21 January 2016
Elizabeth Courtauld Partnership provides GP services to approximately 16000 patients living in West Halstead, Essex. The practice holds a General Medical Services Contract (GMS) with the addition of enhanced services which included extended hours access, childhood vaccination and immunisation scheme, reducing unplanned admissions, and minor Surgery.
The practice has a team of seven GP partners, in addition two salaried GPs, two regular locum GPs, and two registrar GPs. The practice is a training practice and GP registrars are doctors training to be GPs. There are seven female GPs
six male GPs providing a choice of clinician gender. The nursing team comprises three nurse practitioners three nurses and two healthcare assistants. There are a team of 17 non-clinical, administrative, and reception staff members who share a range of roles, two secretaries, a practice manager and an assistant practice manager. The practice works closely with district nurses that share the same building and has access to midwives, palliative care nurses, social workers, health visitors, and therapists to provide care and treatment to their patient population.
The practice is open from 8.30am to 6.30pm Tuesday, Wednesday, Thursday, Friday, and from 8.30am to 8.20pm on Monday. The phone lines are closed daily between 8am to 8.30am and 1pm to 2pm, except for emergencies
The practice has opted out of providing GP services to patients outside of normal working hours such as evenings and weekends. Outside of practice opening hour’s services are provided by ‘111’ and ‘Primecare’ out-of-hours emergency and non-emergency treatment services. Details of how to access the out of hour’s service is available within the practice, on the practice website, and in the practice leaflet.
21 January 2016
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at the Elizabeth Courtauld Partnership on 20 October 2015.
Specifically, we found the practice to be good for providing safe, effective, caring, responsive, and well led services. It was also good for providing services for older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable, and people experiencing poor mental health (including people with dementia).
Our key findings across all the areas we inspected were as follows
Staff knew and carried out their duty to raise concerns, and to report safety incidents. Information about safety was recorded, monitored, and appropriately reviewed to identify trends or recurring themes.
Risks to patients were also assessed, well managed and reviewed to identify any trends or recurring themes.
- Patients’ needs were considered and care was planned and provided in a way that reflected both best practice and recommended current clinical guidance.
- Staff had received the necessary training appropriate for their roles and further training had been encouraged, recognised and planned for through the practice appraisal system.
- Information regarding how to complain about the practice was available to patients and easy to understand.
- The practice staff members had received training regarding safeguarding children and vulnerable adults and knew who to contact with any concerns.
The practice was adequately equipped to treat patients and meet their requirements.
The practice had a well-established Patient Participation Group (PPG) that supported the practice with their opinions regarding suggestions for practice changes.
- There was a well-defined leadership structure and all the staff members we spoke with told us they felt supported in their working roles.
We saw two areas of outstanding practice:
The practice healthcare assistant (HCA) provided a free GP referred nail clipping service for patients. The practice had investigated the need and the alternative local service was expensive for many older people.
One of the GPs at the practice has undertaken further training in substance misuse, and provided a service for patients with this need in the practice. Patients were assessed and stabilised on treatment by the substance misuse teams at secondary care (hospital), then care was transferred to the practice. The GP with further training continued to monitor, screen urine and prescribe for these patients. This avoided them having to undertake the long journeys by public transport to secondary care services.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
21 January 2016
The practice is rated as good for the care of people with long term conditions.
Patients with a long-term condition and those at risk of a hospital admission were identified and provided with longer appointments or home visits when needed. The practice employed two nurses with additional skills in the management of long term conditions (LTC) for asthma, chronic obstructive pulmonary disease (COPD), and diabetes. The two practice nurse practitioners provided minor illness clinics which allowed the GPs to devote more time and appointments to the review and management of long term conditions. Each GP had an individual responsibility for a different LTC. All patients with a long term condition had a named GP and a structured annual review to check their health and medicine requirements were met. The practice nurses and healthcare assistants also hold clinics for this population group to address on-going monitoring of their condition(s) and lifestyle advice.
For those people with more complex needs, the named GP worked with relevant health and care professionals for example community and hospital care to deliver a multidisciplinary care package.
The practice provided patient education as a fundamental part of LTC management and hosted events which were well attended by patients.
Those patients on the palliative care register in need of care were discussed at the monthly multidisciplinary team meetings.
21 January 2016
The practice is rated as good for the care of families, children and young people.
Immunisation rates were high for the standard childhood immunisations and HPV vaccine for teenage girls in comparison with other practices in the local area. Children at risk, for example, children and young people who had a high number of A&E attendances were followed up. On a monthly basis at the GP partnership meetings, they discussed families with safeguarding issues. The GP who knew the child/ family best would attend safeguarding meetings when possible and always provided reports where necessary for other agencies.
GPs work closely with the ‘families and schools together’ (FAST) team based in local primary schools who accept referrals from the practice. The practice also referred young people to a counselling service for teenagers aged 12 to18. Reception staff members were aware of the practice policy in respect of children who attended the surgery alone. They were provided with an appointment in a timely manner. The GP would assess the patient using ‘Gillick’ competence, before carrying out any consultation or treatment. Gillick competency test is used to help assess whether a child has the maturity to make their own decisions and to understand the implications of those decisions.
Appointments were available outside school hours for families with school age children and young people. Family Planning and sexual health requirements were led by a specialist nurse who provided for a full range of contraceptive services, including coil fitting, nexplanon fitting and other common long acting forms of contraception and emergency contraception. The practice told us their policy for confidentiality and discretion was delivered in a non-judgemental approach to make the younger population feel comfortable to use our services. This provision of care was particularly beneficial for the large student population that accessed the service.
The practice worked closely with midwives, and health visitors. They provided antenatal checks and support for mothers during pregnancy, with baby checks and post-natal checks after confinement. The practice also provided family planning services, sign-posted young people towards sexual health clinics, chlamydia, and sexually transmitted disease (STD) screening.
21 January 2016
The practice is rated as good for the care of older people.
Nationally reported data showed that outcomes for patients were above those nationally for conditions commonly found in older people.
The practice offered proactive, personalised care to meet the needs of the older people in the practice population. They provided a range of services, for example; senior health checks, bespoke care plans as part of the admission avoidance enhanced service for people at risk of an unplanned hospital admission. Once a month the practice held a multi-disciplinary meeting (MDT) meeting with GPs, district nurses and the local social work team to discuss patients who had been identified to be at high risk of hospital admission. Weekly MDT meetings with GPs and district nurses were held to discuss older people’s caring needs. The GPs at the practice told us this collaborative work reduced hospital admissions and home visits, although keeping them informed and able to continue monitoring care and treatment.
The practice had made structural changes to provide easy accessibility for people from this population group for example, additional parking spaces, a lift, wheelchair access, hearing loops, and accessible doors and toilets.
The practice had provided a named GP for all patients in this population group, and the healthcare assistant (HCA) provided a free GP referred nail clipping service for patients. The practice had investigated the need and found the alternative local was expensive for many older people. They offered older people home visits, and urgent appointments to meet their needs. The maintenance of a frailty register and use of the template available on the computer medical records system alerted clinicians at the practice to the needs of frail patients.
The practice nurse practitioners regularly visited patients at home and in the four care homes looked after by the practice, to deal with day to day issues in a timely fashion before they developed into more serious problems. The GPs at the practice visited the local Community Hospital twice a day to treat and prescribe for the in-patients referred to the ward staying in the community led beds. They visited and treated all the patients in the community led beds including those registered at other GP practices.
21 January 2016
The practice is rated as good for providing services to 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 offered. Extended hours appointments were provided by GPs on Monday’s, along with minor ailment clinics held by Nurse practitioners and various long term condition clinics for example; Asthma, COPD, and Diabetes that followed normal surgery opening hours from 6.30 pm through to 8.30 pm.
Telephone appointments were available to allow easy access to and avoid unnecessary waiting. The practice offered online appointments and prescriptions as well as a full range of health promotion, screening, and health checks that reflected this population group’s needs. The practice also had online ‘Twitter feed’, an ‘eForum’ and ‘SystmOnline’ to cater for patients who preferred to access information online or outside of working hours.
Patients over 40 years of age are invited to a free health check, to prevent the risk of undetected hypertension, ischemic heart disease and diabetes. We were told during these checks clinicians gave advice on healthy eating and exercise related topics.
Lifestyle changes, such as smoking cessation clinics, and healthy living clinics provided patients advice regarding cholesterol level and weight management
21 January 2016
The practice is rated as good for providing services to people experiencing poor mental health (including people with dementia).
Analysis of data we held showed the percentage of patients experiencing poor mental health at the practice had received a comprehensive agreed care plan; this was 12% higher than the local and national averages within the 2013-2014 data we held. The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
The practice sign-posted patients experiencing poor mental health to access various support groups and voluntary organisations which included cognitive behaviour therapy, crisis intervention, a be-friending service and the drug and alcohol team. Patients were directed to local charities, including ‘MIND’ and ‘CRUSE’, to provide more support.
One of the GP’s at the practice has undertaken further training in substance misuse, and provided a service for patients with this need in the practice. Patients were assessed and stabilised on treatment by the substance misuse teams at secondary care (hospital), then care was transferred to the practice. The GP with further training continued to monitor, screen urine and prescribe for these patients. This avoided them having to undertake the long journeys by public transport to secondary care services.
The practice told us they had above average number of older patients which resulted in them having an above average number of patients with dementia. They screened patients for dementia using recognised clinical tools, and used a template on their surgery computer system for consistency. Patients with suspected dementia had screening blood tests and an electrocardiogram before being referred to the memory clinic at the hospital to confirm the diagnosis.
The practice looked after four residential care homes and one nursing home, with a total population of 229 patients. The majority of the residents had a diagnosis of dementia. Each home was allocated an individual practice GP, who visited regularly to provide continuity of care. A full review of these patients was carried out every six months.
The practice hosted ‘Alzheimers.org’ who provided one to one support to carers of dementia patients. They recognised that caring for people with dementia could be very demanding, and was often undertaken by people who were elderly and not in the best health. The practice understood that these carers required support from the practice and other organisations.
Patients in this population group who had attended accident and emergency (A&E) where they may have been experiencing poor mental health were followed up.
21 January 2016
The practice is rated as good for providing services to people whose circumstances may make them vulnerable.
The practice held registers of patients living in vulnerable circumstances including those living with a learning disability (LD), and living in residential care. They carried out annual health reviews for patients with a learning disability and all of these patients had received a follow-up when we checked the 2013-2014 data available to us. They also provided day to day medical care with longer appointments, and liaised appropriately with LD specialist services.
The practice worked with multi-disciplinary teams in the case management of vulnerable people. Signposting to third sector groups and organisations to access various support as element of their care.
All staff had received training in and knew how to recognise signs of abuse in vulnerable adults and children. They were aware of their responsibilities regarding information sharing and the documentation of safeguarding concerns. Staff knew who the safeguarding lead was at the practice and who to contact with any concerns.