new GPs.

The main practice operates from two storey premises which is serviced by a lift. Patient consultations and most treatments take place on the ground floor. The first floor has a minor surgery suite as well as a treatment room which is used by the surgery for minor surgical procedures. There is free car parking outside the surgery with adequate disabled parking available.

The practice is open between 8.30am 6pm Monday to Friday. The practice also offers telephone consultations for half an hour each morning usually between 8.30 am and 9.00am and in the evening between 4pm and 4.30pm. The practice operated extended hours on three Monday evenings each month and offered appointments during one Saturday morning each month.

When the practice is closed services are provided via the 111 service.

Updated 13 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wrafton House Surgery on 3 February 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.
• 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.
• Some patients expressed difficulty in getting through to the surgery to secure an appointment with a GP.
• 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.

The areas where the provider should make improvement are:

• Complete the investigation into cancer mortality rates; reported higher than CCG and national average, in conjunction with the local Clinical Commissioning Group (CCG) and other appropriate local health partners and undertake any improvement work if needed.

• Continue to monitor the effectiveness of the recent actions taken to improve patient satisfaction in relation to access to care and treatment and make further adjustments as needed

• Take note of the comments on the NHS Choices website and take action as appropriate

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 April 2016

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

• GP and nurse leads were identified for all long-term conditions and patients were monitored appropriately. For example the underlying achievement for diabetes related indicators was comparable to the CCG and national average of 89%. Patients at risk of hospital admission were identified as a priority.

• Longer appointments and home visits were available when needed.

• The practice had signed up to the national directed enhanced service for avoiding unplanned admissions. All identified patients had care plans which were reviewed regularly and any newly identified patients followed up by a designated nurse.

• 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.

• The practice worked with a community matron who supported those with complex needs in the community and regularly reviewed their needs.

• The practice had comprehensive information on long-term conditions available including on its website.

Updated 13 April 2016

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

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

• The practice offered telephone surgery through a dedicated telephone line where parents could call to discuss their concerns and prioritised for a same day appointment if assessed as needing one.

• Appointments were available outside of school hours and the premises were suitable for children and babies. Unwell children were seen at short notice by GPs.

• The practice offered age appropriate health promotion and prevention to children and young people, for example, contraception, chlamydia screening and smoking cessation.

• The practice held quarterly meetings with a health visitor to discuss vulnerable families with child protection plans and others that are causes for concern.

• The practice offered Saturday surgeries to enable at risk children attend the seasonal influenza vaccination clinic.

Updated 13 April 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. Comprehensive health checks were offered to patients 75 years
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. For the housebound patient a practice nurse offered home visits for health checks and seasonal vaccinations such as for influenza and shingles if indicated.
• The practice offered informal tea and chat sessions for older patients that lived alone in the community. These sessions were supported by AgeUK, the practice nurse, the practice patient liaison officer and PPG members.

Updated 13 April 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.

• On-line appointment booking and prescription ordering were available, as well as a range of health promotion and screening that reflected the needs for this age group.

• The practice offered Monday evening and Saturday appointments for patients who could not attend during the day or during weekdays.

 The practice also offered pre-bookable telephone consultations during the lunchtime and early evening giving a choice of consulting while at work.

Updated 13 April 2016

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

• 83% of people diagnosed with dementia had their care reviewed in a face to face meeting in the preceding 12 months, which was comparable to the national figures of 84%.

• 86% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan review in the preceding 12 months, which was comparable to the national figures of 88%.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. Patients were referred as appropriate to Improving Access to Psychological Therapies programme (IAPT) for cognitive behavioural therapy (CBT) and counselling.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

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

Updated 13 April 2016

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

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

• The practice had a vulnerable adult lead GP. There were systems in place for staff to identify and report concerns about patients who may be vulnerable including how to contact relevant agencies in normal working hours and out of hours.

• The practice held a register of patients with a learning disability and offered regular health checks for these patients. They were also offered longer appointments.

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

• The practice worked closely with involved staff in the community such as the district nurse and palliative care nurse, to ensure patient care was coordinated.