Dr Nagle and Partners

Updated 11 February 2016

Dr Nagle and partners is located in a purpose built medical centre on the London Road in a predominantly residential area in Leigh on Sea, Essex. The practice provides services for 17125 patients.

The practice holds a General Medical Services (GMS) contract and provides GP services commissioned by NHS England and Southend Clinical Commissioning Group. A GMS contract is one between GPs and NHS England and the practice where elements of the contract such as opening times are standardised.

The practice population is similar to the national average for younger people and children under four years, and for those of working age and those recently retired, and slightly higher for older people aged over 85 years. Economic deprivation levels affecting children, older people are lower than the practice average across England. However there are pockets of social and economic deprivation across the practice catchment area. Life expectancy for men and women are similar to the national averages. The practice patient list compares similarly to the national average for long standing health conditions. It has a much higher than the national averages for working aged people in employment or full time education lower numbers of working age people that are unemployed.

The practice is managed by seven GP partners who hold financial and managerial responsibility. The practice employs four salaried GPs, six practice nurses and two healthcare assistants / phlebotomists. In total five male and six female GP work at the practice. In addition the practice employs a management team including a practice manager and an assistant practice manager, a reception manager, 12 receptionists and a team of medical secretaries, administrators and prescribing clerks. The practice works with two local further education colleges and employs two apprentices who assist with administrative tasks including receiving and handling inbound post.

Dr Nagle and partners is a training practice and employs / supports five GP registrars (GP registrars are qualified doctors who are undertaking GPs training). Four of the GPs working in the practice are GP trainers

The practice is open between 8am and 6.30pm on weekdays. GP and nurse appointments are available between 8am to 6pm daily. Pre-booked appointments were available between 7am and 8am daily for GP’s, practice nurses, HCA’s and phlebotomy on weekdays.

The practice has opted out of providing GP out of hour’s services. Unscheduled out-of-hours care is provided by IC24 and patients who contact the surgery outside of opening hours are provided with information on how to contact the service.

Updated 11 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Nagle and Partners on 18 December 2015. Overall the practice is rated as good.

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

• The practice ensured that when things went wrong that these were investigated and learning was shared with staff. Risks to patients were assessed and well managed. There were systems for assessing risks including those associated with medicines, premises, equipment and infection control.
• There was a detailed business continuity plan to deal with untoward incidents that may affect the day to day running of the practice.
• Staff were recruited robustly with all of the appropriate checks carried out to determine each person’s suitability and fitness to work at the practice. Where locum GPs were employed verbal references had been sought and this was not recorded.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Clinical audits and reviews were carried out to make improvements to patient care and treatment.

• Staff were supported and received role specific training to meet the needs of patients and there was a system for staff appraisal.
• 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. Complaints were investigated and responded to appropriately and apologies given to patients when things went wrong or their experienced poor care or services.
• The majority of 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 reviewed its appointments system and upgraded the telephone systems to address patients comments about the lack of accessible appointments and difficulties
• The practice had 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 to make improvements to the services provided.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should:

• Review the arrangements for storing temperature sensitive medicines and keep records of actual fridge temperatures.

• Ensure that recruitment files for locum GPs contain a record of all of the checks carried out including references.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 February 2016

The practice is rated as good for the care of people with long-term conditions. GPs and nursing staff had lead roles in chronic disease management and provided a range of clinics including asthma, diabetes and chronic obstructive pulmonary disease (COPD). The practice performance for the management of these long term conditions was similar to or higher than other GP practices nationally.

Patients at risk of unplanned 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 medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

The practice had a dedicated member of staff to coordinate reviews for the management of long term conditions and work was being done to streamline reviews so as to minimise the number of visits for patients with one or more long term condition.

Updated 11 February 2016

The practice is rated as good for the care of families, children and young people. The practice offered same day appointments for children. Appointments were available outside of school hours. Post-natal and baby checks were available to monitor the development of babies and the health of new mothers. The practice contacted all new mothers to remind them to register babies to help promote continuity of care.

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. The practice held monthly safeguarding meetings with relevant health professionals including health visitors to review children who were identified as being at risk.

Immunisation rates were similar to other GP practices 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.

Information and a range of sexual health and family planning clinics were available.

Updated 11 February 2016

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people, and offered home visits and rapid access to telephone advice and appointments for those with enhanced needs.

GPs worked with local multidisciplinary teams to reduce the number of unplanned hospital admissions for at risk patients including those with dementia and those receiving end of life palliative care.

The patient participation group had organised a recent event to promote awareness about dementia. This event was attended by patients and carers. Information and advice was provided by the Alzheimer’s society, Dementia Friends and Age Concern. The practice also hosted the Alzheimer's Society twice monthly who met with patients and/or carers to offer support and advice. The practice was also working towards becoming a Dementia Friendly Practice.

Updated 11 February 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. Pre-booked appointments were available each morning between 7am and 8am.

The practice was proactive in offering online services including on-line appointment booking and electronic prescribing (where patients can arrange for their repeat prescriptions to be collected at a pharmacy of their choice).

The practice offered a full range of health promotion and screening that reflected the needs for this age group including NHS Health Checks.

Updated 11 February 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice reviewed and monitored patients with dementia and carried out face-to-face reviews. Staff at the practice were proactive in carrying out dementia screening and liaised with the dementia community nurses to ensure that care was coordinated and effective to meet patient’s needs.

Patients with mental health conditions were reviewed and had an annual assessment of their physical health needs. Longer appointments and home visits were provided as required.

The patient participation group had organised a recent event to promote awareness about dementia. This event was attended by patients and carers. Information and advice was provided by the Alzheimer’s society, Dementia Friends and Age Concern. The practice also hosted the Alzheimer's Society twice monthly who met with patients and/or carers.  The practice was also working towards becoming a Dementia Friendly Practice.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

Updated 11 February 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. Staff undertook safeguarding training and the practice had a dedicated safeguarding leads for overseeing adult and child safeguarding procedures.

The practice held a register of patients living in vulnerable circumstances including patients with a terminal illness and those with a learning disability. The practice proactively promoted annual health checks for patients with learning disabilities and nurses had received specific training to support these patients.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. This helped to ensure that patients whose circumstances made them vulnerable were supported holistically and that patients who were at a higher risk of unplanned hospital admissions were supported to and treated in their home.

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.