Archived: Cassio Surgery

Updated 28 November 2016

Dr Mark Watson 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 four single handed GP practices based at the same location. The principal GPs at the 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 25 and 39 years. The practice serves a lower than average population of those aged from 15 to 24 years and 45 to 64 years. The population is 61% White British and there is a 26% Asian population (2011 Census data). The area served is less deprived compared to England as a whole.

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 two practice nurses, one healthcare assistant, a practice manager, four members of the secretarial team and six 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 is able to offer patients appointments 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 28 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Mark Watson on 17 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.
• 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:

• Ensure learning and development of staff including regular appraisals for all staff and completion of essential training for example infection prevention and control.
• Implement a system to ensure annual health checks for patients.
• Continue to develop and ensure an active Patient Participation Group.
• Ensure a record of fire alarm testing and fire drills is maintained by the practice.
• Ensure an appropriate system is in place for the safe monitoring of blank prescriptions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 November 2016

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.
• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was above the local CCG and national average. The practice had achieved 94% of the total number of points available, compared to local CCG and national average of 78%.
• 71% of patients diagnosed with asthma, on the register, had received an asthma review in the last 12 months which was comparable with the local CCG average of 76% and the national average of 75%.
• 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 28 November 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 identified as being at possible risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were comparable with the local and national average 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 88% which was comparable with the local average of 83% and national average of 82%.
• 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 28 November 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. 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.
• 77% 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 from May 2016. At the time of inspection the practice had one completed health check recorded on their clinical system. The practice told us that they were reviewing their process and updating their clinical system to ensure the health check template was completed during patient consultations and reviews, which were being carried out for these patients.

Updated 28 November 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 carried out routine NHS health checks for patients aged 40-74 years.
• 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.

Updated 28 November 2016

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.
• 88% of patients with schizophrenia, bipolar affective disorder and other psychoses had their alcohol consumption recorded in the preceding 12 months, which was in line with the local CCG average of 91% and national average of 90%.
• The practice had told patients experiencing poor mental health about how to access various 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 28 November 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 had seven patients on their learning disability register and had completed six health checks in the 2015/2016 year.
• 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 held a register of carers with 31 carers identified, which was approximately 1.5% of the practice list. The practice told us that their local carers’ association was planning to hold a training session for staff to support the practice in identifying and supporting carers.