Archived: Dr J Somers Heslam & Dr C J Griffiths Also known as The Old Exchange

Updated 29 July 2016

Dr J Somers Heslam & Dr C J Griffiths provide general medical services to approximately 3,020 patients in St Ives, Cambridgeshire and the surrounding area. The building provides good access with accessible toilets and two car parking facilities for people with a disability. A local council pay and display car park is situated nearby. The practice provides treatment and consultation rooms on the ground floor with ramp access. The practice is an accredited eastern region clinical research network practice and an accredited training practice. The practice provides services to a diverse population age group, is in a semi-rural location and is a dispensing practice, dispensing to approximately 800 patients. A dispensing practice is where GPs dispense the medicines they prescribe for patients who live remotely from a community pharmacy.

There is one GP partner who holds sole managerial and financial responsibility for the practice. In addition to this, there is one GP registrar who was currently on maternity leave. There is a team of two practice nurses and a health care assistant who run a variety of appointments for long term conditions, minor illness and family health.

There is a practice manager who is supported by an assistant. In addition there is one dispenser and a team of three 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 6pm Monday to Friday. Appointments with the GP are from 8.20am to 12.20pm every morning and 3.20pm to 5.10pm daily. Nurse appointments are generally from 8.30am to 12.30pm and 2pm to 5.15pm daily. Extended hours appointments are offered with the GP, nurse telephone consultations and health care assistant appointments from 6.45am to 8am Monday mornings. In addition to pre-bookable appointments that could be booked up to two weeks in advance, urgent appointments are also available for people that needed them.

The practice does not provide GP services to patients outside of normal working hours such as nights and weekends. During these times GP services are provided by Urgent Care Cambridge via the NHS 111 service. 

Updated 29 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr J Somers Heslam & Dr C J Griffiths on 7 June 2016. Overall the practice is rated as good.

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.
• 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 GP and there was continuity of care, with urgent appointments available the same day.
• The appointment system was flexible and ensured that patients who requested to be seen on the same day were.
• Patients’ needs were assessed and care was planned and delivered following best practice 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.
• The practice proactively managed care plans for vulnerable patients and had effective management strategies for patients at the end of their life.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure, staff felt supported by the management team and were an integral part of the running of the practice.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• The practice should ensure that there is an effective system in place to review patient safety updates from the Medicines Health and Regulatory Authority (MHRA).
• Put systems in place to ensure safety alerts are received by the practice and evidence of actions taken are recorded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 July 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 used the information collected for the Quality and Outcomes Framework (QOF) to monitor outcomes for patients (QOF is a system intended to improve the quality of general practice and reward good practice). Data from 2014/2015 showed that performance for diabetes related indicators was 94%, which was above the CCG and the national averages by 4%.
• 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 GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 29 July 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. Immunisation rates were relatively high for all standard childhood immunisations.
• Immunisation rates were high for all standard childhood immunisations. For example, vaccination rates for children ranged from 94% to 100%, compared against a CCG average ranging from 52% to 96%. Vaccination rates for children aged two to five years old ranged from 92% to 100 with the practice achieving 100% vaccination rates in eight of the 15 immunisation categories for two and five year olds. The practice achieved 100% vaccination rates in eight of the 15 immunisation categories for two and five year olds.
• 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.
• 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.

Updated 29 July 2016

The practice is rated as good for the care of older people.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure were above local and national averages.
• The practice ensured it prioritised care for their older patients and offered proactive, personalised care to meet the needs of older people. Care plans were in place for older patients with complex needs. All patients had a named GP.
• Flu vaccination rates for the over 65s were 88% which was higher than the national figure of 73%.

Updated 29 July 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 uptake for patients aged 60-69 who were screened for bowel cancer in the last 30 months was 68%; this was above the CCG average of 59% and the national average of 58%. The practice uptake for female patients screened for breast cancer in the last 36 months at 84% was also above the CCG and national averages of 72%.

Updated 29 July 2016

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

• 97% of patients diagnosed with dementia had received a face to face review of their care in the last 12 months, which is above the national average of 83%.
• The practice achieved 99% for mental health related indicators in QOF, which was 7% above both the CCG and national averages. The rate of exception reporting was also consistently lower than both the CCG and national averages.
• 88% of patients with ongoing serious active mental health problems had received an annual health check during the past twelve months.
• 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. Leaflets were available in the waiting area on a range of services available for patients and carers.
• 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 all undergone mental capacity act training and had a very good understanding of how to support patients with additional mental health needs and dementia.

Updated 29 July 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.
• The practice had carried out annual health checks for people with a learning disability, 75% had attended for an annual review during 2014-15. All these patients had supporting care plans. The practice offered longer appointments for people 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.