Much Hadham Health Centre

Updated 2 February 2017

Much Hadham Health Centre situated in Ash Meadow, Much Hadham, Hertfordshire is a GP practice which provides primary medical care for approximately 6490 patients. The practice also offers GP consultations at Hunsdon Village Hall, Hunsdon, near Ware and at Little Hadham Village Hall, Shellands, Ware. The practice maintains one patient list and patients can consult at any of the above locations. We did not inspect the Village Hall locations at this time. Together they provide primary medical care to the residents living in Much Hadham and surrounding areas.

Much Hadham Health Centre provides primary care services to local communities under a General Medical Services (GMS) contract, which is a nationally agreed contract between general practices and NHS England. The practice population is predominantly white British along with a small ethnic population of Asian and Eastern European origin.

The practice has three GP partners (one female and two male). There is a nurse practitioner and a practice nurse who are supported by a health care assistant (all females). There is a practice manager who is supported by a team of administrative and reception staff. The local NHS trust provides health visiting and community nursing services to patients at this practice.

Much Hadham Health Centre is a dispensing practice and has a dispensary which is open during surgery times. There are six dispensers supported by a dispensary manager.

Patient consultations and treatments take place on ground level. There is a car park outside the surgery with adequate disabled parking available.

The practice is open Monday to Friday from 8am to 6.30pm. On Thursday the practice is open from 7am. On the first Saturday of each month the practice is open between 8.30am and 11am. There are a variety of access routes including telephone appointments, on the day appointments and advance pre bookable appointments.

When the practice is closed services are provided by Herts Urgent Care via the 111 service.

Updated 2 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Much Hadham Health Centre on 17 November 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. However the process of managing high risk medication needed strengthening.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. However there was not an accessible summary of training records for the practice.
• Most staff had received an annual appraisal in the past 12 months or had confirmed dates for an appraisal to be completed by 31 March 2016.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day.
• The practice had established systems to support carers.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a leadership structure and staff felt supported by management.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Develop a comprehensive approach to assessing infection control compliance.

• Develop systems to update the practice patient records with the results obtained through the hospital results system for patients receiving high risk medication.

• Continue to monitor the recently implemented protocol to code children who had failed to attend a hospital appointment (DNA) so they can be easily identified and acted on.

• Develop systems to periodically corroborate through a laboratory check the test results of patients who self monitor their blood when receiving anticoagulants.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 February 2017

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

• Nursing staff supported by GPs had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• There was a system to identify patients at risk of hospital admission that had attended A&E or the out of hours service and these patients were regularly reviewed to help them manage their condition at home.

• Performance for diabetes related indicators were comparable to the CCG and national average. For example, the percentage of patients with diabetes, on the register, in whom the last blood pressure reading showed good control (in the preceding 12 months) was 71%, where the CCG average was 76% and the national average was 78%.

• Longer appointments and home visits were available when needed.

• All these patients 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 care professionals to deliver a multidisciplinary package of care.

• The practice had recently employed a diabetic nurse and offered pre diabetic screening which was part of a locality initiative with the CCG.

• The practice held regular review meetings involving district nurses, GPs and the local palliative care nurses for people that required end of life care and those on the palliative care register.

Updated 2 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 who were at 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 82%, which was higher than the CCG average of 76% and the national average of 74%.

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

• We saw positive examples of joint working with midwives and health visitors.

• The practice provided a variety of health promotion information leaflets and resources for this population group. . For example, smoking cessation, sexual health immunisations and obesity where patients could have access to dedicated slimming programmes through third party services.

• The practice offered referrals to family planning and related screening such as chlamydia screening.

Updated 2 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.

• All patients over 75 had a named accountable GP.

• All these patients were offered an over 75s health check.

• The practice had identified 2% of the frailest patients at high risk of admissions to hospital (patients with multiple complex needs) and worked with community services in planning support.A dedicated GP oversaw the planning and coordination of care needs for these patients.

• The practice offered phlebotomy services for patients unable to travel to hospital.

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

• The practice supported a local care home and provided daily telephone triage and visited weekly to provide healthcare for the residents.

Updated 2 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 online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• The practice was open from 7am on Thursday and from 8.30am until 11am one Saturday each month.

• Online services were available for booking appointments and request repeat prescriptions.

•  The on-site dispensary which was open until 6.30pm daily enabled patients to collect medication without excessive travel demands.

Updated 2 February 2017

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

• 94% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was above the national average.

• The practice offered annual reviews to all patients on the mental health register which included physical checks.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access support groups and voluntary organisations including the community drugs and alcohol team.

• Patients had access to onsite weekly mental health wellbeing counsellor clinics provided by the local mental health trust.

• 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 2 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 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 informed vulnerable patients about how to access support groups and voluntary organisations.
• The practice held regular health visitor liaison and multi-disciplinary team meetings to discuss the care needs of specific patients.
• 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.
• The practice identified patients who were also carers and signposted them to appropriate support. The practice had identified 104 patients as carers (2% of the practice list). There was a designated carer’s champion who provided information and directed carers to the various avenues of support available to them.