Archived: Dr David Molyneux Also known as Harambee Surgery

Updated 7 January 2016

Harambee Surgery is located in Trawden on the outskirts of Colne. They have 4066 registered patients. They have a higher than national average population of patients aged over 40-65 years. The practice is a dispensing practice.

The practice provides General Medical Services (GMS) under a contract with NHS England. The practice is also contracted to provide a number of enhanced services, which aim to provide patients with greater access to care and treatment on site. They offer enhanced services in; extended hours, childhood vaccinations and minor surgery.

There are four GPs, two male and two female, two female practice nurses and three staff who dispense medication. These are supported by a practice manager and an experienced team of reception/administration staff. This is also a training practice with placements for trainee doctors. The practice has trained registrars for the last 15 years and is currently training FY2 doctors. These are trainee doctors in their 2nd year of foundation training.

The practice also has a healthy mind counsellor, a well-being practitioner, a specialist diabetic nurse, health visitor and pharmacy technician who also work from the practice.

The practice is open between 8am and 6.30pm Monday to Friday with extended hours Monday morning and evening from 7:30 am until 7.10pm. When the practice is closed, out-of-hours services are provided.

Updated 7 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Harambee Surgery on 17th November 2015. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• There was a structured system for providing staff in all roles with annual appraisals of their work and planning their training needs.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• 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.
• 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 good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported and had confidence in the management team. The practice proactively sought feedback from staff and patients, which it acted on.

We saw several areas of outstanding practice including:

• Patients nearing the end of life were visited daily by the GP and provided with GPs contact numbers to support the patients and their families through this difficult time.

• Home visits were provided to mental health patients who may have social phobias and may find visiting the practice stressful.

• GPs provided Individual alcohol/ drug detox for patients to provide prompt support for the management of their addiction.

• Collaboration with the practice’s ‘Friends of Harambee’ resulted in health promotion activities and education for all groups of patients. The practice also worked closely with the local school to promote health education.

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

Importantly the provider should

• Ensure locum packs are up to date and support the GP with relevant information.
• Ensure risk assessments are completed for all aspects of the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 January 2016

The practice is rated as good for the care of people with long-term conditions. Nursing staff had lead roles in chronic disease management and patients at risk of 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.

Patients with long term conditions were offered a single appointment annual review to check that their health and medication needs were being met, rather than attending for repeat appointments. QOF data showed the practice consistently performed well above the CCG and England average in relation to long term conditions management, such as asthma and chronic obstructive pulmonary disease.

Patients nearing the end of life were visited daily by the GP and provided with GP's contact numbers to support the patients and their families through this difficult time.

GPs provided Individual alcohol/ drug detox for patients to provide prompt support for the management of their addiction.

Updated 7 January 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 who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were good 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. Appointments were available outside of school hours and the premises were suitable for children and babies with baby changing facilities, breast feeding room and children’s play area.

The practice provided a full family planning service including the fitting of contraceptive devices. Women taking the contraceptive pill were invited to attend the practice each year for a yearly ‘pill check’ and to discuss long-term contraception.

We saw good examples of joint working with midwives and health visitors. The practice sent a congratulations letter after each birth along with details of how to register the baby, details of the baby clinic and details of the baby’s first immunisation appointment and Mum’s postnatal check. A baby clinic ran weekly with the GP, nurse and health visitor in attendance.

Updated 7 January 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 in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access and extended appointments for those with enhanced needs.

Updated 7 January 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 was proactive in offering online services to both make and cancel appointments and to order prescriptions. The web site also provided links to a full range of health promotion that reflects the needs for this age group.

Updated 7 January 2016

The practice is rated as good for the care of people experiencing poor mental. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

People experiencing poor mental health had been offered an annual physical health check and psychological therapies and the local mental health service was accessible via the practice. All clinical staff had received training on the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) and were able to explain their role in relation to this. The practice proactively identified patients who might be at risk of developing dementia. Patients experiencing poor mental health and those with dementia had a named GP to ensure continuity of care and a single point of contact for other agencies when discussing their care needs.

Patients with mental health needs had access to a ‘Healthy minds’ counsellor based at the practice one day per week. Patients were also helped to access various support groups and voluntary organisations, including the Alzheimer’s society and mental health support group. Home visits were provided to mental health patients who may have social phobias and may find visiting the practice stressful.

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

Updated 7 January 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. It had carried out annual health checks for people with a learning disability and 100% of these patients had received a follow-up. It offered longer appointments for people with a learning disability.

GPs provided Individual alcohol/ drug detox for patients to provide prompt support for the management of their addiction.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about 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 working hours and out of hours.