The Gold Street Surgery

Updated 15 June 2016

The practice is based in Saffron Walden, Essex. A large number of the patients on the practice list are older people. The practice has low level of income deprivation affecting both older people and children.

This practice is a teaching and training practice and has medical students and GP registrars in their final stage of training. GP registrars are fully qualified doctors and will have had at least three years of hospital experience. Medical students may observe patient consultations and examinations with the patient’s consent.

This practice is also a dispensing practice. This means that patients who do not have a dispensing chemist within a 1.6km radius of their house can get their prescribed medicines dispensed at the practice.

The current list size of the practice is 10075 patients. There are four GP partners, three female and one male, and three female salaried GPs. There are four female practice nurses and two female health care assistants (HCAs).

The practice is open every weekday between 8am and 6.30pm. Morning surgeries are from 8.30am to 12.30pm and afternoon surgeries from 3.30pm to 5pm. Same day appointments run to different time schedules as required. Pre-bookable extended hours are offered Monday mornings between 7am and 8am. Book on the day evening telephone appointments are available for telephone advice from Monday to Thursday 6.30pm to 7pm. There is a pre-bookable weekend GP/Nurse/Healthcare assistant service, run from Saffron Walden Community Hospital. Appointments for the weekend service can be made through the practice.

The dispensary is open Monday to Friday 9am to 6pm.

When the practice is closed patients are advised to call 111 if they require medical assistance and it cannot wait until the surgery reopens. The 111 provider is currently Integrated Care 24 (IC24) and the out of hours provider is Partnership of East London Cooperative (PELC).

There is a branch surgery at: School Street, Great Chesterford, Saffron Walden, Essex. The School Street branch surgery is open between 8.00am and 12.30pm, plus Monday and Wednesday afternoons between 3.30 and 5.00pm. This is also a dispensing branch.

The branch surgery was not visited as part of our inspection.

Updated 15 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Gold Street Surgery on 16 March 2016. 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 report incidents and near misses. All opportunities for learning from internal and external incidents were maximised. Outcomes from incidents were shared appropriately.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, the practice took part in peer review and attended post graduate meetings to update their knowledge of best practice.
• Feedback from patients about their care was consistently positive.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, the practice was piloting a multidisciplinary meeting in one of the care homes, in order to improve communication between professionals involved in the resident’s care.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, following feedback from the NHS friends and family test the practice recruited two more salaried doctors.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result. Complainants were informed of the outcome and lessons learned from their complaint.
• 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 stakeholders and was regularly reviewed and discussed with staff.
• Continuous learning was encouraged at all levels both clinical and non-clinical. The practice was keen to maintain, involve and develop staff so there was a high level of satisfaction amongst staff and continuity for patients.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

The areas where the provider should make improvement are:

• Consider taking more proactive steps to improve the identification of patients who are carers.
• Consider how they can improve patient access their preferred doctor.

We saw one area of outstanding practice:

• The practice had undertaken significant work with palliative care patients and patients on their multidisciplinary meeting list to establish decisions on preferred place of care and resuscitation wishes. They had worked with other agencies to ensure that patients end of life choices were fulfilled. The practice had completed an audit and found that 96% of patients had achieved their end of life preferences.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 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.
• The practice operated a recall system for patients with chronic conditions such as asthma, COPD, cardiac disease, diabetes and chronic kidney disease.
• The practice had a weekly diabetes clinic where patients were seen by either a GP, Dietician or nurse according to their need and outcome of checks completed. Dedicated clinics for other long term conditions were also held.
• Nationally reported data showed that outcomes for patients for most long-term conditions were comparable with other practices nationally. Data for annual reviews of patients with respiratory conditions, such as asthma or COPD were much lower than compared to the national average. The practice were aware and had taken action to improve this. For example, they had instigated a weekly nurse led asthma clinic which included telephone reviews for working age patients. We saw evidence that performance in this area had improved as a result.

Updated 15 June 2016

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

• There were strong 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. Where notifications of domestic violence were received the practice ensured staff would be aware of all members of family and extended family who may be affected or at risk following the incident.
• Immunisation rates were similar to the CCG average for standard childhood immunisations. There was a large transient population due to military families living nearby; however the practice had a system in place to follow up those children who did not attend for childhood immunisations.
• The number of patients diagnosed with asthma, on the register, who had an asthma review in the preceding 12 months was much lower than the national average. The outcomes for percentage of patients receiving an annual review were much lower than when compared to the national average however the practice were aware and had taken action to improve this. We saw evidence that performance in this area had improved as a result.
• Clinical staff gave us working examples to demonstrate how children and young people were treated in an age-appropriate way and were recognised as individuals.
• 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 15 June 2016

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

• The practice told us they had double the national average of patients over the age of 85 and had considered what was required to maximise the service offered to this patient group.
• 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 was trialling holding a multi-disciplinary meeting at one of the local care homes with the community matrons.
• Care and treatment of older people reflected current evidence-based practice.
• The practice contacted older people upon discharge from hospital, reviewed their needs and offered appropriate support or referral to support agencies.
• The practice offered a room to a phlebotomy drop in and bookable clinic provided by the local hospital.
• Older people at risk of falls were referred to a dedicated clinic to identify measures to minimise the occurrence. 

Updated 15 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.
• There was a weekly nurse led asthma clinic which included telephone reviews for working age patients.
• 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. Screening included vascular health screening for adults aged 40-74, and lifestyle advice.

• Nationally reported data showed that outcomes for patients for uptake of cervical smears were comparable with other practices nationally. 80% practice average compared with a national average of 81%.
• Nationally reported data showed that outcomes for patients for uptake of bowel and breast screening in the last three years were higher than other practices nationally. For example, 75% of eligible females in the practice aged 50-70 attended for a breast screen compared to a 71% CCG average and a 72% national average.

Updated 15 June 2016

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

• The percentage of patients diagnosed with dementia who had had their care reviewed in a face to face meeting in the last 12 months, was similar to the national average. 89% practice average compared to a national average of 84%. The practice proactively searched for patients at risk of dementia and invited them in for screening.
• The percentage of patients, on the practice register, with a diagnosis of schizophrenia, bipolar affective disorder or other psychosis, that had an agreed care plan documented in their records, was slightly higher than the national average.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. Patients were sent a letter inviting them into the practice for their annual review. In some cases the practice proactively visited patients at home for reviews.
• The practice carried out advance care planning for patients with dementia and supported end of life decisions.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. 

Updated 15 June 2016

The practice is rated as good for the care of people who 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.
• The practice had a specially trained GP and nurse lead for patients with a learning disability and longer appointments were available for this group of patients.
• The practice completed annual health checks for those patients with a learning disability, which included, as required, liaison with the community specialist nurse and the psychiatrist. They also had information in an easy read format on self-care and health screening.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. This included supporting vulnerable patients in achieving their end of life preferences.
• The practice had undertaken significant work with palliative care patients and patients on their multidisciplinary meeting list to establish decisions on preferred place of care and resuscitation wishes. They had worked with other agencies to ensure that patients end of life choices were fulfilled. The practice had completed an audit and found that 96% of patients had achieved their end of life preferences.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• There was information available in other languages, such as Polish, which reflected the local population.
• 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.