Archived: The Garden City Practice

Updated 12 August 2016

The Garden City Practice provides primary medical services, including minor surgery, to approximately 9,970 patients from three premises in Welwyn Garden City, Hertfordshire. The Garden City Practice and Knightsfield are the two main sites whilst Haldens surgery is open three mornings a week. All three premises are converted houses and services are provided on a General Medical Services (GMS) contract, a nationally agreed contract.

The practice serves a lower than average number of patients aged between 20 to 34 years and 55 to 69 years, and a higher than average number of patients aged between 0 to 9 years, 35 to 49 years and those aged 75 and over. The population is 91% White British (2011 Census data). The area served is less deprived compared to England as a whole.

The practice team working across the three premises consists of six GP Partners. Three GPs are female and three are male. There are two nurse practitioners who are prescribers, one practice nurse and one Health Care Assistant. The non-clinical team consists of a practice manager, an assistant practice manager, one administrator, seven receptionists and three medical secretaries. The Garden City Practice is a teaching practice which enables medical students to train at the practice as part of their medical education.

The two main sites are open to patients between 8:30am and 6.30pm Mondays to Fridays. Patients can telephone the practice between 8am and 6pm Mondays to Fridays. The practices have arrangements in place for telephone calls to be diverted to the out of hours service from 6pm to 6:30pm Mondays to Fridays. Appointments with a GP are available from 8:30am to 11:30am and from 3pm to 5.30pm Mondays to Fridays. These sessions are extended as and when required and the practice offers extended opening hours from 9am to 12pm during the first three Saturdays of each month. Emergency appointments are available daily with the duty doctor. A telephone consultation service is also available for those who need urgent advice. Haldens surgery is open between 9am and 12pm Mondays, Wednesdays and Fridays.

Home visits are available to those patients who are unable to attend the surgery and the practice is also able to offer home visits via the Acute In Hours Visiting Service. This is a team of doctors who work across East and North Hertfordshire to visit patients at home to provide appropriate treatment and help reduce admission to hospital. The out of hours service is provided by Hertfordshire Urgent Care and can be accessed via the NHS 111 service. Information about this is available in the practice and on the practice website and telephone line.

Updated 12 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Garden City Practice on 27 April 2016. Overall the practice is rated as good.

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

• There was an effective system in place for reporting and recording significant events.
• Staff had the skills, knowledge and experience to deliver effective care and treatment.
• 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 there was continuity of care, with urgent appointments available the same day.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 August 2016

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

• A nurse practitioner had a lead role in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The practice held a multidisciplinary diabetic clinic for patients on a weekly basis, providing all aspects of diabetes management. The practice worked closely with secondary care and all diabetic patients were invited to attend an annual review with the diabetes consultant.
• Performance for diabetes related indicators was above the CCG and national average. The practice had achieved 95% of the total number of points available, compared to 89% locally and 89% nationally.
• 75% of patients diagnosed with asthma, on the register, had received an asthma review in the last 12 months which was with the same as the national average.
• The practice worked closely with a local multidisciplinary team which provided a rapid response service to support people with long term or complex conditions.
• Longer appointments and home visits were available when needed.
• The practice had re-structured their system for completing patients’ annual reviews. Patients with a long-term condition had a named GP and a structured annual review to check their health and medicines needs were being met.

Updated 12 August 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 identified as being at possible risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were 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 the same as the national average.
• Appointments were available on the same day and outside of school hours. The premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and children’s centres.
• The practice was working with other practices and secondary care services in the locality to design and set up a shared paediatric walk-in clinic to meet growing demand for access to paediatric services during the late afternoon/early evening.

Updated 12 August 2016

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, this included enhanced services for avoiding unplanned admissions to hospital and end of life care.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments when required.
• The practice offered a comprehensive and detailed health check for all patients aged 75 or over which included a six point dementia assessment. The practice had completed 555 health checks for patients aged 75 or over since October 2014, which was 59% of this population group.
• A hearing aid clinic was delivered at the practice by a NHS technician every two months.

Updated 12 August 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 provided a health check to all new patients and carried out routine NHS health checks for patients aged 40-74 years.
• Bowel and breast cancer screening rates were comparable with local and national averages. Data showed 59% of patients aged 60 to 69 years had been screened for bowel cancer in the last 30 months compared to 60% locally and 58% nationally. Data showed 69% of female patients aged 50 to 70 years had been screened for breast cancer in the last 3 years compared to 72% locally and 72% nationally.
• The practice was proactive in offering on line services such as appointment booking and repeat prescriptions, as well as a full range of health promotion and screening that reflects the needs of this age group.
• It offered an appointment reminder text messaging service and additional pre-bookable appointments were made available between 9am and 12pm during the first three Saturdays of each month.
• The practice was planning on providing an Electronic Prescribing Service (EPS) in June 2016. This service would enable GPs to send prescriptions electronically to a pharmacy of each patient’s choice.

Updated 12 August 2016

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

• Senior practice staff had led on a project to establish Dementia Support Workers in GP practices within the locality and had been working with these workers since May 2015. We were told that all patients on the practice dementia register, and their carers, had been offered support and approximately 42% of these patients were actively involved.
• 76% of patients diagnosed with dementia had their care reviewed in a face to face meeting in 2014/2015, which was slightly below the national average of 84%.
• The practice held a register of patients experiencing poor mental health and offered regular reviews and same day contact.
• The practice had access to a NHS counsellor and we were told that patients would be seen shortly after making a referral.
• The practice referred patients to the Improving Access to Psychological Therapies service (IAPT) and encouraged patients to self-refer.
• Performance for mental health related indicators was above the CCG and national average. The practice had achieved 100% of the total number of points available (with 7% exception reporting), compared to 96% locally (12% exception reporting) and 93% nationally (11% exception reporting).
• 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 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 12 August 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 and had completed 37 out of 39 learning disability health checks since April 2015.

• It offered longer appointments and annual health checks for people with a learning disability.
• The practice had a system in place to identify patients with a known disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• Vulnerable patients had been told how to access various support groups and voluntary organisations.
• The practice worked closely with a local women’s refuge centre.
• Staff had received safeguarding training and knew how to recognise signs of abuse in vulnerable adults and children. Staff members 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.