The Cottage Surgery

Updated 16 November 2017

The Cottage Surgery is located in the village of Woodhouse Eaves which is in Charnwood Forest in North Leicestershire. It has approximately 3,000 patients and the practice’s services are commissioned by West Leicestershire Clinical Commissioning Group (CCG).

The practice has a General Medical Services Contract (GMS). The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities.

At The Cottage Surgery the service is provided by one male GP partner, one managing partner, one assistant practice manager, two nurses, two health care assistants and two administration and reception staff.

This provider has one location registered with the Care Quality Commission (CQC) which is

The Cottage Surgery, 37 Main Street, Woodhouse Eaves, Leicestershire. LE12 8RY

The practice is open between 8.30am to 6pm Monday, Tuesday, Wednesday and Friday. Thursday from 8:30am to 12 midday. Primecare covers 8am to 8.30am and 6pm to 6.30pm each day and Thursday afternoon from 12 midday.

A system called Doctor First is in place which enables the practice to manage patient demand in a timely way by a GP talking to all patients before seeing them.

Appointments are available from 8:30am until 6:30pm Monday, Tuesday, Wednesday and Friday and from 8:30am until 1:00pm on Thursdays. Appointments can be made in advance without limitation. The practice does not offer extended hours.

The practice has opted out of the requirement to provide GP consultations when the surgery is closed. The out-of-hours service is provided by Derbyshire Health United. There are arrangements in place for services to be provided when the practice is closed and these are displayed on their practice website.

Updated 16 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Cottage Surgery on 2 December 2016. The overall rating for the practice was requires improvement. The ratings for providing a caring and responsive service were good but the ratings for providing a safe service were inadequate and for providing an effective and well led service were requires improvement as we identified breaches in regulations. The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for The Cottage Surgery on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 5 October 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 2 December 2016.

At this most recent inspection we found that extensive improvements had been made and specifically, the ratings for providing a safe service had improved from inadequate to good and the ratings for providing an effective and well led service had improved from requires improvement to good. The ratings for providing a caring and responsive service remained good. This provided an overall rating of good.

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

• A system called Doctor First had been developed and implemented by the GP partner. in order to improve patient access and on the day care. This resulted in the second lowest A and E attendance of the practices within their Clinical Commissioning Group.

• Patients said they found it easy to speak with and where appropriate have an appointment with a named GP and there was continuity of care, with urgent and non-urgent appointments available the same day.
• There was an open approach to safety and a system in place for reporting and recording significant events and dealing with safety alerts. However we found that alerts and events were not always recorded consistently.
• The practice had clearly defined systems to minimise risks to patient safety. However on the day of our inspection we found that vaccines and emergency medicines were not stored securely and the cold chain policy was not followed consistently.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• The practice had systems, processes and practices in place to keep patients safe and safeguarded from abuse.
• Results from the national GP patient survey were much higher than local and national averages and showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

• Patients spoke highly of the level of care they received and described staff as professional, supportive, sympathetic and always caring.

• Information about services and how to complain was available and easy to understand.

• There was a governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

The areas where the provider should make improvements are:

• Ensure the systems relating to significant events and safety alerts consistently record all events and alerts.

• Review arrangements to ensure patient confidentiality is maintained during consultations.

• Ensure the cold chain policy is followed consistently.

• Ensure treatment room is kept locked when not in use to give assurance that emergency medicines and vaccines are stored securely.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 November 2017

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 and those who were housebound were identified as a priority.
• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less was 96.9% which was 5.9% above the CCG average and 5.6% above the national average. Exception reporting was 0% which was 5.4% below CCG average and 5.5% below national average.
• The percentage of patients with asthma, on the register, who had had an asthma review in the preceding 12 months that includes an assessment of asthma, was 85.2% which was 5.9% above the CCG average and 9.6% above the national average. Exception reporting was 2% which was 7.7% below the CCG average and 5.9% below national average.
• The percentage of patients with chronic obstructive pulmonary disease who had had a review, undertaken by a healthcare professional was 100% which was 9% above the CCG average and 10.4% the national average. Exception reporting was 0% which was 12.2% below the CCG average and 11.5% below national average.
• 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.

Updated 16 November 2017

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 and E attendances.

• Childhood immunisation rates in 2016-17 for the vaccinations given were comparable to CCG/national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 96% to 100% and for five year olds from 94% to 100%.

• The practice’s uptake for the cervical screening programme was 82%, which was comparable to the CCG average of 78% and the national average of 73%.
• The practice encouraged its patients to attend national screening programmes for bowel and breast cancer screening. 69% of patients had been screened for bowel cancer which was above the CCG average of 63% and national average of 58%. 82% of patients had been screened for breast cancer which was above the CCG average of 81% and national average of 73%.
• The practice offered 24 hour and 6 week baby checks. We saw positive examples of joint working with midwives and health visitors.
• A practice nurse had previously been a specialised sexual health nurse and since they joined the practice there had been a slight increase in chlamydia screening.

Updated 16 November 2017

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.
• 7% of the practice population were older people.
• 3% of patients who had been assessed as being at risk had a care plan in place which was slightly above the required national target
• The percentage of patients with hypertension in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less was 91% which was 7.5% above the CCG average and 8.1% above the national average. Exception reporting was 0.8% which was 2.8% below the CCG average and 3.1% below national average.
• Longer appointments and home visits were available for older people when needed, and this was acknowledged positively in feedback from patients.

Updated 16 November 2017

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. For example, a system called Doctor First was in place which enabled the practice to manage patient demand by a GP talking to all patients before seeing them.
• The practice was proactive in offering online services and at the time of our inspection was trialling an e-consult system whereby patients could access an online consultation tool to seek advice from their own GP.
• There was a full range of health promotion and screening that reflects the needs for this age group.

Updated 16 November 2017

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

• 100% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months. Care plans were in place.
• The practice had participated in the West Leicestershire CCG scheme to improve the diagnosis rate for patients with dementia.
• The practice had 23 patients on a mental health register. 90% of patients had received a face to face review in the last 12 months. The practice were supported by a mental health facilitator from the CCG who supported the practice to complete the care plans.
• 100% of patients who had been diagnosed with depression had received a face to face review in the last 12 months.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

Updated 16 November 2017

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.
• 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 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.