The New Surgery

Updated 10 August 2016

The New Surgery is located in purpose built premises on the Shenfield Road in a predominantly residential area in Brentwood, Essex. The practice provides services for 13803 patients. The practice also has a branch surgery located at Geary Drive, Brentwood. We did not visit the branch surgery as part of this inspection.

The practice holds a General Medical Services (GMS) contract and provides GP services commissioned by NHS England and Basildon and Brentwood Clinical Commissioning Group. A GMS contract is one between GPs and NHS England and the practice where elements of the contract such as opening times are standardised.

The practice population is similar to the national average for younger people and children under four years, and for those of working age and those recently retired, and slightly higher for older people aged over 65 years. Economic deprivation levels affecting children, older people are lower than the practice average across England. Life expectancy for men and women are similar to the national averages. The practice patient list is lower than the national average for long standing health conditions. It has a higher than the national averages for working aged people in employment or full time education lower numbers of working age people that are unemployed.

The practice is managed by eight GP partners who hold financial and managerial responsibility. One of the GP partners is the Registered Manager. A Registered Manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run. The practice employs one salaried GP. In total four male and four female GPs work at the practice.

Two nurse practitioners, four practice nurses and one healthcare assistant work at the practice. In addition the practice employs a management team including a practice manager and a team of receptionists, medical secretaries, administrators and prescribing clerks.

The New Surgery is a fully accredited training practice for the East of England Deanery. This means that the practice has a GP Registrar who is a fully qualified doctor who is undertaking GP training in the practice.

The practice is open between 8am and 6pm on weekdays. GP and nurse appointments are available in the morning between 8.30am and 12.20pm. Afternoon appointments are available between 2.30pm and 5.45pm daily. Telephone triage and consultations are available throughout the day.

Pre-booked GP and nurse appointments are available between 8.30am and 12pm on Saturdays.

The branch surgery is open between 8am and 6pm on Mondays, Tuesdays and Thursdays. Appointments are available between 8.30am and 12.20pm and between 2.30pm and 5.45pm.

The practice has opted out of providing GP out of hour’s services. Unscheduled out-of-hours care is provided by IC24 and patients who contact the surgery outside of opening hours are provided with information on how to contact the service.

Updated 10 August 2016

Letter from the Chief Inspector of General Practice

We carried out a desk top review of The New Surgery on 22 July 2016. This was to check the practice had responded appropriately the findings of their announced comprehensive inspection conducted on 20 January 2016. At this inspection the practice was rated as good overall, good for safe, effective, caring and well led domains. The responsive domain was rated as requires improvement.

During our last inspection we required the provider to ensure that all complaints received were fully investigated. Patients were also required to be provided with information as to how they could escalate their concerns should they remain dissatisfied with the outcome or how their complaint was handled. We issued the practice with a requirement notice for improvement in relation to their complaints system.

Additionally, they were asked to review the arrangements for obtaining patient consent. It was required to reflect staff responsibilities for determining who holds parental responsibilities when children are treated. We did not issue a requirement notice for this area of improvement but advised the practice that they should make improvements in relation to providing effective services.

After the inspection report was published the provider sent us an action plan that detailed how they would make the necessary improvements. We were the provided documentary evidence of the improvements they had made and we were able to carry out a desk top inspection without the need to visit the practice.

During this desk top inspection, we reviewed two complaints that had been reported since February 2016. We found both complaints had been acknowledged, investigated and responded to appropriately with all aspects addressed. The complainants had also been informed of how to escalate concerns if they were dissatisfied with the outcome of the practices findings.

We found the practice had revised their consent policy. It has been shared with staff who had confirmed they had read and understood it. Where children were brought to the surgery by a person without parental responsibility, a signed consent form was taken from somebody with parental responsibility before care and treatment was provided. Parents were also required to present the Child Immunisation History (Red Book) and letter of invite for their children’s immunisations in order to evidence that they had parental responsibility for the child concerned.

Overall, we found that the practice had made the necessary improvements required of them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 March 2016

The provider was rated as good for the care of people with long-term conditions.

Nationally reported data showed that the practice performance for the management of long term conditions including diabetes and heart disease were similar to or above other GP practices locally and nationally. The practice offered proactive, personalised care to meet the needs of people with long term conditions including:

• Patients had a named GP who was responsible for coordinating their care and treatment.

• Registers were

• Dedicated nurse led clinics were held to assess and review patients with long term conditions.

• The practice worked

• Direct access was available to vulnerable patients including those who were at risk of unplanned hospital admissions.

• The practice offered services which could be easily accessed such as 24hr blood pressure monitoring, home peak expiratory flow rate (PEFR), home blood glucose testing, insulin pumps and home blood testing which enabled the close monitoring of long term conditions.

Updated 3 March 2016

The provider was rated as good for the care of families, children and young people.

Nationally reported data showed that the practice performance for the uptake of childhood immunisations was similar to or above other GP practices locally and nationally. The practice offered proactive, personalised care to meet the needs of families, children and young people including:

• The practice offered same day appointments for children as needed. Appointments were available outside of school hours.

• Ante–natal, post-natal and baby checks were available to monitor the development of babies and the health of new mothers.

• 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.

• Referrals were made to appropriate counselling services where required.

• The practice reviewed and monitored the health of patients under the age of 18 years to reduce the numbers of unplanned A&E admissions. This was reflected in the practice performance which was significantly lower than the local and national averages.

• The practice held monthly in-house safeguarding meetings with relevant health professionals including health visitors to review children who were identified as being at risk.

• There were procedures in place for obtaining consent. However some staff were unaware of their need to check parental responsibilities when obtaining consent in relation to treating children.

• Children and young adults were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• Information and a range of sexual health and family planning clinics were available.

• Some staff were not sufficiently aware of parental responsibility in relation to providing consent to care and treatment.

Updated 3 March 2016

The provider was rated as good for the care of older people.

Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of older people including:

• All patents including older people had a named GP who was responsible for managing their care and treatment.

• The practice was accessible and offered parking for the disabled, a hearing loop, patient lift and toilet facilities for the disabled.

• Longer appointments, telephone consultations and home visits were provided as needed.

• One GP had extensive experience in treating older people. Appropriate referrals were made to secondary and specialist services as needed.

• The practice provided dementia screening and made appropriate referrals as required.

• Electronic prescribing was available so that patients could collect medicines from their local pharmacy without the need to visit the practice.

• Dedicated GP rounds were made to local care homes to monitor and treat patients.

• The practice worked with other agencies to reduce the number of unplanned hospital admissions.

Updated 3 March 2016

The provider was rated as good for the care of working-age people (including those recently retired and students).

The practice offered proactive, personalised care to meet the needs of families, children and young people including:

• Appointments could be booked in person or by telephone up to six months in advance and up to twenty weeks in advance online.

• Early morning appointments were available from 8.30am and pre-booked GP and nurse appointments were available on Saturday mornings (These could be booked one week in advance). Additional appointments were available over the New Year bank holiday weekend

• Online appointment booking and electronic prescribing facilities were available.

• Patients had access to online consultations via the practice website. Patients could complete a web form with information and / or questions about a range of symptoms and medical conditions. This information was then reviewed by a GP and patients received a call or email with advice or to book an appointment.

• The practice offered a full range of health promotion and screening that reflected the needs for this age group including NHS health checks.

Updated 3 March 2016

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

The practice offered proactive, personalised care to meet the needs of people experiencing poor mental health (including people with dementia), including:

• Patients had access to a named GP to help provide continuity of care.

• The practice carried out dementia screening and carried out face-to-face reviews.

• Patients with mental health conditions were reviewed and had an annual assessment of their physical health needs.

• Rapid access appointments were available as needed.

• Longer appointments and home visits were provided as required.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

Updated 3 March 2016

The provider was rated as good for the care of people whose circumstances may make them vulnerable.

The practice offered proactive, personalised care to meet the needs of people whose circumstances may make them vulnerable including:

• Staff undertook safeguarding training and the practice had a dedicated safeguarding lead.

• The practice held a register of patients living in vulnerable circumstances including patients with a terminal illness and those with a learning disability. This helped to monitor and maintain annual health checks.

• The practice proactively promoted annual health checks for patients with learning disabilities and nurses had received specific training to support these patients.

• Longer appointments were available as needed.

• Home visits were available for these reviews as needed.

• The practice also served an ethnically diverse population and patients whose first language was not English had access to translation services.

• Patients with alcohol and substance misuse issues were offered support and information in relation to their rehabilitation.

• The practice carried out twice weekly GP visits to a local care home for people with a range of neurological and physical disabilities to review and monitor their care and treatment.