Archived: Cassio Surgery

Updated 10 February 2017

Dr Richard Reubin provides primary medical services to approximately 2,350 patients in Colne House, Watford, Hertfordshire. The practice moved into the current premises in 2014 and is one of three single handed GP practices and one GP partnership based at the same location. The principal GPs for all four practices hold joint meetings and share clinical lead roles in a number of areas such as safeguarding, infection control, dementia and diabetes.

The practice serves a higher than average population of those aged between 30 and 49 years and a lower than average population of those aged from 60 to 85 years and over. The practice told us that a higher than average number of patients identify themselves as Asian and that there are high levels of social deprivation within the local area.

The practice is led by one principal GP and is supported by one salaried GP and two regular locums. Two GPs are male and two GPs are female. The practice team works across the four GP practices in Colne House and consists of three practice nurses, one health care assistant, a practice manager, four members of the secretarial team and seven members of the administration and reception team.

The practice is open to patients between 8am and 6:30pm Monday to Friday. Appointments with a GP are available from 9am to 11.30am and from 4pm to 6pm daily. Emergency appointments are available daily. The practice is a member of Watford Care Alliance and this service enables the practice to offer appointments to patients during extended opening hours at a number of practices across the locality.

Home visits are available to those patients who are unable to attend the surgery and the Out of Hours service is provided by Hertfordshire Urgent Care and can be accessed via the NHS 111 service. Information about this is available in the practice and on the practice website.

Updated 10 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Richard Reubin on 21 December 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.
• 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.
• 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.
• 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.
• 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 provider was aware of and complied with the requirements of the Duty of Candour.

The practice should make improvements in the following areas:

• Implement a system to ensure annual health checks for patients are correctly recorded.
• Continue to encourage patients to attend cancer screening programmes.
• Continue to develop and ensure an active Patient Participation Group.
• Continue to identify and support carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 February 2017

The practice is rated as good for the care of people with long-term conditions.

• Nurses had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• 94% of patients newly diagnosed with diabetes, had a record of being referred to a structured education programme within 9 months after entry on to the diabetes register, which was comparable with local CCG and national average.
• 64% of patients diagnosed with asthma, on the register, had received an asthma review in the last 12 months which was below the local CCG average of 75% and the national average of 76%. Exception reporting was 0% which was below the local CCG average of 6% and national average of 8%.
• Longer appointments and home visits were available when needed.
• All patients with a long-term condition 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 10 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 identified as being at possible 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.
• The practice’s uptake for the cervical screening programme was 81% which was comparable with the local average of 82% and national average of 81%.
• Appointments were available on the same day and outside of school hours.
• We saw positive examples of joint working with midwives and health visitors.

Updated 10 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. This included enhanced services for avoiding unplanned admissions to hospital and end of life care.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments when required.
• 67% of patients aged 65 years or over had received a seasonal flu vaccination in the 2015/2016 year.
• The practice worked closely with a multidisciplinary team to support older people and patients considered to be in the last 12 months of their lives.
• The practice began providing health checks for patients aged over 75 years from May 2016. The practice provided these health checks during patient consultations and reviews. However, at the time of inspection the practice was not coding the completed health checks on their clinical system. The practice told us that they were reviewing their process and updating their clinical system to ensure that these health checks were being correctly recorded.

Updated 10 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 on line services such as appointment bookings, an appointment reminder text messaging service and repeat prescriptions, as well as a full range of health promotion and screening that reflects the needs of this age group.
• Extended appointment times were available to patients on a daily basis.
• Data from 2014/2015 showed: 34% of patients aged 60 to 69 years had been screened for bowel cancer in the last 30 months compared to the local CCG average of 59% and national average of 58%.
• 59% of female patients aged 50 to 70 years had been screened for breast cancer in the last three years which was below the local CCG and national average of 72%. The practice had sent letters out to relevant patients over the past three months to encourage uptake.

Updated 10 February 2017

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

• The practice held a register of patients experiencing poor mental health and offered regular reviews and same day contact.
• 100% of patients diagnosed with dementia (11 patients) had their care plan reviewed in a face to face review within the last 12 months.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive care plan documented in the preceding 12 months was 77%, which was below the local CCG average of 92% and national average of 89%. Exception reporting was 0% which was below the local CCG average of 10% and national average of 13%.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• The practice had told patients experiencing poor mental health about how to access support groups and voluntary organisations.
• The practice referred patients to the Improving Access to Psychological Therapies service (IAPT) and encouraged patients to self-refer.
• The practice had a system in place to follow up patients who had attended A&E where they may have been experiencing poor mental health.

Updated 10 February 2017

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 had nine patients on their learning disability register. The practice provided health checks to these patients however at the time of inspection the practice was not coding the completed health checks on their clinical system.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• Vulnerable patients had been told how to access support groups and voluntary organisations.
• Staff had accessed safeguarding training and knew how to recognise signs of abuse in vulnerable adults and children. Staff members 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.
• The practice’s computer system alerted GPs if a patient was also a carer. The practice held a register of carers with 13 carers identified, which was approximately 0.5% of the practice list.