Archived: Felmores Surgery

Updated 8 November 2016

Felmores Surgery is also known as Aryan Medical Centre. It is located in the heart of a housing development. The practice has a branch surgery based in Hoover Drive, Laindon. The practice is a partnership consisting of two male and one female partner. They are supported by a male GP, female practice nurse, reception and administrative staff and overseen by a practice manager.

Felmores Surgery is open between 8.30am to 6.30pm with the exception of Monday when they offer an extended service providing consultations until 8pm. GP appointments were from 8.40am to 1pm and 4pm to 6.30pm. In addition to pre-bookable appointments that could be booked up to two weeks in advance, routine on the day and urgent appointments were also available for patients that needed them. Nurse appointments were available Monday and Friday 8.30am to 2pm and Wednesday 12.30 to 6.30pm.

The branch surgery opens mornings from Monday to Friday at 9am to 1pm. Nurse appointments are available on Thursday from 9.30am to 1pm. Every alternate Monday the evening clinic alternates between the main and branch surgery from 6.30am to 8pm.

The patient population is approximately 4276. Their patients are more heavily represented amongst the age groups, birth to under 18year olds. With lower than the CCG and national average of patients over 65 years, over 75years and over 85 years of age. Male life expectancy is below the CCG and national average. Deprivation levels are high, above both the local and national averages for children and older people.

The practice provides a range of services including, minor surgery, nurse run clinics (asthma, diabetes, heart disease and hypertension), contraception services, child health surveillance travel vaccinations, antenatal and postnatal care.

The practice does not provide out of hour’s services. Patients are advised to call the national 111 service who will advise patients of the service they require. Currently their out of hour’s service is provided by IC24 and commissioned by Basildon and Brentwood CCG.

The practice had a comprehensive website detailing opening and appointment times. There is health information including signposting to support and specialist services.

The practice has been inspected on two previous occasions in November 2013 and Match 2014. The practice was found compliant with the Health and Social Care Act 2008 in March 2014.

Updated 8 November 2016

Letter from the Chief Inspector of General Practice

We carried out a desk top review of Felmores Surgery on 6 October 2016. This was to check the practice had addressed areas for improvement highlighted during their earlier announced comprehensive inspection conducted on 8 June 2016. At this inspection the practice was rated as good overall, good for effective, caring, responsive and well led domains. The safe domain was rated as requires improvement.

During our last inspection we found the provider had not undertaken DBS checks for staff undertaking chaperone duties and did not have a risk assessment in place as to why one was unnecessary. The provider was asked to remedy these and a requirement notice for these improvements was issued.

The provider was also advised they should take action in the following areas;

• Ensure the recording, analysis and actions for a significant event are fully documented and learning revisited ensure improvements have been maintained.
• Ensure cleaning schedules can demonstrate the type and frequency of the cleaning required for the rooms and equipment.
• Ensure clinical audits have sufficient narrative to identify learning and how this has been embedded to improve practice.
• Ensure records of discussions, decisions and actions are appropriately documented and shared amongst the practice team. Actions should be revisited to ensure tasks are completed and learning embedded into practice. 

After the inspection report was published the provider sent us an action plan that detailed how they would make the necessary improvements. We were then provided with documentary evidence of the improvements they had made. We were able to carry out a desk top inspection without the need to visit the practice.

During this desk top inspection, we reviewed documents that demonstrated that all staff now had appropriate DBS checks in place including those required to undertake chaperone duties. We found their recording, investigation, analysis and sharing of learning had improved and had been documented. They had revised their cleaning schedules and provided a narrative analysis to their clinical data and how it had informed and improved clinical performance. 

We were satisfied that the practice had made the required improvements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 July 2016

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

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met.
• The practice nurse worked closely with the lead GP in the assessment and management of patients with chronic diseases and those patients at risk of hospital admission were identified as a priority.
• Patients were invited for relevant vaccinations such as flu, pneumococcal and age related shingles vaccination. For example, the practice had immunised 95% of their patients on the diabetic register with the influenza vaccine achieving above the national average 94%.
• The practice had low accident and emergency admissions. The practice provided holistic and responsive care through regular consultations, medicine reviews and follow ups being given to their patients.
• Same day and longer appointments were provided in addition to home visits which were available when needed.
• For those patients with the most complex needs, the named GP and practice nurse worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 5 July 2016

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

• Children were treated in an age appropriate manner and clinical templates utilised for the recording of consent and to evidence their competency to make decisions.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Children four years of age and under were seen the same day and children five years and above were triaged by the GP to assess their clinical needs prior to offering an appropriate appointment.
• The practice was committed to safeguarding the care of children. The maintained a register of all those at risk or on a child protection plan. They followed up with the children’s families and carers regarding non-attendance for health appointments, including those with the health visitor or hospital.
• Immunisation rates were high for all standard childhood immunisations, achieving 93% to 100% for vaccinations given to children under two years of age and 95% to 99% for five year olds.

• The practice nurse provided a range sexual health advice and health screening services. For example, the practice’s uptake for the cervical screening programme was 85%, which was above the national average of 82%.

• The practice reported good joint working with midwives and health visitors.

Updated 5 July 2016

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

• The practice has a lower than local and national representation of patients amongst this population group. However, they offer individualised care to them.
• Longer appointments were available and staff assisted patients with sight and hearing impairments, on the patients’ request.
• Home visits, including evening and weekends were provided but patients were offered open priority access Monday to Friday and this had proven to be effective. The practice reported home visits to be infrequent.
• Patients were invited for flu, pneumococcal and age related shingles vaccination.
• The practice conducted multidisciplinary meeting to discuss patients with complex care needs and those on the palliative care register. In addition, regular discussions were held with a range of specialists and care community care service to coordinate services (such as the dementia care team, district nursing team, occupational health and ambulance services) to meet patient needs.

Updated 5 July 2016

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

• The practice understood the needs of their working patients. They offered early consultations starting at 8.40am Monday to Friday and late consultations on Monday’s alternating between their main and branch surgeries. They also conduct telephone consultations where appropriate.
• The practice offered on-line appointments and electronic prescribing for acute and repeat prescriptions. Patients were invited to submit an online request for their repeat prescriptions and could collect them at a pharmacy of their choice.
• The practice was proactive in offering a full range of health promotion and screening that reflected the needs for this age group.

Updated 5 July 2016

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

• Patients with poor mental health receive regular scheduled consultations and short notice and no notice appointments were accommodated where there was a clinical need.
• Patients received regular medicine reviews and medicines were prescribed weekly or fortnightly where required, to mitigate the risk of the medicines being abused.
• The practice achieved above the national average for their management of patients with poor mental health. For example, 91% of their patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in their records within the last 12 months and 98% had their alcohol consumption recorded.
• The practice had higher than the national average for the percentages of their patients diagnosed with dementia receiving a face to face review within the preceding 12 months. They achieved 86% in comparison with the national average of 84%.
• The practice regularly worked with multi-disciplinary teams (such as the crisis support mental health teams, memory clinics, and the emotional health and well-being mental health services) in the case management of people experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for all their patients with dementia.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health or had dementia.
• Staff were confident identifying patient needs and signposting or referring them to support services.

Updated 5 July 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. All of whom were invited for annual health checks and non-attendance followed up.
• Longer appointments were provided with GPs and the practice nurse.
• The practice staff knew their patients and recognised and responded to individual’s specific need changing their behaviour to support them.
• Staff had undertaken safeguarding training signposted and referred patients to various support groups and voluntary organisations.
• The practice held multidisciplinary meetings and communicated regularly with partner services to coordinate care provision to meet their patient’s needs.