Siam Surgery

Updated 1 December 2016

The practice area covers the town of Sudbury and extends into the outlying villages. The practice offers health care services to around 9350 patients. It is located in a new, purpose built health centre and has consultation space for GPs and nurses, as well as professionals including midwives, physiotherapists, health visitors, school nurses and social services. The practice holds a General Medical Service (GMS) contract with the local CCG.

• There are five GP Partners at the practice (two female and three male), four practice nurses including one nurse prescriber.
• A team of administration and reception staff support the management team. The practice manager is support by an assistant practice manager and a reception manager.
• The practice is open between 8am and 6.30pm Monday to Friday and appointments are available from 8.20am to 6pm. Patients are able to book evening and weekend appointments with a GP through Suffolk GP+.
• When the practice is closed, patients are asked to call the out of hours service, which is provided by Care UK, or to dial 999 in the event of a life threatening emergency.

• The practice demography is similar to the national average.
• Male and female life expectancy in this area is in line with the England average at 79 years for men and 83 years for women.

Updated 1 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Siam Surgery on 24 October 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.
• Patient safety alerts were logged, shared and initial searches were completed and the changes effected.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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 improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure with a relaxed and friendly management style, and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

The areas where the provider should make improvement are:

• Review the chaperone policy and procedure and the arrangements for documenting written patient consent for invasive procedures.
• Following the practice's own audit work, drive work forward to ensure that patients on warfarin are identified and reviewed as appropriate.
• Ensure that portable appliance testing (PAT) is completed in accordance with the practice risk assessment.
• Ensure that patient’s privacy is maintained whilst using the minor surgery room.
• Ensure that written information on the practice’s complaints policy is available in the waiting room.

We saw one area of outstanding practice:

• The practice nurse contacted every patient who had been diagnosed with cancer to provide support and advice on local support services and benefits. Peripherally inserted central catheter (PICC) line care was also offered to patients to reduce the need for them to travel to West Suffolk Hospital. PICC is a form of intravenous access that can be used for a prolonged period of time, for example for patients receiving long term chemotherapy.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 December 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. Patients who had a hospital admission were reviewed on discharge. The practice nurse also contacted patients with respiratory needs following an unplanned admission, to offer support and advice.
• The practice nurses held three respiratory clinics per week and offered telephone consultations. Joint clinics were held monthly with the specialist respiratory nurse.
• The practice used the information collected for the Quality and Outcomes Framework (QOF) to monitor outcomes for patients (QOF is a system intended to improve the quality of general practice and reward good practice). Data from 2014/2015 showed that performance for diabetes related indicators was 81%, which was below the local average of 92% and national average of 89%. The practice explained their performance was lower as they had prioritised work on admission avoidance. Exception reporting for diabetes related indicators was 9% which was below the local average of 12% and the national average of 11% (exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).

• Longer appointments and home visits were available when needed.
• Patients with complex needs 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 December 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 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 offered a full range of contraception services and chlamydia screening.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Midwives, health visitors, school nurses and social services were based in the health centre. We saw positive examples of joint working with these professionals.
• Parent and child parking was available at the practice.

Updated 1 December 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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• GPs and nursing staff provided home visits to patients living in the eight nursing and residential homes covered by the practice.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis, dementia and heart failure were above the local and national averages.

Updated 1 December 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.
• Patients were able to book evening and weekend appointments with a GP through Suffolk GP+ (Suffolk GP+ is for patients who urgently need a doctor’s appointment, or are not able to attend their usual GP practice on a weekday.)
• 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.
• The practice’s uptake for the cervical screening programme was 82% which was comparable to the CCG average of 81% and the national average of 82%.

Updated 1 December 2016

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

• 87% of patients experiencing poor mental health had a comprehensive care plan, which was in line with the local average of 88% and the national average of 89%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• 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 1 December 2016

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

• The practice worked closely with a learning disability nurse and annual health assessments for people with a learning disability were undertaken by the practice nurse and the GP. The practice had 53 patients on the learning disabilities register. 44 of these patients have had or have been booked for a health review since April 2016.
• The practice offered longer appointments and appointments at quieter times for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• 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.