Archived: Layer Road Surgery

Updated 1 June 2016

Layer Road Surgery provides primary care services via a General Medical Services (GMS) contract to approximately 6200 patients from premises with patient parking to the front of the building.

The practice provides its services to patients from South West Colchester encompassing the military accommodation area of the Town. Its patient population mainly comprises of military families with young children, however recently their patient numbers have increased and become more diverse amongst other patient population groups. The area has low numbers of ethnic minority groups in comparison with the national average however there is a significant population of people with Nepalese origin within the military living locally.

There are two GP partners; female, three salaried GPs one male two female, two practice nurses and two healthcare assistants in the clinical team. In the non-clinical team there is; a practice manager, a finance manager, and seven members of reception and administrative staff.

The practice opening hours and clinical sessions are; Monday to Friday 8am to 6.30pm, consultation sessions run throughout the day including lunch time sessions to give patients additional access.

The practice has opted out of providing GP out of hour’s services. Patients requiring a GP outside of normal practice working hours were advised to contact the 111 non-emergency services. Patients requiring emergency treatment are able to contact the out of hour’s service which is provided by Care UK.

Updated 1 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Layer Road Surgery on 15 March 2016. Overall the practice is rated as good.

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

• Staff knew how to raise concerns, and report safety incidents. Safety information was recorded, monitored, and reviewed to identify trends or recurrent themes. When safety events occurred they were investigated comprehensively. Any issues identified were shared internally with staff members and externally in an honest manner.

• Risks to patients were well managed in an open systematic way. The system for assessing risks included those associated with; premises, equipment, medicines, and infection control.

• Patient care was planned and provided to reflect best practice using recommended current clinical guidance.

• Staff received appropriate on-going training for their roles and further training was encouraged, recognised and planned through leaning events.

• Comprehensive information regarding how to complain was available at the practice and on the practice website.

• The practice staff members had received training regarding the safeguarding of children and vulnerable adults, and knew who to contact with any concerns.

• The practice was suitably equipped to treat patients and meet their primary care needs. The equipment was checked and maintained to make sure it was safe to use.

• Patient comments were extremely positive when we spoke with them during the inspection. Members of the practice patient participation group were proactive and involved with practice development.

• The leadership structure at the practice was well-established and all the staff members we spoke with said they were supported in their working roles by both the practice management and the GPs.

The area where the provider should make improvement is:

Continue to improve systems to identify the number of carers at the practice as the current number identified is lower than the national average.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 June 2016

The practice is rated as good for the care of people with long-term conditions. Performance for the management of long term conditions was higher than other GP practices nationally. GPs and nursing staff had lead roles in chronic disease management and provided a range of clinics including asthma, diabetes and chronic obstructive pulmonary disease (COPD).

The practice responded to the needs of people with long-term conditions providing:

• Set chronic disease clinics were less popular to patients; consequently appointments were booked into normal surgery sessions with flexible longer appointment times.

• Home management and more urgent visits were available when needed.

• The “year of care” model for diabetes as part of the enhanced service provision was adopted by the practice with the aim of increasing patient to take ownership of their condition which has been shown to improve care.

• Patients had a named GP and a structured annual review to check that their health and medicine needs were being met.

• The long term condition patients named GP worked with relevant health and care professionals in the practice and the local community to deliver a multidisciplinary package of care.

• Shared care with Colchester General Hospital was delivered for the monitoring of various disease-modifying medicines where the practice arranged and reviewed blood results.

• Patients with diabetes, asthma, and COPD were recalled for review by a GP or nurse with specialist training to ensure consistent care. Patients were seen and monitored according to their clinical need and sent a reminder when their review was due.

Updated 1 June 2016

The practice is rated as good for the care of families, children and young people. The practice responded to the needs of families, children and young people by providing:

• The practice had a large proportion of young military families registered; this meant a high demand for acute illnesses especially in children.

• They found that their military families relocated frequently, and this reflected in their high patient turnover. Social isolation was found to be an issue for this group of patients, and contributed to high consultation rates.

• An effective working relationship with health visitors and school nurses had been established, with multi-disciplinary safeguarding meetings being undertaken bi-monthly.

• Children living in disadvantaged circumstances and those who were at risk, for example, children and young people with a high number of A&E attendances were monitored closely by the practice.

• Consistently higher Immunisation rates were achieved for all standard childhood immunisations in comparison to national averages.

• Cervical screening data showed the practice had 84% of women aged 25-64 held a record in their notes that a cervical screening test has been performed in the preceding 5 years. This was higher than the national reported average of 81%. The practice explained this had been the result of a considerable amount of work due to the cultural wishes of many of the military patients and their families registered at the practice to achieve. 

• Appointments were available outside of core school hours, the premises had been adapted for children and baby changing facilities were available.

• GPs attended child protection conferences when appropriate.

• Safeguarding information was coded onto patients’ computer medical records.

• The staff used ‘Gillick’ competency testing for children under 16 years of age.

• Staff members were familiar with and had access to local advice/safeguarding/support services for families and health promotion services to young people and families (e.g. weight management).

• Family planning services were available as were appointments to monitor the development of babies and the health of new mothers.

• Family planning clinics including the fitting of contraceptive devices were offered. Patient’s high satisfaction rates in the survey carried out by the practice.

Updated 1 June 2016

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

• Although the practice had a low number of people registered in this population group they offered proactive, personalised care to meet the needs of older people.

• All patients over 75 years were informed by letter of their named GP and could change this GP if they wished.

• Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice was responsive to the needs of older people including:

  • The provision of home visits with both GPs and nurses.

  • Hospital admissions avoidance was discussed at monthly multidisciplinary team meetings to reduce unplanned hospital admissions for their frail elderly, and patients who were in receipt of palliative care. There were personalised care plans for patients at high risk of hospital admission to support the reduction of emergency referrals.

  • Each emergency admission was reviewed on discharge to ensure patients and their carers had the clinical input and medicine they needed. Following admissions for a fall patients were referred to specialists who were experienced in falls prevention.

  • Senior health checks and unplanned admission avoidance care plans were provided to patients from this population group. This also included high rates of seasonal flu/pneumonia/shingles vaccinations.

  • Dementia screening was provided opportunistically and also on request. The practice focused on primary prevention wherever possible.

• • A carer’s policy and recently produced Carer’s guide provided details of local and voluntary agencies to provide support. Patients were coded as carer’s on the practice computer records system to ensure staff members could support them.

Updated 1 June 2016

The practice is rated as good for the care of working-age people (including those recently retired and students). The needs of working age people, those recently retired and students had been recognised and the practice had modified services to ensure they were accessible, adaptable, and could offer continuity of care. For example:

• Offering online services to book appointments, and order repeat prescriptions.

• Telephone consultations were available on a daily basis with both doctors and nurses.

• A full range of health promotional services such as smoking cessation, weight management, health checks, and flu vaccination clinics on occasional Saturdays.

• The practice tried to be as flexible and accommodating with regards to appointments for this population group where possible.

Updated 1 June 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice had adapted their services to meet the needs of people within this population group for example:

• Annual reviews took place for patients experiencing poor mental health, including a mental health plan review. These annual reviews were used as an opportunity for the screening of other underlying health conditions.

• Regular telephone and face to face reviews to monitor people during periods of poor mental health were available.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice had provided people experiencing poor mental health information about how to access support groups and voluntary organisations.

• The practice followed up patients who had attended accident and emergency from this population group.

• For those patients prescribed with potentially addictive medicines the practice issued limited supplies and kept them under close supervision.

• Patients within this population group were referred for specialist mental health input when required.

• In view of the population demographics they had a small number (16) patients living with dementia. They were provided an annual review to monitor their general health and placed on a priority care register to allow them easier access to their GP on the same day if this was required.

Updated 1 June 2016

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

The practice had tailored services to meet the needs of people within this population group for example:

• The practice had a register of 30 patients living with a learning disability. They also recognised other people living in vulnerable circumstances for example homeless people and held a ‘priority list’ of patients that was accessible to all receptionists making appointments to ensure they were able to offer the most suitable appointments.

• Homeless people were allowed to use the practice address to enable them to access health services.

• Longer appointments for patients with a learning disability were available. Annual learning disability checks were provided. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• Vulnerable patients were shown how to access various support groups and voluntary organisations.

• Staff knew how to recognise the signs of abuse in vulnerable adults and children, they were also aware of their responsibilities. This included information sharing, documentation of safeguarding concerns and who to contact. Practice staff knew they could ask the safeguarding lead at the practice for advice should there be any concerns.

• Home visits were offered to those patients unable to attend for routine or emergency care, including vaccination.

• The practice had flexibility regarding missed appointments and made their services as easy to access as possible for this population group.