Dr. C.P.M. Lewis & Partners Also known as Audley Mills Surgery

Updated 3 March 2016

Dr C.P.M.Lewis & Partners, also known as Audley Mills Surgery, is located in the town centre of Rayleigh, Essex. The practice operates out of two buildings in very close proximity, both of which have reception staff and waiting rooms. There is no parking available for patients, although there is a pay and display cark park nearby and good transport links. At the time of our inspection, the practice list size was approximately 20,000 patients and this list was open to new patients.

The practice has 10 partner GPs, three salaried GPs and at the time of the inspection there were four trainee GPs. There are five nurses, two healthcare assistants (HCA) and three phlebotomists. There is a practice manager, a practice business manager and a large team of receptionists and administrative staff. This practice is a training practice for GPs and nurses. All GPs took key roles in the provision of this training.

The practice is open from 7am Monday to Friday. The practice is open until 8pm on Mondays and Thursdays and until 6.30pm on Tuesdays, Wednesdays and Fridays. Appointments are available all day throughout the practice opening hours. When the practice is closed, out of hours care is provided by IC24.

The practice has a Personal Medical Services (PMS) contract and offers enhanced services such as childhood immunisations, extended hours access, learning difficulties and minor surgery.

Updated 3 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr C.P.M. Lewis & Partners on 19 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. Not all non-clinical staff understood how to recognise and report 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, however verbal complaints were not always recorded.
• Most patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Staff had an understanding of consent and the Mental Capacity Act, however there was not a consent policy in place to support staff in making or documenting decisions about consent.
• 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.
• There was a range of staff meetings which were recorded. There was limited sharing of information across the whole practice, as a result of this some non-clinical staff lacked an understanding of the practice performance and vision.
• The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider should make improvement are:

• Update all staff on the recognition and recording of significant events.

• Ensure verbal complaints are always recorded.

• Introduce a consent policy.

Ensure the practice performance and vision is shared with all staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 March 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.

• Data showed the practice was comparable to national averages for diabetes care, with one exception. An audit had since been carried out to address this variation.

• The practice had started a virtual diabetes clinic where patients would receive test results and follow up advice via email.

• 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 3 March 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.

• 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.

• Cervical screening rates were above average; 96.16% of women aged 25 to 64 years old had a cervical screening test performed in the preceding five years (01/04/2014 to 31/03/2015) compared to 81.83% nationally.

• 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 and health visitors.

• The practice were running a monthly family planning clinic which had received very positive feedback.

Updated 3 March 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.

• The practice had 86 patients in care homes and carried out weekly visits to ensure patients received continuity of care.

Updated 3 March 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 open from 7am daily and open until 8pm twice a week for patients who worked during the day.

• 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.

Updated 3 March 2016

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

• 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. There were counselling services available within the practice.

• 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; we saw evidence of very good care provided to patients with poor mental health.

Updated 3 March 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 those with a learning disability.

• The practice offered longer appointments for patients with a learning disability upon request.

• 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.