Archived: Sarum House Surgery

Updated 1 December 2014

Sarum House is in Hereford City Centre and has 11,000 patients.  The practice is located in an older building in an historical area of the city.  The building has been modernised and extended over the years but due to its location has no further space for development.  Hereford serves a mainly white British population with strong agricultural roots with some light industry.  There is a substantial eastern European population which dates back to the 1940s and has grown in recent years.  The practice has a higher proportion of people over 45 than the England average and in particular, a higher proportion of people over retirement age.

The practice has five partners, three salaried GPs and is a training practice with one GP registrar in post at the time of the inspection.  A GP Registrar or GP trainee is a qualified doctor who is training to become a GP through a period of working and training in a practice. 

Five of the GPs are female and four are male.  The practice has six nurses and one health care assistant. The clinical team are supported by a practice manager, deputy practice manager and a team of reception staff and medical secretaries.  Some of the practice team are part time.  This provides some inbuilt flexibility for covering annual leave and sickness.

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

This was the first time CQC had inspected the practice.  Based on information we gathered as part of our intelligent monitoring systems we had no concerns about the practice.  Data we had access to showed that the practice was achieving results that were in line with the England or Clinical Commissioning Group average in most areas.

The practice does not provide out-of-hours services to their own patients.  Patients are provided with information about the local out-of-hours services based in Hereford city which they can access by using the NHS 111 phone number.

Updated 1 December 2014

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Sarum House on 1 October 2014.  The inspection team was led by a CQC inspector and included a GP specialist advisor, a practice manage and an Expert by Experience.  We found that Sarum House provided a good service to patients in all of the five key areas we looked at.  This applied to patients across all age ranges and to patients with varied needs due to their health or social circumstances.

Our key findings were as follows:

• The practice had comprehensive systems for monitoring and maintaining the safety of the practice and the care and treatment they provided to their patients.
• The practice was proactive in helping people with long term conditions to manage their health and had arrangements in place to make sure their health was monitored regularly.
• The practice was clean and hygienic and had robust arrangements for reducing the risks from healthcare associated infections.
• Patients felt that they were treated with dignity and respect.  They felt that their GP listened to them and treated them as individuals.
• The practice had a well-established and well trained team with expertise and experience in a wide range of health conditions.

There were areas where the practice needs to make improvements. 

The practice should:

• Ensure that all clinicians have an up to date awareness of the Mental Capacity Act 2005 and Gillick competence. 
• Introduce a more robust stock control and rotation record for vaccines.
• Consider providing an alarm call in the disabled toilet.
• Carry out Disclosure and Barring Service checks for any non-clinical staff who undertake chaperone duties.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 December 2014

This practice is rated as good for the care of people with long term conditions.  The practice had effective arrangements for making sure that people with long term conditions were invited to the practice for annual and half yearly reviews of their health.  Members of the nursing team at the practice ran these clinics and each had an area of specialism such as diabetes or rheumatology.

People whose health prevented them from being able to attend the surgery received the same service from one of the practice nurses who arranged visits to them at home (including patients in the three care homes the practice supports). Patients told us they were seen regularly to help them manage their health.

The practice held clinics together with the local specialist diabetes service and hosted a physiotherapist for three days a week to provide ease of access to physiotherapy treatment.

Updated 1 December 2014

This practice is rated as good for the care of families, children and young people.  The practice held weekly childhood vaccination clinics for babies and children.  Child ‘flu vaccinations were also provided.  A ground floor surgery was used to make access easier for families.  A midwife came to the practice twice a week to see expectant mothers.  Staff told us that ante natal and post natal appointments for mothers were usually done by the female GPs.  The practice provided a family planning service.

Updated 1 December 2014

This practice is rated as good for the care of older people.  Patients over the age of 75 had a named GP and were included on the practice’s ‘avoiding unplanned admissions’ list to alert the team to people who may be more vulnerable.  The GPs carried out visits to people’s homes if they were unable to travel to the practice for appointments.  The practice was in the process of delivering its ‘flu vaccination programme.  The practice nurse was arranging to do these at people’s homes if their health prevented them from attending the clinics at the surgery.  The practice worked with three local care homes to provide a responsive service to the people who lived there.

Updated 1 December 2014

This practice is rated as good for the care of working age people, recently retired people and students.  The practice provided extended opening hours until 6pm for people unable to visit the practice during the day and also had arrangements for people to have telephone consultations with a GP.  They were also able to book evening and weekend appointments for patients with a local GP extended hours ‘hub’. The practice was in the process of inviting patients between the ages of 40 and 74 for NHS Health checks.  Students were being offered Meningitis C vaccinations before they started at college or university.

Updated 1 December 2014

This practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice had a register of people at the practice with mental health support and care needs and invited them for half yearly and annual health checks.  Staff described close working relationships with the local mental health team which worked with the practice to identify patients’ needs and to provide patients with counselling, support and information.

The practice was alert to the complex needs of people who were living with dementia.  They worked with a designated dementia nurse from the local NHS Mental Health Trust with whom they liaised about the care and treatment patients needed. 

Updated 1 December 2014

This practice is rated as good for the care of people living in vulnerable circumstances.  One of the practice nurses was the lead for learning disability care at the practice and the practice had a learning disability (LD) register.   All patients with learning disabilities were invited to attend for an annual health check.  Staff told us that the practice did not have any travelling individuals or families currently registered at the practice.  We learned that when homeless people came to the practice the team provided appropriate care and treatment and supported them with establishing a correspondence address if possible.