Archived: Parsonage Surgery

Updated 14 October 2016

Parsonage Surgery situated in Bishops Stortford, Hertfordshire is a GP practice which provides primary medical care for approximately 4,900 patients living in Bishops Stortford and surrounding areas.

Parsonage Surgery provides primary care services to local communities under a General Medical Services (GMS) contract, which is a nationally agreed contract between general practices and NHS England. The practice population is predominantly white British along with a small ethnic population of Asian Polish and other Eastern European origin. The practice has a large population of working age patients with young families.

The practice has two GP partners (one male and one female). There are two nurse prescribers supported by a health care assistant. There is a practice manager who is supported by a team of administrative and reception staff. The local NHS trust provides health visiting and community nursing services to patients at this practice.

This practice is located on the grounds of Herts and Essex Community Hospital and benefits from onsite parking which is pay and display. Adequate parking is also available for those patients with mobility issues.

The practice is open Monday to Friday from 8am to 6.30pm except on Tuesday when the practice is open until 8pm and on Thursday when the practice is open until 7.30pm. The practice offers a variety of access routes including telephone appointments, on the day appointments and advance pre bookable appointments.

When the practice is closed services are provided by Herts Urgent Care via the 111 service.

Updated 14 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Parsonage Surgery on 14 July 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. However systems relating recording of monitoring information of historic safety alerts and children not attending hospital appointments (DNA) needed strengthening.
• 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 easy to understand. 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 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:

• Continue to monitor the recently implemented system to monitor historic safety alerts.

• Continue to monitor the recently implemented protocol to code those children who had failed to attend a hospital appointment (DNA) so they could be easily identified and acted on.

• Ensure modifications to the access doors to the practice are carried through as planned in conjunction with the facilities directorate of Essex Community Hospital so access to patients with limited mobility can be improved.

• Continue to monitor patient survey results and ensure improvement to access to the practice over the phone.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 October 2016

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

• Nursing staff supported by the GP had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators were better than the national average. For example, the percentage of patients with diabetes, on the register, in whom the last blood glucose reading showed good control in the in the preceding 12 months (01/04/2014 to 31/03/2015), was 84%, compared to the CCG average of 76% and the national average of 78%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. These were arranged through One Stop Clinics which enabled patients to receive appropriate reviews and care in one appointment rather than multiple appointments throughout the year.

• 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 14 October 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 relatively 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’s uptake for the cervical screening programme was 79%, which was comparable to the CCG average of 76% and the national average of 82%.

• 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 and health visitors.

• The practice provided a variety of health promotion information leaflets and resources for this population group.

• The practice offered discreet referrals to the onsite Sexual Health Hertfordshire clinic for family planning and related screening such as chlamydia screening.

Updated 14 October 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.

• All patients over 75 had a named accountable GP.

• All these patients were offered an over 75s health check.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice worked closely with Community Nursing Team and the Rapid Response Service (a service provided by the Hertfordshire County Council and East and North Hertfordshire Clinical Commissioning Group incorporating a partnership of health professionals social care workers to help people stay well and independent) and coordinated care at home.

• The practice had identified older patients at high risk of admissions to hospital (patients with multiple complex needs, and involving multiple agencies) and worked community services in planning support.

• The practice provided a vaccination service for the housebound.

• The practice offered spirometry, ECGs, ambulatory blood pressure monitoring (ABPM) and phlebotomy services on site for the older patient avoiding the need to travel to a general hospital.

• The practice worked with local pharmacies and arranged the delivery of medicines to the housebound.

Updated 14 October 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.
• 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 offered late evening appointments on Tuesday 6.30pm till 8pm and on Thursday from 6.30pm till 7.30pm for working patients and those who could not attend during normal opening hours.

• The practice provided telephone triage and ring back service by a duty GP at the patient’s request where appropriate.

• The practice offered pre bookable appointments up to six weeks in advance which could be booked in person by telephone or online.
• The practice offered NHS Health checks smoking cessation advice and travel immunisations.
• The practice had enrolled in the Electronic Prescribing Service (EPS). This service enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.

Updated 14 October 2016

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

• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was above the national average. 

• The practice offered annual reviews to all patients on the mental health register which included physical checks.

• 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 including the community drugs and alcohol team.

• Patients could self refer to the local Wellbeing Team through the practice reception.

• Patients attending the hospital memory clinic with a diagnosis of dementia and who were stabilised on their medication were managed by the practice avoiding frequent visits to the hospital clinic.

• The practice had a system in place to follow up patients who had attended A&E 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.

Updated 14 October 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.
• 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 support groups and voluntary organisations.
• The practice held regular health visitor liaison and multi-disciplinary team meetings to discuss the care needs of specific patients.
• The practice held regular review meetings involving district nurses, GP’s and the local palliative care nurses for people that require end of life care and those on the palliative care register.
• 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.
• The practice identified patients who were also carers and signposted them to appropriate support.