Archived: Abbey Practice

Updated 15 August 2016

Abbey Practice is situated in the Stepgates area of Chertsey. The practice is located in the Chertsey Family Health Centre which is a purpose built property. The building is owned by NHS Estates and there are three providers sharing the property. This practice is not the major tenant. At the time of our inspection there were approximately 11,380 patients on the practice list.

The practice has four GP partners and five salaried GPs (three male and six female), four nurses, a healthcare assistant, a practice manager, reception and administration staff. The practice is a training practice, and at the time of our inspection had two GP registrars. (Teaching practices take medical students and training practices have GP trainees and F2 doctors).

The practice is open between 8am and 6.30pm Monday to Friday. Extended hours surgeries are offered 6.30pm to 7pm Tuesday, Wednesday and Thursday evenings and 8.30am to 12pm every Saturday. Patients requiring a GP outside of normal hours are advised to call the surgery where they are redirected to an external out of hours service. The practice has a Personal Medical Services (PMS) contract and offers enhanced services for example; various immunisation and learning disabilities health check schemes.

The practice population has a higher number than average of younger patients birth to four years and patients 85 years or older. It also has a slightly higher than average percentage of patients with long standing health conditions and slightly higher than average number of patients with caring responsibilities.

The service is provided at the following location:-

The Abbey Practice

Chertsey Family Health Centre

Stepgates

Chertsey

Surrey

KT16 8HZ

Updated 15 August 2016

Letter from the Chief Inspector of General Practice

Following an announced comprehensive inspection of Abbey Practice in November 2015, the practice was given an overall rating of good with requires improvement for providing safe services.

At our previous inspection we identified concerns relating to recruitment checks and the use of patient specific direction (PSD). A Patient Specific Direction is the written instruction, signed by a doctor, for medicines to be administered to a named patient after the patient has been assessed on an individual basis.

After the comprehensive inspection, the practice wrote and provided an action plan to tell us what they would do in respect of our inspection report findings and to meet legal requirements. We undertook this focused inspection on 12 July 2016 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. Overall the practice is rated as good following this inspection.

Our previous inspection in November 2015 found the following areas where the practice must improve:

• Ensure recruitment arrangements include all necessary employment checks for all staff, and that Disclosure and Barring Service (DBS) Checks have been completed for those staff who undertake chaperone duties
• Ensure Person Specific Directions (PSD) are in place for the health care assistant.

We also identified some areas in which the practice should improve:

• Ensure the annual appraisal process is robust so that all staff have annual appraisals. At this inspection we saw evidence that all staff had received an appraisal within the last twelve months and that there was a planned schedule for future appraisals.
• Ensure that lessons learnt from significant events are communicated to the appropriate staff to support improvement. At this inspection we saw evidence that there was a clear system in place for recording and investigating significant events and that this learning was shared widely enough to support improvement.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk

Our key findings across the areas we inspected for this focused inspection were as follows:

• Risks to patients were assessed and well managed including recruitment checks.
• The practice had a robust system in place for the use of PSDs.
• There was a system in place for staff appraisals.
• The practice had a clear process for the recording and investigation of significant events and this learning was shared widely enough to support improvement.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 January 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.

• A salaried GP and a practice nurse had completed the Warwick Course, which is advanced diabetic care training; two GP partners had also attended diabetic care courses.

• For those patients with more complex diabetic needs there was a monthly clinic with the local diabetic specialist nurse

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 21 January 2016

The practice is rated as good for the care of families, children and young people.

• Immunisation rates for the standard childhood immunisations were mixed. For example immunisation rates at 12 months were below CCG average (the practice pneumococcal immunisation average was 70.2% whilst the CCG average was 83%) but at 5 years they were similar to the CCG average.

• 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.

• 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.

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

• Emergency processes were in place and referrals were made for children whose health deteriorated suddenly.

• We saw good examples of joint working with midwives, health visitors and school nurses; this was demonstrated particularly well during a recent measles outbreak.

Updated 21 January 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.

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

• There was a good system in place for ensuring continuity of care for home visits and for patients in nursing homes.

• The practice had good relationships with a range of support groups for older patients. The reception manager was working with a charity to provide drop in sessions every two weeks.

• There were arrangements in place to provide flu and pneumococcal immunisations to this group of patients.

• Patients were able to speak with or see a GP when needed and the practice was accessible for patients with mobility issues.

• We saw evidence the practice was working to the Gold Standards Framework for those patients with end of life care needs.

Updated 21 January 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 had extended opening with bookable appointments on Saturdays 8:30am till 12pm and also offered lunch time surgeries.

• Health promotion advice was offered and we noted health promotion material available throughout the practice.

• Electronic Prescribing was available which enabled patients to order their medicine on line and to collect it from a pharmacy of their choice, which could be closer to their place of work if required.

Updated 21 January 2016

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

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• It 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.

• It had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support people with mental health needs and dementia.

Updated 21 January 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 homeless people, travellers and those with a learning disability.

• We saw evidence of a good knowledge among the clinical and administration staff of the particular difficulties this population group may be facing.

• It offered longer appointments for people with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• It had told 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.