The Village Surgery

Updated 21 December 2016

The Village Surgery provides a range of primary medical services, including minor surgical procedures from its location on Amenbury Lane, in Harpenden, Hertfordshire. The practice has a branch surgery located on Marford Road, in Wheathampstead, Hertfordshire. The practice maintains one patient list and patients can access either practice. We did not visit the branch surgery on the day of our inspection.

The practice serves a predominantly White British population of approximately 16,000 patients. There are slightly higher than average populations of males and females aged 5 to 14 years and 40 to 49 years. There are significantly lower than average populations of patients aged 20 to 34 years, demonstrating a high proportion of working families. The practice is located on the commuter belt to London and national data indicates the area is one of low deprivation and low unemployment in comparison to England as a whole.

The clinical team consists of six male and three female GP partners, a female salaried GP, a lead practice nurse, two additional practice nurses and a health care assistant. The practice also employs a paramedic working as an Emergency Care Practitioner (ECP). The team is supported by a practice manager, a deputy practice manager and a team of administrative staff. The practice holds a General Medical Services (GMS) contract for providing services, which is a nationally agreed contract between general practices and NHS England for delivering general medical services to local communities. The local NHS trust provides health visiting and community nursing services to patients at this practice.

The practice is a teaching practice with one accredited GP trainer and one trainee doctor.

The practice at Amenbury lane operates from a two storey purpose built property and patient consultations and treatments take place on ground level. There is limited staff car parking available to the rear of the practice with designated disabled parking bays. There is a large public car park nearby to the practice for patients to use.

The Village Surgery at Amenbury Lane is open between 8am and 6pm Monday to Friday. The branch surgery is open from 8am till 1pm and from 2.30pm till 6pm Monday to Friday. In addition, pre-bookable appointments are available at both practices from 7am on Wednesdays. Extended hours appointments are available non – routinely on Tuesday and Wednesday evenings at the Amenbury Lane practice until 8pm.

The out of hours service is provided by Hertfordshire Urgent Care Services and can be accessed via the NHS 111 service. Information about this is available in the practice and on the practice website and telephone line.

At the time of our inspection, the registration of The Village Surgery with CQC to provide regulated activities was not accurate and the practice did not have a registered manager appointed, as required under the CQC (Registration) Regulations 2009. They were also not registered to provide regulated activities for maternity and midwifery services. Prior to our inspection the practice submitted applications to appoint a manager and to provide regulated activities for maternity and midwifery services to ensure their registration with us is accurate.

Updated 21 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Village Surgery on 8 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.
• 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.

We saw one area of outstanding practice:

• The practice had identified 22% of its patient population as aged under 16 years. The practice manager had organised a health talk on common children’s illnesses for parents of children aged under 5 years, led by the Emergency Care Practitioner (ECP). This had been offered to patients registered at the practice and those registered at two neighbouring practices.

The area where the provider should make improvement is:

• Continue to monitor recently adopted procedures for managing blank prescriptions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 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.
• Performance for diabetes related indicators was comparable to the Hertfordshire Valley Clinical Commissioning Group (CCG) and national averages. 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) was 72%, where the CCG average was 77% and the national average was 78%.
• Longer appointments and home visits were available when needed.
• Staff worked together and with other health and social care services to understand and meet the range and complexity of patients’ needs along with assessment and planning of ongoing care and treatment.
• 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 more complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 21 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 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 83%, which was comparable to the CCG average and national averages of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice had identified 22% of its patient population as aged under 16 years. The practice manager had organised a health talk on common children’s illnesses for parents of children aged under 5 years, led by the Emergency Care Practitioner (ECP). This had been offered to patients registered at the practice and those registered at two neighbouring practices.
• A male GP and female GP provided clinical sessions at a local boarding school.
• The practice maintained a dedicated noticeboard and information on the practice website for young adults.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• Family planning and contraceptive advice was available.

Updated 21 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.
• All eligible patients were offered an over 75s health check.
• The practice supported patients residing in local nursing and residential homes.
• The practice provided influenza, pneumonia and shingles vaccinations.
• Longer appointments were available for all patients, including the elderly.
• The practice facilitated the locality Community Navigator once a month to provide social support to patients, for example, help completing application forms.
• All patients over the age of 75 had a named GP.

Updated 21 December 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice recognised its position on the commuter belt for London and 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 health checks to all new patients and carried out routine NHS health checks for patients aged 40-74 years.
• The practice offered smoking cessation advice and travel immunisations available on the NHS and privately, including Yellow Fever.
• Pre-bookable appointments were available from 7am on Wednesday mornings. In addition the practice offered evening appointments on Tuesdays and Wednesdays until 8pm; however these were not available every week.
• Telephone consultations were available daily.
• 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.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs of this age group.

Updated 21 December 2016

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

• The percentage of patients with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months (01/04/2015 to 31/03/2016) was 79% which was comparable to the CCG and national averages.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• Performance for mental health related indicators were comparable to local and national averages. For example, the percentage of patients on lithium therapy with a record of lithium levels in the therapeutic range in the preceding 4 months was 86% where the CCG average was 91% and the national average was 90%.
• The practice held a register of patients experiencing poor mental health and invited them to attend annual reviews. The practice had told patients experiencing poor mental health about how to access 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 21 December 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. At the time of our inspection there were 28 patients on the learning disability register of which 11 had received an annual review (since April 2016)
• 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 palliative care meetings in accordance with the national Gold Standards Framework (GSF) involving district nurses, GP’s and other local services (as needed).
• 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 responded to and supported the needs of transgender patients.
• The practice had identified 1% of the practice list as carers. The practice was making efforts to identify and support carers in their population. A member of staff had been trained as a Carers Champion and the practice had facilitated coffee mornings for carers and their dependants.