Archived: Church Farm Surgery

Updated 26 May 2017

Church Farm Surgery provides personal medical services to a population of approximately 4,000 patients in Aldeburgh and the surrounding villages in Suffolk. The practice’s patient population is below the CCG and national averages for patients aged 0 – 54 years, but above the CCG and national averages for patients aged 55 and over. The practice patient demographics are mainly affluent, white, middle class residents. The practice provides treatment and consultation rooms on the ground floor with level access. Parking is available.

The practice has a team of three GPs (one male and two female) who are partners which mean they hold managerial and financial responsibility for the practice. In addition to this, there is one male salaried GP. There is a nursing team, which includes three nurses, two phlebotomists and one healthcare assistant who run a variety of appointments for long term conditions, minor illness, and family health. There is a practice manager who joined the practice in March 2017 and is supported by a team of non-clinical administrative, secretarial and reception staff who share a range of roles, some of whom are employed on flexible working arrangements.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments with GPs are from 8.50am to 11.30am and from 3.30pm to 5.30pm with overflow appointments at the end of morning and afternoon surgeries to ensure patients who needed to be seen are seen on the day. In addition to pre-bookable appointments that can be booked up to three weeks in advance, urgent appointments are also available for people that need them. Appointment times with GPs have been increased to 12 minutes to ensure patients are given sufficient time during their consultation to address their needs.

The practice is part of a local group of GP practices, the Deben Health Group. A group of eight practices brought together to work together on financial, educational and clinical matters and to share learning and development.

The practice takes part in the Suffolk Federation GP+ scheme which offers routine appointments outside of opening hours. The practice is able to book appointments for patients with this service.

Out of hours care is provided by CareUK via the NHS 111 service.

Updated 26 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Church Farm Surgery on 22 July 2016. The overall rating for the practice was Good with requires improvement for providing safe services. The full comprehensive report on the July 2016 inspection can be found by selecting the ‘all reports’ link for Church Farm Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 11 April 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 22 July 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as Good for the safe domain. However on the inspection of 22 July 2016, there were areas of practice where the provider needed to make improvements.

We found that the provider must:

• Ensure records relating to the recruitment and management of staff are complete and include Disclosure and Barring Service (DBS) checks for all clinical staff. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).
• Ensure systems in place are sufficient to ensure patients who were prescribed high risk medicines had the necessary monitoring to support safe prescribing. The practice must ensure the results of appropriate blood monitoring tests are recorded in the patients’ records.

In addition we found the practice should;

• Ensure patients waiting for their appointments in all areas of the practice could be clearly seen by reception staff to enable closer monitoring in case of change in condition.
• Implement an extended clinical audit programme to encompass outcomes wider than prescribing.
• Continue to ensure patients with a learning disability receive annual health checks.
• Continue to proactively identify carers.
• Undertake regular fire drills.

At this inspection, on 11 April 2017, we found evidence that;

• The practice had developed a system to ensure that records relating to the recruitment and management of staff were in place. We saw that DBS checks had been undertaken for all clinical staff and a process was in place to audit all records relating to new staff recruitment.
• The practice had ensured the results of appropriate blood monitoring tests were recorded in the patients’ records to ensure the necessary monitoring was in place for safe prescribing.

The areas where the provider should continue to make improvement are;

• Continue to risk assess and monitor patients waiting for their appointments in all areas of the practice, to ensure they can be clearly seen by staff to enable closer monitoring in case of a change in their condition.
• Implement an extended clinical audit programme to encompass outcomes wider than prescribing.
• Improve staff understanding of the computer operating system in order to consistently code patient groups and produce accurate performance data.
• Continue to ensure patients with a learning disability receive annual health checks.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 October 2016

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.
• Performance for diabetes QOF related indicators was 87% which was below the CCG average by 3% and the national average by 2%.
• 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 17 October 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 who were at risk, for example, children and young people who had a high number of A&E attendances
• 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 80%, which was comparable to the CCG average of 80% and above the national average of 72%.
• 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, health visitors and school nurses.
• Childhood immunisation rates for the vaccinations given were above CCG/national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 94% to 100% and five year olds were all above CCG and national averages at 100%.

Updated 17 October 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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. All home visits were triaged by a clinician to prioritise visits and ensure appropriate clinical intervention.
• The practice offered health checks for patients aged over 75.
• Nationally reported data showed that outcomes for patients for some conditions commonly found in older people including heart failure were above local and national averages.
• The practice worked in cooperation with local practices in providing care plans for vulnerable and/or with complex needs at risk of hospital admission.
• The practice provided weekly and ad-hoc medical services by named GPs to nursing and residential homes. One GP undertook daily clinics at the local hospital to oversee patients’ chronic needs. GPs also attended nursing and residential homes when requested.
• The practice worked closely with the parish nurse to provide support to older patients.

Updated 17 October 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 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 encouraged its patients to attend national screening programmes for bowel and breast cancer screening. The bowel cancer screening rate for the past 30 months was 63% of the target population, which was in-line with the CCG average of 63% and above the national average of 58%.The breast cancer screening rate for the past 36 months was 80% of the target population, which was in line with the CCG average of 80% and above the national average of 72%.

Updated 17 October 2016

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

• 80% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.
• Performance for mental health related QOF indicators was 91% which was in-line with the CCG average and 2% below national averages.
• 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 17 October 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 homeless people, travellers and those with a learning disability.
• 40% of patients diagnosed with a learning disability who had their care reviewed in a face to face meeting in the last 12 months, which is lower than the national average.
• 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.