Archived: The Sollershott Surgery

Updated 1 September 2016

The Sollershott Surgery provides a range of primary medical services to the residents of Letchworth Garden City and the adjoining borders of Hitchin and Baldock. The practice was established in 1963 and has been at its current location of 44 Sollershott East, Letchworth Garden City, Hertfordshire, SG6 3JW since 1989.

The practice population is pre-dominantly white British with a higher than average 60 to 79 year age range. National data indicates the area is one of low deprivation. The practice has approximately 5,500 patients and services are provided under a general medical services contract (GMS), this is a nationally agreed contract with NHS England.

There are two GP partners, both male and they employ one female salaried GP and one female locum GP. There is one practice nurse and one health care assistant, both female. The practice is currently recruiting a further practice nurse and has a vacancy for a GP partner. There are also a number of reception and administration staff led by a practice manager.

The practice is open from 8.30am to 6.30pm Monday to Friday, with access via the telephone from 8am daily. Appointments are available from 8.40am to 11am and 4pm to 5.30pm on Mondays, Tuesdays and Thursdays and from 8.40am to 11am and 3pm to 4.30pm Wednesdays and Fridays. The practice does not offer any extended opening hours appointments.

When the practice is closed out-of-hours services are provided by Herts Urgent Care and can be accessed via the NHS 111 service.

Updated 1 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Sollershott Surgery on 12 May 2016. Overall the practice is rated as inadequate.

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. However, reviews and investigations were not thorough enough. Lessons learnt from incidents and near misses were not shared within the practice.
• Risks to patients were assessed in most areas but identified mitigating actions were not implemented.
• Complaints of a clinical nature were not investigated by a clinician and learning from complaints had not been shared with practice staff.
• The practice had not sought feedback from patients via their virtual patient participation group (PPG).
• Data showed patient outcomes were comparable to the local and national averages.
• Patients said they were treated with compassion, dignity and respect.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvements are:

• Systems and processes must be established and operated effectively to ensure good governance.

• Ensure blank prescriptions are stored securely at all times and there is a system in place to monitor the use of the blank prescription forms.

• Ensure that all staff employed are supported by receiving appraisals and complete the training essential to their roles.

• Implement the actions identified in the risk assessment relating to fire safety, including staff training and fire drills.

• Complete a risk assessment to identify mitigating actions for not having a defibrillator on the premises.

• Ensure a legionella risk assessment is completed by a person competent to carry out the task.

• Investigate safety incidents formally and ensure that lessons learnt are shared with practice staff.

• Implement a process to ensure that complaints are investigated by the appropriate person, monitor complaints for trends and share learning from complaints with the practice staff.

• Implement systems and processes to ensure there is effective communication with practice staff.

• Engage with the virtual PPG to gather feedback from patients.

In addition the provider should:

• Review the business continuity plan and update the contact numbers.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement, we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 September 2016

The provider was rated as inadequate for safety and well-led and requires improvement for effective and responsive. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good practice.

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

• Performance for diabetes related indicators was similar to the national average. For example, the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 92% compared to the local average of 90% and the national average of 88%.

• 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 and care professionals to deliver a multidisciplinary package of care.

Updated 1 September 2016

The provider was rated as inadequate for safety and well-led and requires improvement for effective and responsive. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good practice.

• 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.

• The practice’s uptake for the cervical screening programme was 88%, which was better than the CCG average of 86% and the national average of 82%.

• 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.

Updated 1 September 2016

The provider was rated as inadequate for safety and well-led and requires improvement for effective and responsive. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good practice.

• 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.

• Weekly visits were made to a local care home in addition to home visits as required.

Updated 1 September 2016

The provider was rated as inadequate for safety and well-led and requires improvement for effective and responsive. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good practice.

• 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.

• NHS health checks were offered by the practice for patients aged 40 to 74 years.

Updated 1 September 2016

The provider was rated as inadequate for safety and well-led and requires improvement for effective and responsive. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good practice.

• 87% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average.

• 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 various support groups and voluntary organisations.

• 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.

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

Updated 1 September 2016

The provider was rated as inadequate for safety and well-led and requires improvement for effective and responsive. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good practice.

• 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 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.

• An identified member of staff was the carers’ champion. They had received training for this role from the local CCG. There was a carers’ noticeboard in the waiting area and written information was available to direct carers to the various avenues of support available to them.