Archived: Dr Jones Sr Practice

Updated 29 July 2016

Dr Jones Sr Practice is located in East Tilbury, Essex. The practice has a general medical services (GMS) contract with the NHS. There are approximately 4897 patients registered at the practice.

The practice is registered with the Care Quality Commission as a partnership and there are five partners. There is one nurse working at the practice. A healthcare assistant is in the process of being recruited.

There is a practice manager and an assistant practice manager, and seven members of administrative staff, two of which are secretaries.

The practice is open from Monday to Friday between the hours of 7.30am and 5.30pm. The GP surgeries are available on Mondays, Tuesdays and Thursdays between 9am and 11.30am and 2.30pm and 4.30pm and on Wednesdays and Fridays between 7.30am and 8am for early appointments, then 9am to 11.30am and 2.30 to 4.30pm.

The practice has opted out of providing 'out of hours’ services which is now provided by the South East Essex Doctors Service. Patients can also contact the non-emergency 111 service to obtain medical advice if necessary.

Updated 29 July 2016

Letter from the Chief Inspector of General Practice

On 12th November 2015, we carried out a comprehensive inspection at Dr Jones Sr. The practice was rated as requires improvement overall, with requires improvement for safe and well-led and good for effective, caring and responsive services. The practice was issued with a requirement notice for improvement. We also made some advisory recommendations where the practice should make other improvements in the effective domain but these were not the subject of a requirement notice.

In particular, we found that improvements were required in relation to safeguarding procedures, staff awareness of Gillick consent, the training of chaperones, the monitoring of emergency medicines and reviews of patients on blood thinning treatments, the monitoring of uncollected prescriptions for vulnerable patients, clinical attendance at meetings, updates of NICE guidelines for clinical staff and the recording of complaints.

After this inspection the practice sent us an action plan that identified how they would achieve the improvements and the date when they would be completed. We then carried out an announced focused inspection at Dr Jones Sr Practice on 5th July 2016 to check that the necessary improvements had been made.

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

• The records of patients who were subject of safeguarding concerns were detailed. They included all relevant information and referenced where other agencies had been involved.

• Staff were aware of Gillick competency in relation to children under the age of 16 who wished to book an appointment without a parent or guardian being present.

• Staff had received chaperone training to ensure that they were equipped for the role. GPs recorded when a chaperone had been used.

• There was a system in place to monitor the expiry dates of emergency medicines in the practice and when carried by GPs when they were away from the practice.

• The practice ensured that vulnerable patients who had not collected their prescriptions were reviewed to ensure that they were not at risk of their health deteriorating.

• Nurses attended clinical team meetings.

• National Institute for Health Care Excellence (NICE) guidance was reviewed and cascaded to clinical members of staff.

• All complaints were recorded so that any trends or themes could be identified.

• Patients requiring repeat prescriptions for blood thinning medicines were appropriately monitored before a prescription was issued.

We were satisfied that the practice had made the required improvements to justify a change of rating to good for the safe and well-led domains.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 January 2016

The practice is rated as good for being caring, effective and responsive and this includes this population group. The practice was rated as requires improvement for safe and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• 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.
• Patients with palliative care needs received support from a variety of healthcare professionals. Multidisciplinary meetings took place monthly to discuss and plan the individual care and treatment needs of patients.
• Nursing staff had received specialist training to manage patients with diabetes. Performance data reflected that the management of diabetes was comparable and in some cases higher, than the national average.
• Patients could receive home visits for their health reviews or consultations where required.
• A system was in place to recall patients that required regular follow-up tests to manage their condition.

Updated 7 January 2016

The practice is rated as good for being caring, effective and responsive and this includes this population group. The practice was rated as requires improvement for safe and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• All staff had received appropriate training in safeguarding children and young persons. A lead for safeguarding had been identified.
• Not all staff were aware of Gillick competence in relation to children under the age of 16 attending for treatment without a parent or guardian.
• Immunisation rates were relatively high for all standard childhood immunisations.
• The practice provided cervical screening services for their patients and an effective recall and reminder system was in place.
• Child and family consultation services were available in the community for patients referred by the practice. This included conditions such as autism and attention deficit hyperactive disorder.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice provided opportunistic chlamydia screening services targeting 16 to 24 year olds.

Updated 7 January 2016

The practice is rated as good for being caring, effective and responsive and this includes this population group. The practice was rated as requires improvement for safe and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 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.
• The practice liaised with community dieticians to identify patients at risk and to provide appropriate care and treatment.
• GPs were allocated care homes to attend to conduct weekly ‘ward rounds’ and consultations with patients.
• A document library, which gave information to patients about local services and organisations that could provide support, was available for patients.
• A monthly multidisciplinary meeting took place to discuss the care and treatment needs of patients considered to be frail to avoid unnecessary hospital admissions.
• The appointment system was flexible and included telephone consultations and home visits.
• Nurses visited patients in their own homes to provide phlebotomy and flu vaccination services.

Updated 7 January 2016

The practice is rated as good for being caring, effective and responsive and this includes this population group. The practice was rated as requires improvement for safe and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 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.
• Early morning surgeries were available for commuters to receive GP and nurse consultations.
• The practice offered a range of health promotion and screening that reflected the needs for this age group. Health checks were available for those patients over the age of 40.
• Smoking cessation clinics were in place.

Updated 7 January 2016

The practice is rated as good for being caring, effective and responsive and this includes this population group. The practice was rated as requires improvement for safe and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice regularly worked with multi-disciplinary teams in the case management of people 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.
• A register was in place and health reviews were carried out annually.
• Staff had a good understanding of how to support people with mental health needs and dementia.
• Longer appointments were made available for patients with mental health issues so time could be given to their health care needs. Practice staff reminded patients when appointments were due to ensure they were not missed.

Updated 7 January 2016

The practice is rated as good for being caring, effective and responsive and this includes this population group. The practice was rated as requires improvement for safe and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• The practice advised 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.
• A three monthly multidisciplinary meeting took place to discuss the care and treatment needs of patients considered to be frail and may deteriorate rapidly.
• Carers or relatives were consulted about the care and treatment needs of patients after consent was obtained. Staff were aware of the Mental Capacity Act 2005 guidance in relation to the capacity to make decisions.
• Annual health checks took place for patients with learning disabilities and longer appointments were available.