Archived: Sutherland Lodge Surgery

Updated 28 January 2016

Sutherland Lodge surgery is located on the outskirts of the city of Chelmsford. The practice provides a primary medical service (PMS) to just over 12,000 patients of a diverse age group. The practice is a training practice for doctors who are training to become GPs, for junior doctors and medical students.

There was a team of four GP partners, three GP associates, one GP registrar and a GP trainee within the practice on the day of the inspection. Partners hold managerial and financial responsibility for running the business. There are four male and four female GPs. The GPs are supported by a practice manager, a mental health trained nurse, seven practice nurses, two health care assistants, a dispensary team, administration and office team.

Patients using the practice also had access to community staff including a community matron, district nurses, community psychiatric nurses, health visitors, physiotherapists, speech therapists, counsellors, podiatrists and midwives.

The practice was open between 8am and 6.30pm Monday to Friday. Appointments were from 8.30am to 11.30am and 2.00pm to 6.20pm daily. Patients requiring a GP outside of normal working hours are advised to contact the 111 service and the call will then be allocated to the most appropriate service this service is used between 6.30pm until 8am Monday to Friday and from 6.30pm Friday evening through the weekend to 8am Monday morning.

The practice has a Personal Medical Service (PMS) contract and also offers enhanced services for example; timely diagnosis and support for people with dementia, memory assessments, dermatology clinic, influenza and pneumococcal immunisations as well as monitoring the health needs of vulnerable people with complex needs and learning disabilities.

Updated 28 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sutherland Lodge Surgery on 14 October 2015. Overall the practice is rated as outstanding.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.

• There was a strong commitment to providing co-ordinated, responsive and compassionate care for patients, particularly people experiencing poor mental health (including people with dementia) and older people who are frail and at risk of memory loss.

• Information about services and how to complain was available. The practice actively sought patient views about improvements that could be made to the service and worked with the Patient Participation Group (PPG) to do this.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.
• The practice proactively sought to educate their patients to manage their medical conditions and improve their lifestyles. Additional in house services were available and delivered by staff with advanced qualifications, skills and experience.
• The practice used audits and had shared information from one of their audits with other practices to promote better patient outcomes.
• The practice had a clear vision which had quality and safety as its top priority. A business plan was in place, monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

We saw several areas of outstanding practice including:

• The practice employed a mental health nurse that worked collaboratively with the GPs to develop mental health care plans. She held her own patient lists that were patients that had been referred to her by the GP. Patients could be referred directly into the mental health services, signed posted to support groups and receive support from the practice.

• The practice carried out a bi-monthly skin clinic ran by a GP with a diploma in dermatology. This GP liaises closely with the local Dermatology consultant and has reduced the number of hospital referrals by being able it identify and treat minor symptoms locally. Data showed that the practice referral rates to hospital were lower than national and CCG averages for skin legions.

• The practice used a form called ‘for you about you’; this contained information that is useful for other medical professions and contained the patient’s medical history as well as their thoughts and wishes about the level of care they wanted to receive.

• The practice provided training and teaching to medical students and GP trainees, they also offered a placement to student nurses.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 January 2016

The practice is rated as outstanding for the care of people with long-term conditions. Nationally reported data showed that outcomes for patients were consistently high, for example for patients with diabetes. The practice had improved the patient pathway for diabetes management so it was a team approach and focused on holistic patient care. Nursing staff and GPs worked with patients to ensure jointly agreed care plans with patient-centred goals. Diabetes care included strategies to promote motivation and self-management. Patients with long-term conditions who were at risk were placed on the practice’s avoiding unplanned admissions register. The most complex and at risk patients including those with end of life care needs were discussed at weekly practice meetings, in addition to the three monthly palliative care meetings, to ensure patients were closely monitored.

There were further recall systems for patients with chronic disease and treatment monitoring investigations for arthritis and long-term mental health. Patients on potentially toxic medicines or those taking medicines with side effects were offered regular medicine reviews. The dispensary team flagged up overdue medication reviews to the GPs who then organised reviews. The dispensary team also monitored for any over or under use of medicines which would then be communicated to the GPs.

Patients with long term conditions were reviewed following discharge from hospital. This was undertaken by the usual GP either by phone or visit. Appropriate information was uploaded to the out of hours GP system.

The practice actively promoted health education about long term conditions and encouraged self-help; they performed well line with CCG and national averages in all vaccination schemes.

The practice maintained an up to date carers’ register, invited carers annually for a health check and linked them to the practice mental health nurse who also carried out a welfare and support role.

Updated 28 January 2016

The practice is rated as outstanding 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 above CCG and national rates 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. Appointments were available outside of school hours. We saw good examples of joint working with midwives, health visitors and school nurses.

Updated 28 January 2016

The practice is rated as outstanding for the care of older people. Nationally reported data showed that outcomes for patients were consistently above the national average for conditions commonly found in older people. The practice had introduced a number of initiatives to improve the care of older people. They had identified an increasing number of older people and organised care to better meet their needs this included early memory loss documentation and they had a Mental health nurse that took responsibility for this register.

The practice provided regular ward round visits to the local care homes as part of a scheme initiated by the CCG. We saw that the GPs were visiting the care homes over and above this; often several times a week. The practice used a form called ‘for you about you’; this contained information that will be useful for any other medical professions and contained the patients thought and wishes about the level of care they wanted to receive. Outcomes had been agreed to monitor the effectiveness of this document. For example reviewing the percentage of patients who had had a multi-disciplinary follow up assessment after admission to hospital. The document also stated what patients and staff in the care home should expect and promoted the best interests of the patient.

The practice had systematically implemented emergency health care plans, avoiding admission plans and do not attempt resuscitation (DNAR) to reduce burdensome interventions and unnecessary admission to acute care. We saw the information was evidence based and provided guidance to clinical staff. There was a register of vulnerable older patients who were at risk of admission to hospital. This was populated by internal practice discussion and use of a risk stratification tool. If older patients were at risk of admission, they had a care plan of on-going wishes and care needs. Patients then consented to relevant information being added to the OOH (out of hours) software system, so GPs could provide continuity of care. There was a monthly multi-disciplinary team (MDT) meeting to discuss the patients most at risk or those with on-going needs. The team also reviewed hospital admissions and discharges. Systems were in place to highlight any patients on this list and initiate an early GP review. The local care home said the GPs, without prompting, visited any patient who had been discharged from hospital.

The practice used specific templates for the general older person health check that prompted a falls assessment, dementia screen, carer details and offered carers wellbeing/health checks.

Updated 28 January 2016

The practice is rated as outstanding 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.

The practice was proactive in offering online services for appointments and prescriptions and using technology to improve accessibility for this population group, for example text message reminders, cancellations and results. The practice provided a virtual patient participation group option for those who were unable to attend the meetings in order to capture the views of this population group. The practice offered a range of health promotion services including cervical screening, bowel and breast cancer screening and smoking cessation.

Updated 28 January 2016

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

The practice had a higher than national and local incidence of mental illness. The practice employed a mental health nurse that managed her own case load ensuring continuity. Ninety seven percent of people experiencing poor mental health had received an annual physical health check and medication review.

Those deemed most at risk were placed on the avoiding unplanned admissions register and had collaborative care plans. Those at risk of medication abuse were put onto weekly prescriptions and the dispensary team kept a diary to ensure the prescription is collected before a new one is dispensed.

The practice was signed up to the dementia enhanced service. The practice had provided dementia training for clinical and non-clinical staff to improve awareness.

Updated 28 January 2016

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable. The practice held registers of patients living in vulnerable circumstances including homeless people, adults at risk, children at risk, carers and those with a learning disability. 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. The practice closely monitored vulnerable children. A nominated child safeguarding administrative and clinical lead attended child protection meetings. 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 recognised the need to provide extra support for marginalised groups and maintained close links with a local homeless shelter, delivering flu clinics for these patients and offered health checks.