Archived: Dr Baguant and Partners Also known as The Health Centre, Redbourn

Updated 31 August 2017

Dr Baguant and Partners (also known as Redbourn Health Centre) provides a range of primary medical services from its premises at The Health Centre, 1 Hawkes Drive, Redbourn, St Albans, Hertfordshire, AL3 7BL. The practice has a registered manager in place. (A registered manager is an individual registered with CQC to manage the regulated activities provided).

The practice serves a population of approximately 7,714. The area served is less deprived compared to England as a whole. The practice population is mostly white British. The practice serves an above average population of those aged from 0 to 14 years, 40 to 49 years and 65 to 69 years. There is a lower than average population of those aged from 15 to 39 years.

The clinical team includes one male and two female GP partners, one male and three female salaried GPs, two practice nurses and one healthcare assistant. The team is supported by a practice manager, an assistant practice manager and 10 other secretarial, administration and reception staff. There is one directly employed cleaner. The practice provides services under a General Medical Services (GMS) contract (a nationally agreed contract with NHS England).

The practice is fully open (phones and doors) from 8am to 1pm and 2pm to 6.30pm Monday to Friday. Between 1pm and 2pm daily the doors are closed but the phone lines remain open. There is routinely (usually) extended opening from 7.30am to 8am on Tuesdays and Thursdays and from 6.30pm to 7.30pm every second Monday and Tuesday. The practice also opens one Saturday each month from 9am to midday for GP pre-bookable appointments. Appointments are available from 8.30am to 11.30am and 2.30pm to 6.30pm daily, with slight variations depending on the doctor and the nature of the appointment.

An out of hours service for when the practice is closed is provided by Herts Urgent Care.

Updated 31 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Baguant and Partners on 7 December 2016. The overall rating for the practice was good. However, we identified a breach of legal requirements. Improvements were needed to systems, processes and procedures to ensure the practice provided safe services. Consequently the practice was rated as requires improvement for providing safe services. The full comprehensive report from the 7 December 2016 inspection can be found by selecting the ‘all reports’ link for Dr Baguant and Partners on our website at www.cqc.org.uk.

After the comprehensive inspection, the practice wrote to us and submitted an action plan outlining the actions they would take to meet legal requirements in relation to;

• Regulation 12 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014

- Safe care and treatment.

The area identified as requiring improvement during our inspection in December 2016 was as follows:

• Ensure a sufficient process is in place and adhered to for the appropriate management of clinical notifications, for example pathology test results.

In addition, we told the provider they should:

• Ensure that notices around the practice advising patients that chaperones are available are clearly visible.
• Take steps to ensure that hot water temperatures at the practice are kept within the required levels and a comprehensive water temperature checking process is in place.
• Ensure that the fire risk assessment document is located and available.
• Ensure that all staff employed are supported by receiving appropriate supervision and appraisal and are completing the essential training relevant to their roles, including safeguarding and infection prevention and control training.
• Continue to identify and support carers in its patient population.
• Ensure the practice’s area of below average Quality and Outcomes Framework (QOF) performance for diabetes related indicators is improved.

We carried out an announced focused inspection on 2 August 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach of regulation that we identified in our previous inspection on 7 December 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our key finding on this focused inspection was that the practice had made improvements since our previous inspection and were now meeting the regulation that had previously been breached.

The practice is now rated as good for providing safe services.

On this inspection we found:

• A sufficient process was in place and adhered to for the management and review of clinical notifications received from secondary care services, specifically pathology test results.

Additionally where we previously told the practice they should make improvements our key findings were as follows:

• Notices around the practice advising patients that chaperones were available were clearly visible.
• All staff had completed adult and child safeguarding and infection prevention and control training within the required timescales.
• An up to date and fully completed fire risk assessment was available.
• Water temperature checks were completed and recorded. Although many recorded water temperatures were above or below the required levels the appropriate investigations as to the causes of this had been completed and work was planned to rectify the situation in the near future.
• A programme was in place to ensure all staff received an appraisal on an annual basis and this was on schedule. We found that all non-clinical and nursing staff, including those previously overdue their annual appraisals had received a fully documented appraisal between November 2016 and July 2017.
• Through implementing a new protocol and coordinated practice wide approach, the practice had improved its Quality and Outcomes Framework (QOF) performance for diabetes related indicators. (QOF is a system intended to improve the quality of general practice and reward good practice). Figures provided by the practice showed that from April 2017 to August 2017 the practice had achieved 68% of the total number of points available with seven full months of the year remaining. The senior staff we spoke with said the forecast was for the practice to considerably improve on its full year achievement of 81% in the 2015/2016 year and 83% in the 2016/2017 year.
• The practice had identified inaccuracies in the way it recorded (coded) the services it provided to carers. We saw the practice had completed a piece of work to investigate and resolve the issues which included updating its policy and developing a carers toolkit as a process guide for staff to follow. Several staff members completed a full review of the practice’s carers register (those patients on the practice list identified as carers) to ensure the coding for each individual adequately reflected the services offered to them. As of 2 August 2017 the practice had identified 204 patients on the practice list as carers. This was approximately 2.6% of the practice’s patient list. Of those, 186 (91%) had been invited for a health review in the past 12 months. This was a considerable improvement on the 32% invited for a health review in the 12 months up to our inspection in December 2016.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 March 2017

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.
• 79% of patients on the asthma register had their care reviewed in the last 12 months. This was similar to the CCG average of 75% and the national average of 76%.
• Performance for diabetes related indicators was below the CCG and national average. The practice achieved 81% of the points available compared to the CCG and national average of 90%. The practice was aware of its below average performance and a plan of action was in place to improve this.
• All newly diagnosed patients with diabetes were managed in line with an agreed pathway.
• 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 GPs worked with relevant health and care professionals to deliver a multi-disciplinary package of care.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

Updated 20 March 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 may be at risk, for example, children and young people who had a high number of A&E attendances.
• Immunisation rates were comparable to other practices in the local area 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 83% which was similar to the CCG and national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• There were six week post-natal checks for mothers and their children.
• A range of contraceptive and family planning services were available.

Updated 20 March 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.
• The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs.
• Older people had access to targeted immunisations such as the flu vaccination. The practice had 1,422 patients aged over 65 years. Of those 953 (67%) had received the flu vaccination at the practice in the 2015/2016 year.
• There was one care home in the practice’s local area which included residents with increased needs. There was a nominated GP for the home who completed a scheduled ward round once each week to ensure continuity of care for these patients.

Updated 20 March 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 offered online services such as appointment booking and repeat prescriptions as well as a full range of health promotion and screening that reflects the needs for this age group.
• There was additional out of working hours access to appointments to meet the needs of working age patients. There was routinely (usually) extended opening from 7.30am to 8am on Thursdays and from 6.30pm to 7.30pm every second Monday and Tuesday. The practice also opened one Saturday each month from 9am to midday for GP pre-bookable appointments.
• 67% of female patients aged 50 to 70 years had been screened for breast cancer in the past three years compared to the CCG and national average of 72%.

Updated 20 March 2017

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

• 96% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was above the CCG average of 85% and national average of 84%.
• Performance for mental health related indicators was above the CCG and national averages. The practice achieved 100% of the points available compared to the CCG average of 95% and the national average of 93%.
• The practice regularly worked with multi-disciplinary teams in the case management of people 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• There was a GP lead for mental health.
• Mental health trust well-being workers were based at the practice twice each week on Tuesdays and Fridays. Patients could self-refer to these. A NHS counsellor was available at the practice once each week on Mondays. Patients could access this service to obtain psychological and emotional counselling and advice through referral from the GPs.

Updated 20 March 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. There were 28 patients on the practice’s learning disability register at the time of our inspection. Of those, all had been invited for and 10 (36%) had accepted and received a health review in the past 12 months. Senior staff at the practice were aware of the low number of patients with a learning disability receiving a health review and could demonstrate they were responding to it.
• The practice offered longer appointments for patients with a learning disability and there was a GP lead for these patients.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• The practice informed vulnerable patients about how to access 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.
• Additional information was available for patients who were identified as carers and there were nominated staff leads for these patients.
• The practice had identified 151 patients on the practice list as carers. This was approximately 2% of the practice’s patient list. Of those, 48 had been invited for and 47 (31%) had accepted and received a health review in the past 12 months. Senior staff at the practice were aware of the low number of carers invited for a health review and could demonstrate they were responding to it.