Caddington Surgery

Updated 21 April 2016

Caddington Surgery provides a range of primary care services from its location at 33, Manor Rd, Luton, Bedfordshire which has purpose built premises with access for the disabled and a small car park in front of the building. The practice is arranged over two floors with consulting rooms on both floors. Patients with mobility issues are seen on the ground floor.

Primary care medical services are provided under a General Medical Services (GMS) contract to approximately 4858 patients. The practice has a lower than average number of male and female patients aged 0 to 39 and higher than average number of male and female patients aged 65 and over.

The practice had not had a full time practice manager for some time and the GPs had been undertaking some of the management of the practice. The practice had recruited a new practice manager who started the week of the inspection.

The clinical staff team consists of a male GP partner, three female GP partners and a female salaried GP. In addition there is a community matron, who is also an advanced nurse practitioner, two practice nurses and a health care assistant (HCA). The team is supported by a practice manager, a senior administrative assistant and a team of administrative and reception staff. The practice is open every weekday from 8.30am to 6.30pm and is closed for an hour each day between 1.00 and 2.00pm except Thursdays. In response to patient feedback the practice has extended hours appointments on Wednesday 7.30am to 8am, Thursday 7.15am to 8am and Tuesday 6.30pm and 7.15pm. The practice has also increased the number of pre bookable appointments to allow patients requiring volunteer community transport to get to the surgery. Early appointments can be booked on-line. Telephone consultations are also available. Care UK provides a service for patients requiring a GP out of normal hours. Additional pre bookable appointments are made available following patient requests.

Updated 21 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Caddington Surgery on 12 January 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 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 that there was continuity of care. Urgent appointments were available the same day and there was an extended hours service. Appointments could be booked over the telephone or online.
• Patients were also offered telephone consultation appointments.
• 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 area where the provider should make improvement is:

• Ensure policies are in place for all processes, are readily available and that timescales for review are adhered to.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 April 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 indicators were above the national average, for example, the percentage of patients on the diabetes register, with a record of having a foot examination and that had been risk classified within the preceding 12 months was 98% where the national average was 88%.
• 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 had reduced the number of hospital admissions for patients with long term conditions.

Updated 21 April 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.
• 74% of patients diagnosed with asthma, on the register, had an asthma review in the last 12 months compared to the CCG average of 77% and national average of 76%.
• 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 uptake for cervical screening was 82% comparable to the national average of 80% to the CCG average.
• 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, health visitors and school nurses. The practice worked closely with the health visitor to support the traveller community in the area.

Updated 21 April 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.
• GPs and the community matron visited patients in care homes weekly.
• The community matron had developed an extensive programme to deal with avoiding hospital admissions
• All patients over the age of 75 were reviewed if not seen in the past 12 months and the community matron undertook over 75 health checks.
• Blood tests were available for patients aged over 75 who were unable to get to the hospital.

Updated 21 April 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 consulted with the patients and the patient participation group and introduced extended hours appointments from 7.15am to 8am. These appointments could be booked in advance. Patients could also have a telephone consultation if preferred.

Updated 21 April 2016

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

• 93% of patients diagnosed with dementia who had had their care reviewed in a face to face meeting in the last 12 months, which is higher than the national average of 84%
• The percentage of patients experiencing poor mental health who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 100% where the national average was 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of people 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.
• The practice 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 patients with mental health needs and dementia.
• The practice carried out dementia screening and referred to the memory service.

Updated 21 April 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.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• The practice informed 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.