Archived: Dr Tehmton Sepai Also known as Markyate Surgery

Updated 3 August 2016

Dr Tehmton Sepai provides primary medical services to approximately 4,083 patients in Markyate village and the surrounding areas. Services are provided on a General Medical Services (GMS) contract (a nationally agreed contract). Dr Tehmton Sepai is a semi-rural dispensing practice and dispenses to approximately 1,420 patients. The practice is located on the border of Hertfordshire and Bedfordshire.

The practice serves a lower than average population of those aged between 15 to 34 years, and a higher than average population of those aged between 40 and 69 years. The population is 96% White British (2011 Census data). The area served is less deprived compared to England as a whole.

The practice team consists of three GPs which includes one salaried GP and one regular locum GP who has been providing six sessions a week at the practice since August 2014. Two GPs are male and one GP is female. There is one registered nurse who works as a locum at the practice 14 hours a week. There is one Health Care Assistant and two dispensers. The non-clinical team consists of a practice manager, an assistant practice manager, a practice secretary and four members of the receptionist team.

The practice is open to patients between 8am and 1pm and from 2pm to 6.30pm Mondays to Fridays. Appointments with a GP are available from 9am to 12pm and from 4pm to 6.30pm Mondays to Fridays. Emergency appointments are available daily and a telephone consultation service is also available for those who need urgent advice.

Home visits are available to those patients who are unable to attend the surgery and the out of hours service is provided by Hertfordshire Urgent Care and can be accessed via the NHS 111 service. Information about this is available in the practice, on the practice website and telephone line.

Updated 3 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Tehmton Sepai on 14 June 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 in most cases.
• 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.
• 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.
• 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.
• 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 make improvements are:

• Complete the daily checks as identified in the Legionella risk assessment, take any required action following these checks and continue to make efforts to ensure the landlord completes the required action to manage all risks as identified in the Legionella risk assessment.
• Complete regular fire drills in accordance with the practice’s fire safety policy.
• Change the taps in the patient toilet to meet the required specification.
• Continue to try to re-establish the patient participation group and address the lower than average satisfaction scores in the national patient survey.
• Continue to work with the patient participation group to ensure members are informed and involved in how improvements could be made for the benefit of patients and the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 August 2016

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

• Performance for diabetes related indicators was better than the CCG and national average. The practice had achieved 100% of the total number of points available, compared to the local average of 81% and national average of 89%.
• The practice held an anticoagulation clinic and offered patients the required checks at the practice on a regular basis.
• 83% of patients diagnosed with asthma, on the register, had received an asthma review in the last 12 months which was better than the local average of 76% and national average of 75%.
• Longer appointments and home visits were available when needed.
• All patients with a long-term condition 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 3 August 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 identified as being at possible 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’s uptake for the cervical screening programme was 82% which was comparable with the local average of 83% and national average of 82%.
• The practice offered a range of family planning services. Baby vaccination clinics and ante-natal clinics were held at the practice on a weekly basis.
• We saw positive examples of joint working with midwives, health visitors and local schools.

Updated 3 August 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, this included enhanced services for avoiding unplanned admissions to hospital and end of life care.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments when required.
• Clinical staff worked with the integrated community matron team to manage the care of older people.

• Regular visits to two local nursing homes were carried out by a named GP for continuity of care and emergency visits were also provided when needed. We spoke to the home managers who told us that the practice was very responsive and provided an excellent service.
• The practice was pro-active in providing flu vaccinations for older people and at risk groups and offered health checks for patients aged over 75.

Updated 3 August 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 provided a health check to all new patients and carried out routine NHS health checks for patients aged 40-74 years.
• Data showed 73% of female patients aged 50 to 70 years had been screened for breast cancer in the last three years compared to a local and national rate of 72%.
• The practice was proactive in offering on line services such as appointment booking, an appointment reminder text messaging service and repeat prescriptions, as well as a full range of health promotion and screening that reflects the needs of this age group.

Updated 3 August 2016

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

• 95% of patients diagnosed with dementia had their care reviewed in a face to face meeting in 2014/2015, which was above the local average of 85% and national average of 84%.
• The practice held a register of patients experiencing poor mental health and offered regular reviews and same day contact.
• The practice had access to a NHS counsellor who held weekly appointments at the practice.
• The practice referred patients to the Improving Access to Psychological Therapies service (IAPT) and encouraged patients to self-refer.
• Performance for mental health related indicators was better than the CCG and national average. The practice had achieved 100% of the total number of points available compared to 96% locally and 93% nationally. Exception reporting was below the local and national average.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• 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 3 August 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.

• It offered longer appointments and annual health checks for people with a learning disability. The practice had completed 34 health checks out of 36 patients on the learning disability register between 2015/2016.

• The practice had a system in place to identify patients with a known disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• Vulnerable patients had been told how to access various support groups and voluntary organisations.
• Staff had accessed safeguarding training and knew how to recognise signs of abuse in vulnerable adults and children. Staff members 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.