Archived: Link End Surgery

Updated 27 March 2017

Drs Sefton-Fiddian, Fuller, Adeney and Smith, also known locally as Link End Surgery, is located in a residential area of Malvern, Worcestershire. The practice is registered with the Care Quality Commission (CQC) as a partnership provider and holds a General Medical Services (GMS) contract with NHS England. The GMS contract is a contract agreed nationally between practices and NHS England for delivering primary care services to local communities. At the time of our inspection, Drs Sefton-Fiddian, Fuller, Adeney and Smith was providing medical care to approximately 6,000 patients. 

The practice is in premises converted from a bungalow. The current partners self-funded a new consultation/minor operations room in August 2015. The patient waiting room was upgraded at the same time.

Car parking is available onsite and on the street outside. There is a ramp from the car park to the front entrance and all the downstairs consultation rooms, reception area and toilets are accessible to patients in wheelchairs.

There are three GP partners, although only two are currently registered with the CQC (the application of the third is in progress). One GP partner has been on long term sick leave since March 2016. The practice manager has been on long term sick leave since September 2016, so the reception manager is carrying out as many of the managerial tasks as possible. The practice has the support of a practice manager from a local practice, who works at the practice for two days a week as a consultant practice manager. The practice also has a clinical pharmacist, two nurses, a health care assistant and reception and administrative staff. 

Drs Sefton-Fiddian, Fuller, Adeney and Smith is an approved training practice for trainee GPs. A trainee GP is a qualified doctor who is training to become a GP through a period of working and training in a practice. There is currently one GP trainee at the practice.

During the week the practice is open from 8.30am to 6pm. Appointments are available during these hours. The practice telephone lines are open from 8am until 6.30pm. The practice is closed at weekends. The practice has taken the decision to suspend the extended hours service due to the current staffing problems.

Out of hours cover is provided by Care UK. Patients can attend the Minor Injuries Unit (MIU) at the nearby hospital for treatment for cuts and grazes, sprains, fractures, broken bones, minor head injuries and minor burns and scalds. The MIU is open from 9am until 9pm for seven days a week.

Updated 27 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Sefton-Fiddian, Fuller, Adeney and Smith on 17 January 2017. Overall the practice is rated as good.

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

• The practice was operating under severe pressure due to the inability to recruit a GP partner, and the long term absences of another GP partner and the practice manager. Nevertheless all staff remained committed to providing the highest possible standard of care to patients.
• There was an open and transparent approach to safety and an effective system for reporting and recording significant events.
• Risks to patients were assessed and well managed.

• Staff had the skills and expertise to deliver effective care and treatment to patients in line with current evidence based guidance.
• Patients said that they were treated with kindness, dignity and courtesy and that clinical staff involved them in decisions about their care and treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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.

The areas where the provider should make improvement are:

• Develop the staff training matrix and maximise opportunities for staff training.
• Monitor prescribing trends by repeating audits in order to check compliance with current prescribing guidelines. For example, the antibiotic audit.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 March 2017

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

• GPs and nursing staff had lead roles in chronic disease management, for example, asthma, chronic lung disease and diabetes. Patients at risk of hospital admission were identified as a priority.
• The percentage of patients with diabetes on the register in whom the last diabetic reading was at an appropriate level in the preceding 12 months was 88%, which was 7% above the CCG average and 10% above the national average.
• The practice hosted clinics run by the community diabetes specialist nurse and also funded additional diabetic specialist nurse clinics. The practice actively promoted the ‘Mapmydiabetes’ online education website.
• 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.
• There were links on the practice website to associations for long term conditions, for example, Asthma UK, Coeliac UK and Diabetes UK. 

Updated 27 March 2017

The practice is rated as good for the care of families, children and young people.

• There were systems 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 Accident & Emergency (A&E)attendances. Immunisation rates were relatively 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 cervical screening uptake was 83%, which was in line with the Clinical Commissioning Group (CCG) average of 83% and slightly higher than the national average of 81%.
• 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.
• A GP was the medical officer for a local boarding school.

Updated 27 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.
• The practice had signed up to the unplanned admissions enhanced service.
• The practice had a frailty register which recorded the 1% frailest patients. These patients had access to enhanced support and care via the pro-active care team.
• Longer appointments were available to those patients who needed them.

Updated 27 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 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.
• Patients could book routine GP appointments online at a time that was convenient for them as well as request repeat prescriptions.
• A text messaging service was due to be implemented in February 2017.
• Extended hours appointments had been suspended due to the partnership operating with only two GP partners instead of four.
• NHS health checks were offered by the nursing team.

Updated 27 March 2017

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

• 90% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was 4% above the Clinical Commissioning Group (CCG) average and 6% above the national average.
• 100% of patients with poor mental health had had a comprehensive care plan documented in the last 12 months, 7% above the CCG average and 11% above 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 hosted weekly clinics with a mental health worker.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system 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 27 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 no homeless patients or travellers at the time of our visit, but staff were able to tell us how they would be registered.
• The practice offered longer appointments for patients with a learning disability.
• There were 14 patients on the learning disability register, seven of whom had had annual reviews. The remainder were scheduled for March 2017.
• 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.
• The practice had a designated safeguarding lead.
• 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.
• The practice hosted a weekly substance misuse clinic.