The Surgery

Updated 18 July 2018

The surgery is located in Hornchurch in Essex. The practice is commissioned by Havering Clinical Commissioning Group (CCG) to provide general medical services to approximately 3,660 patients.

The practice is run by two GP partners (one male and one female) working a total of 13 sessions per week. Other clinical services are provided by a practice nurse working 28 hours a week and a healthcare assistant. The clinical staff are supported by a part-time practice manager and seven reception/administrative members of staff.

Information published by Public Health England rates the level of deprivation within the practice population group as nine on a scale of one to 10. (Level one represents the highest levels of deprivation and level 10 the lowest.)

The practice is open Monday 7.30am to 6.30pm; Tuesday 8.00 am to 7.00pm; Wednesday 7.30am to 6.30pm; Thursday 8.00am to 6.30pm; Friday 8.00 to 7.00pm. The nurse offers extended hours appointments Monday and Wednesday morning and Tuesday evening. The doctor offers extended hours on Tuesdays and Fridays.

Appointments can be booked over the telephone, online or in person at the surgery. Patients are provided information on how to access an out of hour’s service by calling the surgery.

The practice is registered by the CQC to provide diagnostic and screening procedures, treatment of disease disorder and injury, maternity and midwifery services.

The practice runs a number of services for its patients including; chronic disease management, and new patient checks.

Updated 18 July 2018

We carried out an announced comprehensive inspection at The Surgery on the 12 October 2017. At this inspection we rated the practice as good overall and for the key questions of effective, caring, responsive and well-led with the exception of safe which we rated requires improvement. The full comprehensive report on the inspection can be found by selecting the ‘all reports’ link for The Surgery on our website at www.cqc.org.uk.

We carried out an announced focused inspection at The Surgery on 29 May 2018. This inspection was carried out to review the actions taken by the practice to improve the quality of care and to confirm whether the practice was providing a safe service and was now meeting legal requirements.

The overall rating for the service is Good.

The key questions are rated as:

Are services safe? - Good

At this inspection, we found:

• The practice had reviewed their systems and procedures for significant events and this ensured the consistent recording of significant events.
• Patients would be informed and offered an apology if involved in a significant event.
• New staff had a written induction program to follow.
• The practice had installed a new e learning program to ensure that staff completed their essential training. This provided the practice manager with an overview of staff training.
• The practice had carried out clinical internal audit.
• The practice held the monthly practice meetings on different days of the week to ensure that all staff could attend.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice.

Updated 27 November 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• At 100% performance for diabetes related indicators was above the CCG average of 80% and the national average of 90%.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• All these patients had a named GP and there was a system to recall patients for 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 27 November 2017

The practice is rated as good for the care of families, children and young people.

• From the sample of documented examples we reviewed we found there were systems to identify and follow up children living in disadvantaged circumstances and who were at risk.

• Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

  Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 27 November 2017

The practice is rated as good for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Where older patients had complex needs, the practice shared summary care records with local care services. For example District Nurses and Integrated Care Services.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. For example patients aged over 75 were provided with health information packs and information about counselling and support for patients specifically aimed at older adults via self-referral.

• The practice had several patients who lived at a local care home. Feedback from the service was positive and staff spoke highly of the service they received.

Updated 27 November 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours.

• 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.

• Cervical screening appointments included early morning and late evening appointments for those who worked.

Updated 27 November 2017

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

• The practice carried out advance care planning for patients living with dementia.

• 74% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the Clinical Commissioning Group (CCG) and national average of 79%.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia. Prompt referrals were made for patients presenting with any signs of mental health issues ensuring early treatment and management of their symptoms.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• At 100% performance for mental health related indicators was above the CCG average of 92% 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 living with dementia.

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 27 November 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 homeless people, travellers and those with a learning disability.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

• 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.