Archived: Boxwell Road Surgery

Updated 17 March 2017

Boxwell Road Surgery provides a range of primary medical services from its premises at 1 Boxwell Road, Berkhamsted, Hertfordshire, HP4 3EU.

The practice serves a population of approximately 5,561. The area served is less deprived compared to England as a whole. The practice population is mostly white British. The practice serves an above average population of those aged from 5 to 9 years, 40 to 69 years and 75 years and over. There is a considerably lower than average population of those aged from 20 to 34 years.

The clinical team includes one male and two female GP partners, one female salaried GP, one nurse practitioner, one practice nurse and two healthcare assistants. The team is supported by a practice manager and 10 secretarial, administration and reception staff. The practice provides services under a General Medical Services (GMS) contract (a nationally agreed contract with NHS England).

The practice is fully open (phones and doors) from 8am to 6.30pm Monday to Friday. There is no lunchtime closure at the practice. There is extended opening one Saturday each month from 8.30am to 12.30pm for GP, nurse and healthcare assistant pre-bookable appointments. Appointments are available from 8.30am to midday and 2pm to 5.30pm daily, with slight variations depending on the doctor and the nature of the appointment.

An out of hours service for when the practice is closed is provided by Herts Urgent Care.

Updated 17 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Boxwell Road Surgery on 9 November 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 managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• The patients we spoke with or who left comments for us were very positive about the standard of care they received and about staff behaviours. They said staff were friendly, respectful, kind and understanding. They told us that their privacy and dignity was respected and they were involved in their care and decisions about their treatment.
• Information about services was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Most patients were positive about access to the practice and appointments. Some patients said getting an appointment in advance could be difficult and there could be a considerable wait to see a GP when making a pre-bookable appointment. However, those patients said access to urgent and same day appointments was good.
• 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 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 improvements are:

• Ensure that systems in relation to patients prescribed higher risk medicines are strengthened to ensure all patients are monitored and reviewed at the required intervals.
• Ensure plans of action to control and resolve risks identified by the health and safety and fire risk assessments are completed.
• Take steps to ensure that hot water temperatures at the practice are kept within the required levels.
• Ensure there is a formal and coordinated practice wide process in place for how staff access guidelines from NICE and use this information to deliver care and treatment.
• Ensure that all staff employed are supported by a formal induction process and by receiving appropriate supervision and appraisal.
• Ensure that a documented policy on patient consent is in place.
• Continue to support carers in its patient population and patients with a learning disability by providing annual health reviews.
• Ensure that, where practicable and appropriate, all reasonable adjustments are made for patients with a disability in line with the Equality Act (2010).
• Ensure the full written complaints procedure is accessible to patients.
• Ensure that where systems and processes have been recently introduced or re-introduced after considerable gaps, that they are fully embedded and consistently adhered to.
• Take steps to ensure that cross-team communication is comprehensive and maximises opportunities for information sharing and learning in the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 March 2017

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.
• 81% of patients on the asthma register had their care reviewed in the last 12 months. This was similar to the CCG average of 75% and the national average of 76%.
• Performance for diabetes related indicators was above the CCG and national average. The practice achieved 100% of the points available compared to the CCG and national average of 90%.
• All newly diagnosed patients with diabetes were managed in line with an agreed pathway.
• 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 GPs worked with relevant health and care professionals to deliver a multi-disciplinary package of care.

Updated 17 March 2017

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 may be at risk, for example, children and young people who had a high number of A&E attendances.
• Immunisation rates were comparable to other practices in the local area 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 practice’s uptake for the cervical screening programme was 86% which was similar to the CCG and national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• There were six week post-natal checks for mothers and their children.
• A range of contraceptive and family planning services were available.

Updated 17 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.
• Older people had access to targeted immunisations such as the flu vaccination. The practice had 1,008 patients aged over 65 years. Of those 858 (85%) had received the flu vaccination at the practice in the 2015/2016 year.
• There were four care homes in the practice’s local area. For all of these, the GPs visited as and when required to ensure continuity of care for those patients.

Updated 17 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 offered online services such as appointment booking and repeat prescriptions as well as a full range of health promotion and screening that reflects the needs for this age group.
• There was additional out of working hours access to appointments to meet the needs of working age patients. There was extended opening one Saturday each month from 8.30am to 12.30pm for GP, nurse and healthcare assistant pre-bookable appointments. There was also no lunchtime closure at the practice every day from Monday to Friday.

Updated 17 March 2017

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

• 79% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was similar to the CCG average of 85% and national average of 84%.
• Performance for mental health related indicators was above the CCG and national averages. The practice achieved 100% of the points available compared to the CCG average of 95% and the national average of 93%.
• 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 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.
• Mental health trust well-being workers were based at the practice once a week every Tuesday. Patients could self-refer to these. NHS counsellors were available every day at the practice. Patients could access this service to obtain psychological and emotional counselling and advice through referral from the GPs.
• There was a GP lead for mental health and dementia.

Updated 17 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 15 patients on the practice’s learning disability register at the time of our inspection. Of those, two (13%) had accepted and received a health review in the past 12 months. The practice had only recently started participating in this enhanced level service, hence the low uptake of health reviews at the time of our inspection.
• The practice offered longer appointments for patients with a learning disability and there was a GP lead for these patients.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• 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.
• Additional information was available for patients who were identified as carers and there was a nominated staff lead for these patients.
• The practice had identified 126 patients on the practice list as carers. This was approximately 2.3% of the practice’s patient list. Of those, 24 (19%) had accepted and received a health review in the past 12 months. Senior staff at the practice were aware of the low number of carers receiving a health review and could demonstrate they were responding to it.