Archived: Stuart House Surgery

Updated 6 June 2016

Stuart House Surgery provides primary medical services to approximately 8,200 patients in Boston, Lincolnshire. At the time of our inspection the practice consisted of two GP Partners and two salaried GP’s providing 22 GP sessions weekly, two nurse practitioners with prescribing privileges providing 12 sessions weekly, four practice nurses, three health care assistants and a phlebotomist .They are supported by a team of management, administration, reception and cleaning staff.

The practice is located within the area covered by NHS Lincolnshire East Clinical Commissioning Group (CCG). A CCG is an organisation that brings together local GP’s and experienced health professionals to take on commissioning responsibilities for local health services.

The practice has a General Medical Services contract. (The GMS contract is a contract between general practices and NHS England for delivering primary care services to local communities).

It is not a dispensing practice.

The practice has a higher than average percentage of older patients, with 19% being over 65 and of those 43% were over 80 years of age.

Boston and South Holland have some of the highest levels of migrant workers in England, they being predominantly form eastern Europe, particularly Latvia, Lithuania and Poland. Some 14% of the practice population do not have English as a first language.

Stuart House Surgery has opted out of providing out-of-hours services to their own patients. The out-of-hours service is provided by Lincolnshire Community Health Services NHS Trust and is accessed by NHS111.

The practice had a website which we found had an easy layout for patients to use. It enabled them to access a range of information about the healthcare services provided by the practice

We had previously inspected this practice on two occasions, in October 2014 and August 2015. As a result of the August 2015 inspection we issued the provider with an Enforcement Notice.

Updated 6 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stuart House Surgery on 6 April 2016. Overall the practice is rated as good.

We had previously inspected this practice on 17 August 2015. On that occasion breaches of

legal requirements were found. After the inspection the practice wrote to us to say what they

would do to meet the following legal requirements set out in the Health and Social Care Act (HSCA) 2008:

• Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Safe Care and treatment

• Regulation 17 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Good governance.

• Regulation 18 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Staffing.

• Regulation 19 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Fit and proper persons employed.

We found at this inspection of 6 April that improvements had been made since the previous inspection of August 2015 when the practice had been rated as ‘Requires Improvement’.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said there was continuity of care, with urgent consultations 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.

We saw one area of outstanding practice:

• The practice had a total of 135 patients who lived in one of 12 nursing of residential homes in Boston and surrounding villages. We saw that the high incidence of requests for home visits to these patients placed a considerable strain upon the service and we looked at records that showed that ten to 15 home visits to this category of patient was a common daily occurrence. On one particular day in the previous week eight of the nine home visits had been to these patients. The practice had responded to this demand on services and resources by employing a full time community based nurse practitionerto help meet the need of this patient group and to manage patients with long term conditions in their own homes.

The areas where the provider should make improvement are:

• Ensure that there is a system in place to undertake interim audits and checks of infection prevention and control in-between annual audits.

• Ensure that all meetings with other healthcare professionals, for example Health Visitors are routinely documented.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 June 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.

• The practice was performing higher than the national average in four of the five indictors for diabetes.

• 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 6 June 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 or did not attend hospital appointments.

• Immunisation rates were relatively high for all standard childhood immunisations.

• Family planningadvice and a full contraceptive service was available including vasectomy, coil andcap fitting.

• 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 76% which was comparable to the CCG average of 75% and the national average of 74%.

• 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 6 June 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.

• The practice recognised the needs of the large numbers of patients in nursing and residential care and responded in an appropriate manner to requests for home visits for these patients.

• The practice was working to identify frail patients and working with the CCG to formulate an appropriate framework to identify and meet their needs.

Updated 6 June 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.

Updated 6 June 2016

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

• 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.

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

Updated 6 June 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.

• 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.