Bridge Cottage Surgery

Updated 23 June 2016

Bridge Cottage Surgery provides primary medical services, including minor surgery, to approximately 16,200 patients from two premises in Hertfordshire. Bridge Cottage Surgery is the main site located in Welwyn and Kimpton Surgery is a branch surgery located approximately five miles away in the village of Kimpton, Hertfordshire. Services are provided on a General Medical Services (GMS) contract (a nationally agreed contract). Bridge Cottage Surgery shares its premises with a local pharmacy which the GP Partners set up five years ago. The pharmacy is no longer owned by the GPs and the pharmacy now operates as a separate legal entity.

The practice serves a lower than average population of those aged between 0 to 4 years and 20 to 39 years, and a higher than average population of those aged 45 years and over. The population is 95% White British (2011 Census data). The area served is less deprived compared to England as a whole.

The practice team consists of six GP Partners, three GPs are female and three are male. There are four salaried female GPs. There are two nurse practitioners, who are qualified to prescribe certain medications, one practice nurse (who also works as an assistant to the practice manager) and one Health Care Assistant. The non-clinical team consists of a practice manager, a reception manager, four members of the administration team, and seven members of the receptionist team.

The practice told us that two GP partners had retired and one GP partner had emigrated within the last 12 months. The practice was in the process of actively recruiting GPs and had recently employed two salaried GPs.

Bridge Cottage Surgery has been approved to train doctors who wish to undertake additional training (from four months up to one year depending on where they are in their educational process) to become general practitioners. The practice currently has one ST3 GP trainee (GPs in their third year of speciality training).

The main surgery is open to patients between 8am and 6pm Mondays to Fridays. Patients can telephone the practice between 8am and 6:30pm Mondays to Fridays. Appointments with a GP or nurse are available from 8am to 12pm and from 2pm to 5pm Mondays to Fridays. Emergency appointments are available daily with the duty doctor. A telephone consultation service is also available for those who need urgent advice. Kimpton surgery is open between 9am and 12pm Mondays to Fridays and appointments with a GP are available between 10am and 11:30am.

Home visits are available to those patients who are unable to attend the surgery and the out of hours service is provided by Hertfordshire Urgent Care and can be accessed via the NHS 111 service. Information about this is available in the practice, on the practice website and telephone line.

Updated 23 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bridge Cottage Surgery on 10 May 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.
• 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.
• 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.
• 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:

• Monitor and assess systems and processes to ensure regular appraisals for all staff and the monitoring and management of staff training.

• Continue to identify and support carers.

• Ensure a fire drill is completed at both premises on a regular basis.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 June 2016

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

• A nurse practitioner had a lead role in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The practice held a multidisciplinary diabetic clinic for patients two times a week, providing all aspects of diabetes management. The practice worked closely with secondary care and all diabetic patients were invited to attend an annual review with the diabetes consultant.
• Performance for diabetes related indicators was in line with the CCG and national average. The practice had achieved 92% of the total number of points available, compared to local and national average of 89%.
• 72% of patients diagnosed with asthma, on the register, had received an asthma review in the last 12 months which was comparable with the local and national average of 75%.
• Longer appointments and home visits were available when needed.
• All patients with a long-term condition 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 23 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 identified as being at possible risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were 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 practice was registered as a C-Card service provider. This is a service where people aged 13-24 can access confidential sexual health and family planning services and speak to trained professionals, obtain free condoms and advice around contraception, consent and sexually transmitted infections.
• The practice’s uptake for the cervical screening programme was 83% which was comparable with the national average of 82%.
• Appointments were available on the same day and outside of school hours. The premises were suitable for children and babies.
• We saw positive examples of joint working with midwives and health visitors.

Updated 23 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, this included enhanced services for avoiding unplanned admissions to hospital and end of life care.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments when required.

• Regular visits to local nursing homes were carried out by GPs and emergency visits were also provided when needed. We spoke with one of the nurses at one of these nursing homes who told us that the practice provided a good service.
• The practice worked closely with a rapid response service in place to support older people and others with long term or complex conditions to remain at home rather than going into hospital or residential care.
• The practice was pro-active in providing flu vaccinations for older people and at risk groups.
• The practice had completed 938 health checks for patients aged over 75 in the last 12 months, which was 60% of this population group.

Updated 23 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 provided a health check to all new patients and carried out routine NHS health checks for patients aged 40-74 years.
• Bowel and breast cancer screening rates were above and comparable with local and national averages. Data showed 74% of female patients aged 50 to 70 years had been screened for breast cancer in the last three years compared to 72% locally and 72% nationally.
• The practice was proactive in offering on line services such as appointment booking, an appointment reminder text messaging service and repeat prescriptions, as well as a full range of health promotion and screening that reflects the needs of this age group.
• The practice offered a virtual travel clinic which enabled patients to submit details of their planned travel on line. The nursing team would then provide detailed information and advice to the patient via e-mail and would arrange an appointment accordingly.
• The practice had a room available for patients to complete health questionnaires and monitor their height, weight and blood pressure independently. A computer would record details into the clinical system and patients would be alerted if they needed to make an appointment. This room was accessible to patients from 7am to 10pm Mondays to Saturdays and between 10am and 8pm each Sunday.

Updated 23 June 2016

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

• 98% of patients diagnosed with dementia had their care reviewed in a face to face meeting in 2014/2015, which was above the local average of 86% and national average of 84%.
• The practice held a register of patients experiencing poor mental health and offered regular reviews and same day contact.
• The practice had access to a NHS counsellor who held weekly appointments at the practice.
• The practice would refer patients to the Improving Access to Psychological Therapies service (IAPT) and would encourage patients to self-refer.
• Performance for mental health related indicators was in line with the CCG and national average. The practice had achieved 95% of the total number of points available (with 11% exception reporting), compared to 96% locally (12% exception reporting) and 93% nationally (11% exception reporting).
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place 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 23 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.

• It offered longer appointments and annual health checks for people with a learning disability. The practice had completed 42 health checks out of 59 patients on the learning disability register since April 2015.
• The practice provided services to four residential homes for people with a learning disability. We spoke with staff at three of these homes who told us that GPs were responsive to urgent requests and provided a good standard of care and treatment.

• The practice had a system in place to identify patients with a known disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• Vulnerable patients had been told how to access various support groups and voluntary organisations.
• The practice worked closely with a local women’s refuge centre and fast tracked new registration and urgent medication requests for these patients.
• Staff had accessed safeguarding training and knew how to recognise signs of abuse in vulnerable adults and children. Staff members 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.