Archived: Cedar House Surgery

Updated 15 December 2017

The Cedar House Surgery is situated in St Neots, Cambridgeshire, just off the main high street. The practice has a primary medical services (PMS) contract with the NHS. There is a branch site approximately two miles away and there are approximately 13,000 patients registered at the practice. Patients can choose to be seen at either location. We did not visit the branch site as part of this inspection.

The practice has four partner GPs, two female, two male, and five salaried GPs, all female. All partner GPs have lead responsibilities and management roles. The practice also teaches medical students. There are two advance nurse practitioners (known by the practice as consultant nurses), four practice nurses, and four health care assistants. A reception manager and a team of eleven receptions, three secretaries and a prescribing clerk support the practice manager.

The surgery is open Monday to Friday between 8.30am and 6pm; there is an extended surgery until 8.15pm on Wednesday and Thursday evenings. Out of hours services are provided by Herts Urgent Care via the 111 service.

The practice patient age profile was similar to the national average with the life expectancy of patients above the national average. The male life expectancy was 80.4 years compared to the national average of 79.4 years. The female life expectancy was 85.2 years compared to the national average of 83.1 years. The deprivation score is above the England average indicating that the practice serves a less deprived area.

Updated 15 December 2017

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection April 2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Cedar House Surgery on 14 November 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• The practice evidenced that they worked as a cohesive team with clear clinical oversight to provide patient centred care to their patients.
• The practice had reviewed and developed innovative skill mix within the practice. For example, they employed two advance nurse practitioners, one who specialised in the care of children, and one whose role included visiting patients living in care homes.
• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Practice staff involved and treated patients with compassion, kindness, dignity, and respect.
• Patients found the appointment system easy to use and reported that they were able to access care on the day when they needed it however some patients told us they had difficulty in booking appointments in advance. This was also reflected in the latest GP national GP patient survey data.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• Information about services and how to complain was available to patients and the practice recorded verbal and written complaints.

The areas where the provider should make improvements are:

• Continue to monitor patient survey data and implement changes to continue to improve patient access.
• Continue to identify carers to ensure that they receive appropriate support and care.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 July 2015

The practice is rated as good for the care of patients with long term conditions. The practice held a register of patients suffering with poor mental health and other long-term conditions. They held regular multidisciplinary meetings with other healthcare professionals to plan and coordinate care and treatment (a multi-disciplinary team is a team of health and social care staff. It includes professionals such as nurses, doctors, social workers, psychologists and benefits workers). Patients with diabetes received regular reviews of their condition by clinical staff. There is additionally a respiratory nurse who worked to a locally agreed set of medications and is supported in their function. The practice worked closely with the community nurses for patients with respiratory and heart conditions. Patients with palliative care needs were allocated a named GP who was responsible for their on-going care and support needs.

Updated 9 July 2015

The practice is rated as good for the care of families, children and young people. A qualified paediatric nurse was available at the practice to provide specialist care and treatment for families and children. The practice held baby and immunisation clinics for children. There were evening family planning clinics available that patients could attend. The appointment system met the needs of families, children and young people. The practice had a designated child safeguarding lead who worked closely with the health visiting team. Regular safeguarding meetings were held at the practice and concerns cascaded to staff at weekly practice meetings.

Updated 9 July 2015

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. There were home visits available for patients which were housebound. Consulting rooms were available on the ground floor for patients with limited mobility and there was a range of enhanced services available for housebound patients with good links into secondary referral. The patients we spoke to stated their care was considered, compassionate and appropriate for their needs.

Updated 9 July 2015

The practice is rated as good for the care of working age population. The practice offered late night appointments on a Wednesday and Thursday evening to enable access for those that work. Appointments could be booked on the day or in advance. Patients could see a GP of their choice and this provided continuity of care. The practice offered a choose and book service for patients being referred to secondary care. NHS Health checks were offered to patients between the ages of 40 and 75 with no pre-existing long term health conditions.

Updated 9 July 2015

The practice is rated as good for the care of people experiencing poor mental health. Patients experiencing poor mental health were offered an annual review of their physical and mental health needs. Patients were offered double appointments where required and were referred to other supportive services where appropriate. Practice staff worked in conjunction with the local mental health team to ensure patients had the support they needed. The clinical team worked with both the local children’s mental health team and the older people’s mental health team, we were told that there was difficulty referring to mental health teams from clinicians. Patients were supported to access emergency care and treatment when experiencing a mental health crisis. The practice showed an on-going commitment to staff training and development in respect of mental health. The practice had a designated adult safeguarding lead and a communications strategy to ensure patients were protected.

Updated 9 July 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice held a register of vulnerable patients including those with a learning disability. It had carried out annual health checks for people with a learning disability and these patients had a personalised care plan in place. It offered longer appointments for patients that needed them. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients 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 and out of hours.