Archived: Chells Surgery

Updated 17 February 2017

Chells Surgery provides a range of primary medical services to the residents of Stevenage from its purpose built location of 265 Chells Way, Stevenage, Hertfordshire, SG2 0HN. The practice has been at its current location since 1969 and has recently undergone an extensive redevelopment and expansion of the premises.

The practice population is ethnically diverse and covers all ages with a slightly higher than average number of patients aged 45-59 years. National data indicates the area is one of lower deprivation. The practice has approximately 14,350 patients with services provided under a general medical services (GMS) contract, a nationally agreed contract with NHS England.

There are seven GP partners, five male and two female and they employ two female salaried GPs. The nursing team consists of six practice nurses; all female. There are also a team of reception, administrative and cleaning staff all led by a practice manager and a premises manager.

The practice is open from 8am to 6.30pm Monday to Friday with extended opening hours from 7am to 8am daily.

When the practice is closed out of hours services are provided by Herts Urgent Care and can be accessed via the NHS 111 service.

Updated 17 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Chells Surgery on 18 October 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. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was delivered in line with current evidence based guidance. Staff had been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• Picture signage was used around the practice for those patients who had difficulty reading. For example, there were pictures of the different specimen pots used by patients above the different boxes they put them in ready for collection or testing.
• The practice had a newly refurbished and extended building that was designed with good facilities and was well equipped to treat patients and meet their needs.
• 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.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

• The practice had developed an enhanced support service, this consisted of a team of five senior administrative staff (GP assistants) who were able to provide additional support and guidance to patients who had complex health and social care needs. For example, palliative care patients, the elderly, patients with long term conditions and those experiencing vulnerable circumstances. The service provided a single point of contact for the patient, their carer and any other provider involved in their care. Patients referred to the service were able to order repeat prescriptions over the telephone. Members of the team were able to co-ordinate services and equipment for patients. For example, community nurses, MacMillan nurses and Hertshelp, a local advice service. At the time of the inspection there were 247 patients receiving enhanced support. The practice kept a folder of compliment letters and cards they received from patients. We saw feedback from patients to show that the enhanced support service was positive.

The areas where the provider should make improvement are:

• Continue to review the data from the Quality and Outcomes Framework (QOF) and make improvements in relation to long term conditions where they are below others when compared to the local and national averages.
• Ensure consent for procedures, including verbal consent, is documented in the patient’s notes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 February 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 were identified as a priority.
• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were below others when compared to the local and national averages for some long term conditions.
• The practice had worked with a hospital diabetic consultant and a diabetic specialist nurse to identify learning points for improving patient care.
• 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. These patients were referred to the enhanced support service.

Updated 17 February 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&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• The practice’s uptake for the cervical screening programme was 90%, which was better than the CCG average of 83% and the national average of 82%.
• 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 identified young carers and currently had two on their carers register.

Updated 17 February 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.
• Over 75 year health checks were completed for the housebound by a nurse in the patient’s home.
• Weekly ward rounds were carried out at a local care home.

Updated 17 February 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.
• 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.
• Appointments were available with the nursing staff from 7am daily.

Updated 17 February 2017

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

• 88% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84%.
• Performance for mental health related indicators was comparable to the CCG and national average. The practice achieved 98% of available points, with 15% exception reporting compared to the CCG average of 96% and the national average of 93%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients 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.
• 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.
• Patients experiencing poor mental health were referred to the enhanced support service.

Updated 17 February 2017

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people and 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 support groups and voluntary organisations.
• The practice informed us they registered patients with no fixed abode and with their consent arranged for a patient advocate to assist them with communicating their health needs.
• The practice identified patients who were also a carer and placed an alert on the computer system so staff were aware. The practice had identified 226 patients as carers which equated to approximately 1.5% of the practice list
• 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.
• Vulnerable patients were referred to the enhanced support service. The practice had developed the enhanced support service, this consisted of a team of five senior administrative staff (GP assistants) who were able to provide additional support and guidance to patients who had complex health and social care needs. The service provided a single point of contact for the patient, their carer and any other provider involved in their care. Patients referred to the service were given a letter and an information leaflet with a direct dial telephone number that bypassed the reception. Patients referred to the service were able to order repeat prescriptions over the telephone. Members of the team were able to co-ordinate services and equipment for patients.We saw feedback from patients about the enhanced support service was positive.