Bennetts End Surgery

Updated 17 January 2017

Bennetts End Surgery situated in Gatecroft, Hemel Hempstead, Hertfordshire is a GP practice which provides primary medical care for approximately 17,400 patients living in Hemel Hempstead and surrounding areas.

Bennetts End 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 Afro Caribbean and Eastern European origin.

The practice has ten GPs partners (six female and four male) one salaried GP (female) and one female retainer GP (the retainer scheme facilitates GPs to maintain their clinical skills through part-time working with educational and mentoring support). There are three practice nurses. The nursing team is supported by two health care assistants. There is a managing partner 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.

The practice provides training to doctors studying to become GPs. Additionally the practice facilitates the training of nurses, managers, administrative staff and work experience students.

Patient consultations and treatments take place on ground level. There is a car park outside the surgery with adequate disabled parking available.

The practice is open Monday to Friday from 8am to 6.30pm. On Saturday morning the practice is open between 8am and 12.30pm. There are 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 17 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bennetts End Surgery on 3 November 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 some aspects of managing high risk medication 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. However there was not an accessible summary of training records for the practice.
• All staff had received an appraisal within the last 12 months.
• 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 GP and there was continuity of care, with urgent appointments available the same day.
• The practice had established systems to support carers.
• Patient satisfaction with telephone access to appointments was lower than CCG and national averages.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a 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 improvement are:

• Develop a comprehensive approach to assessing infection control compliance.
• Continue to monitor the recently implemented system to manage patients that were offered anticoagulants but were not taking this medicine including evidence of any reasoning and or rationale.
• Develop a record keeping system so staff training records are readily available.
• Continue to identify and support carers.
• Continue to monitor measures implemented to improve national patient survey results, for example satisfaction results in relation to telephone access to appointments.
• Continue to encourage patients to attend cancer screening programmes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 January 2017

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

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

• There was a system to identify patients at risk of hospital admission that had attended A&E or the out of hours service and these patients were regularly reviewed to help them manage their condition at home.

• Performance for diabetes related indicators were comparable to the CCG and 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 preceding 12 months (01/04/2015 to 31/03/2016), was 68%, compared to the CCG average of 77% 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.

• 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.

• The practice offered newly diagnosed patients with diabetes a 20 minute lifestyle consultation with the practice nurse which emphasised the need for lifestyle changes and regular monitoring.

Updated 17 January 2017

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 82%, which was comparable to the CCG average of 83% and the national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• There was a drop in clinic called ‘Teen Screen’ for adolescents to discuss health matters.

• 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 referrals to family planning and related screening such as chlamydia screening.

Updated 17 January 2017

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 had identified 2% of the frailest patients at high risk of admissions to hospital (patients with multiple complex needs, and involving multiple agencies) and worked with community services in planning support.

• There was a home phlebotomy service including testing for patients who received anticoagulants.

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

• The practice supported a local care home and visited twice a week to carry out a ward round.

Updated 17 January 2017

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.

• This population were given priority appointments focussed on early morning and late afternoon.

• The practice opened each Saturday from 8am till 12.30pm.
• 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 17 January 2017

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

• 99% 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 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 hosted a shared care clinic with Hertfordshire’s Drug and Alcohol Recovery Service (The CGL Spectrum) to support drug dependant patients.
• 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.

• The practice had installed dementia friendly white lighting. This lighting was recognised as being beneficial for patients with dementia, by enabling them to enhance their sensory abilities and engage more actively in their consultations.

Updated 17 January 2017

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, GPs and the local palliative care nurses for people that required 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. The practice had identified 201 patients as carers (approximately 1% of the practice list). The practice had identified two carer’s champions who provided information and directed carers to the various avenues of support available to them.

• The practice had established regular Carers Health Check Clinics to support carers and offer health checks and flu vaccinations

• The practice had worked with the National Association of Citizens Advice Bureaux (CAB) in developing an anti-poverty strategy and had plans to provide a CAB outreach clinic on site.