10 May 2016
The practice is based in the town of Ongar near to the local leisure centre. There is limited car parking available at the practice so patients are able to use the leisure centre car park which is opposite. The practice moved in 2014 from another area of Ongar to purpose built, accessible facilities.
The practice welcomes patients from Ongar and the surrounding rural area, its rough boundary is the M11 to the west, Abbess Roding to the north, Radley Green to the east and Doddinghurst to the south.
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 have had at least three years of hospital experience. Medical students may sit in on consultations and examinations with the patient’s consent.
It 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 from here.
The current list size of the practice is 10314. There are five GP partners, one female and four male, and one male and two female salaried GPs. Between them they offer a total of 59 sessions each week. The gender of the GP registrars will change each intake, however at the time of our inspection there were four female and two male GP registrars. There are four female practice nurses and one female health care assistant (HCA).
The practice is open between 8.00am and 6.30pm Monday to Friday. Pre booked appointments are from 9am to 9.30am and 5.30pm to 6pm. Same day appointments are from 9.40am to 12pm and 4pm to 5.20pm. Pre bookable extended hours are offered Tuesdays 6.30pm to 8pm and Wednesdays 7am to 8am. The practice operates a ‘sit and wait’ clinic all day Mondays and Friday mornings instead of the same day appointment system. The dispensary is open Monday to Friday 9am to 6pm and during extended hours.
When the practice is closed patients are advised to call 111 if they require medical assistance and it cannot wait until the surgery reopens. There is also a pre bookable weekend service, via Stellar Healthcare, across West Essex based at seven hubs. Appointments are made through the practice.
10 May 2016
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Ongar War Memorial Medical Centre on 8 March 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.
- The majority of 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.
- The practice had good facilities and was well equipped to treat patients and meet their needs.
- Patients said they found it was very difficult to make appointments with both a named GP and for same day appointments. Patients told us that there was limited continuity of 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 forum. For example, they had piloted ‘sit and wait’ clinic to try to solve appointment issues and sought patient feedback on the outcome. The provision of services was then changed in response to their feedback.
- 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 complied with the requirements of the Duty of Candour.
The areas where the provider should make improvement are:
- Consider obtaining children’s pads for the defibrillator.
- Improve the identification of patients who are carers.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
10 May 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.
- Nationally reported data showed that outcomes for patients with long-term conditions were comparable or slightly lower than other practices nationally. For example, numbers of patients with long-term conditions, such as diabetes, receiving appropriate reviews were comparable to the national average.
- Longer appointments and home visits were available when needed. Multiple problems could be discussed in one consultation with the GP.
- 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 practice worked with relevant health and care professionals to deliver a multidisciplinary package of care.
- Information about support groups was evident in the reception area.
- The practice had future plans to further improve continuity and quality of care offered to this group of patients.
- Where the practice identified patients at high risk of developing a long term condition such as, diabetes, they provided tailored life style information to those patients.
10 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, young people who had young babies.
- Immunisation rates were either similar to or higher than the CCG average for the majority of standard childhood immunisations.
- The number of patients diagnosed with asthma, on the register, who had an asthma review in the preceding 12 months was slightly lower than the national average.
- Nationally reported data showed that outcomes for patients for uptake of cervical smears were comparable with other practices nationally.
- Parents and younger 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.
- Patients confirmed that 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 community children’s nurses. The local health visitors were based in the same building as the practice.
- The practice participated in monthly multidisciplinary meeting to identify children in need of further support.
- When a patient reached the age of 16 years, the practice pro-actively provided them with information to support them to follow a healthy lifestyle. Young people were also encouraged to be part of the Patient Forum.
10 May 2016
The practice is rated as good for the care of older people.
- The practice age demographic had a higher than average percentage of over 65 year olds.
- The practice offered proactive, personalised care to meet the needs of the older people in its population.
- Multiple health issues could be discussed in one consultation with the GP.
- The practice was responsive to the needs of older people, and offered home visits, longer appointments and urgent appointments for those with enhanced needs.
- The practice contacted older people upon discharge from hospital, reviewed their needs and offered appropriate support or referral to support agencies.
10 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 and flexible.
- The practice offered extended hours and pre-bookable surgeries on Wednesday mornings and Tuesday evenings.
- The practice was proactive in offering online and telephone services as well as a full range of health promotion and screening that reflected the needs for this age group.
- The practice participated in electronic prescribing, with patients able to specify the pharmacy that they wished their prescriptions to be sent to.
- There were pre bookable Saturday and Sunday appointments available as part of a locality wide scheme. These appointments were not based at the practice premises.
10 May 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 lower than the national average.
- Patients in the early stages of dementia, who may find it difficult to make an appointment in the usual way, were identified and support given to ensure they received timely medical care.
- 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 in line with 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.
- There was information available for patients experiencing poor mental health about how to access various support groups and voluntary organisations.
10 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 travellers, those with a learning disability and those who may be temporarily vulnerable due to circumstances.
- The practice offered longer appointments and annual health checks for patients with a learning disability.
- The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
- The practice informed vulnerable patients about how to access various support groups and voluntary organisations. There were also notice boards which displayed local and national information.
- Staff knew how to recognise signs of abuse in vulnerable adults and children. There were clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.