The Practice Leecon Way & Hawkwell

Updated 13 February 2017

The Practice Leecon Way & Hawkwell, Essex has a main branch located in a residential area of Rochford, in addition to a smaller branch surgery in a residential area of Hawkwell. The practice is managed by a corporate provider, The Practice plc. The main practice is within a purpose built building whereas the branch surgery is in a converted residential building. There is on street parking available at both surgeries as well as good public transport links. We visited both premises on the day of our inspection.

There is a female salaried GP, a male long-term locum GP and two female practice nurses. There is a practice manager, an assistant practice manager and a team of reception staff.

The practice offers extended opening hours and is open as follows:

The practice and branch surgery had varying opening hours across seven days a week, with extended evenings, early mornings and weekends.

When the practice is closed patients are signposted to out of hours services accessed by calling 111. Out of hours care is provided by Nestor Primecare Services Ltd.

Updated 13 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Practice on 14 April 2016. Overall the practice was rated as good but required improvement for providing safe services.

During our last inspection we required the provider to make the following improvements;

• Record, investigate, analyse and share the learning from significant events thoroughly and consistently.
• Ensure the safe storage of vaccines in line with the recognised guidance and the practice policy.
• Implement a system to monitor the use of prescriptions.

A requirement notice was not issued. However, the practice put an action plan in place to address the areas requiring improvement an ensure they were resolved.

On 19 October 2016 we conducted a desk top review and found;

• The practice had revised their management of significant incidents. Staff had received training in the recognition of incidents and the escalation of concerns. All incidents as before, were overseen by the practice manager and reviewed monthly under the practice governace arrangements.
• The practice had investigated the disparity with the recording of a fridge temperature. A stock check of all vaccines had been conducted on the day. Staff had been advised to record all information and actions they had taken for transparency. Regular audits were conducted of the recording systems to ensure staff adhered to the cold chain policy.
• The practice ensured the safe and secure management of prescriptions as required under guidance.

We were satisfied that the practice had made the required improvements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 May 2016

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

• Nursing staff who had specialist training, had lead roles in chronic disease management including diabetes and COPD.
• Patients at risk of hospital admission were identified as a priority, offered additional support and monitored to reduce this risk.
• Performance for diabetes indicators was comparable to national averages. For example, 96% of patients with diabetes, on the register, had an influenza immunisation in the preceding year, 1 August to 31 March, (01/04/2014 to 31/03/2015) this was comparable to the national average of 94%.
• Patients with long term conditions were provided with longer appointments to ensure all their needs were identified and discussed.
• All these patients had a named GP and were made aware of this.
• These patients received annual reviews 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 13 May 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 who were at risk, for example, children and young people who had a high number of A&E attendances.
• Immunisation rates were consistently 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.
• 85% of women aged 25-64 had a cervical screening test performed in the previous five years (01/04/2014 to 31/03/2015) which was slightly higher than the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Young people were treated in an age appropriate way and staff were aware of and understood Gillick competency testing.
• There was a lead GP for safeguarding children and all staff had received appropriate training in this.

Updated 13 May 2016

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

• The practice had a larger than average population group aged 40 to 69 years old. The practice offered proactive, personalised care to meet the needs of the older people in its population. All patients had a named GP and were made aware of this.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Patients at risk of hospital admission and those receiving palliative care were discussed regularly and offered support.
• Hospital admissions were monitored and followed up to ensure the continuity of care.
• The practice proactively identified older patients who required additional support and offered this support either within the practice or by signposting to other organisations. Information was available in the waiting area to offer support to patients and their families.

Updated 13 May 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.
• Online services including booking appointments were available. Electronic prescribing was also used to improve patient services.
• The practice provided early morning, evening and weekend appointments for working age people.
• The practice promoted a full range of health advice and screening that reflects the needs for this age group. This included signposting to organisations to help with smoking cessation and dietary advice.

Updated 13 May 2016

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

• 71% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is lower than the national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia, these meetings were documented and patient care records were updated.
• The practice carried out advance care planning for patients with dementia to ensure patient’s wishes were understood and documented.
• The practice had told patients experiencing poor mental health, and their families, 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 and discussed this at staff meetings.
• An external provider offered patients counselling services within the practice.

Updated 13 May 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.
• The practice offered longer appointments for patients with a learning disability and communicated with the families and carers of these patients.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients, these meetings were documented and patient care records were updated.
• The practice informed vulnerable patients and their families about how to access various support groups and voluntary organisations.
• Home visits were available for vulnerable patients unable to attend the practice.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. All 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.
• Staff had undertaken training in the Mental Capacity Act, 2005 as well as safeguarding training and had a very good understanding of how to protect vulnerable people.