The Writtle Surgery

Updated 2 May 2017

The Writtle Surgery is a dispensing practice and is situated on the outskirts of Chelmsford in the village of Writtle. The practice covers the village of Writtle and the surrounding villages of Roxwell and Good Easter, hamlets of Highwood, Cookmill Green, Chignal St. James and part of Willingale. The practice has limited parking available in their car park but patients may park on the road immediately outside.

The practice has approximately 8041 patients. The practice serves a diverse demographic. They provide services to patients with disabilities, patients in sheltered housing accommodation, students attending Writtle College (Essex University), Showman communities and those from travelling communities. Their patients have a higher life expectancy for both males and females than the local and national averages

The practice team consists of five GP partners (female and male), a salaried GP (female) and an extensive nursing team of three practice nurses and two healthcare assistants. The clinical team is supported by reception staff, secretaries, administrators and a team of four dispensers, all overseen by the practice manager. The practice also benefits from the support of a pharmacist two days a week to assist with patient medicine reviews.

The practice is open from 8am to 6.30pm Monday to Friday and occasional Saturday mornings for seasonal vaccination clinics. The practice dispenses to 20% of their patient population.

Out of hours provision is commissioned by the local CCG from and patients may attend local emergency medical services at Broomfield Hospital, Chelmsford or Princess Alexandra Hospital, Harlow.

The practice has a comprehensive website provide information on opening times, services, staff and patient group including their newsletter.

Updated 2 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Writtle Surgery on 18 January 2017. The overall rating for the practice was good. The full comprehensive report on the January 2017 inspection can be found by selecting the ‘all reports’ link for The Writtle Surgery on our website at www.cqc.org.uk.

However, we rated the practice as requires improvement for providing safe services as we found medicines had not been stored in accordance with guidance. The fridge temperature had exceeded the recommended levels six times within three months. The dispensary staff had not recognised the significance of this and failed to follow cold chain procedure to ensure the medicines integrity.

This inspection was an announced focused inspection carried out on 24 March 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection 18 January 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings for the March inspection were as follows:

• We found the practice was storing medicines in accordance with guidance and cold chain procedures are followed.
• The practice had evidenced within their clinical meeting minutes their discussions of significant incidents and had scheduled the review of them to ensure learning had been embedded into practice.
• The practice medicine management lead was responsible for ensure the timely auctioning and consistent response to safety alerts.
• The practice was working with their patient participation group to educate patients on alternative methods of booking an appointment to reduce demand on the phone system and improve patient experience of the service.
• The nursing team lead on the inspection of emergency equipment and maintained records of checks conducted. These were overseen by the medicine management lead GP and the practice manager.

• The practice had reviewed their medicine management procedures to ensure they were reflective of practice.
• The dispensary staff conducted and maintained records of checks conducted for all their controlled drugs stock against their register, including the timely and safe destruction of controlled drugs.
• The practice was actively identifying and supporting patients with caring responsibilities. They had increased their number of carers by 34 patients to 88 patients, 1% of their patient list.

At this inspection we found that the medicines were being appropriately stored and monitored. Consequently, the practice is now rated as good for providing safe services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 February 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.
• The pharmacist held weekly clinics of 20-40 minute appointments, conducting medicine reviews with patients with long term conditions. They also conducted home visits for polypharmacy patients.
• Performance for diabetes related indicators were above the national average. For example, 79% of the practices patients with diabetes, on the register in whom the last IFCC-HbA1C is 64mmol/mol or less in the preceding 12 months.
• The practice offered their patients access to blood pressure monitoring devices for home use.
• All patients had a named GP and a structured annual review to check their health and medicines needs were being met. For patients with complex need they had a named GP who worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 23 February 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 were at risk, for example, children and young people who had failed to attend appointments or had attended A&E.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Immunisation rates were high for all standard childhood immunisations.
• The midwife attended the practice weekly and offered bookable appointments.
• The practice offered monthly family planning clinics (including long acting reversible contraception) on a Tuesday or Wednesday morning for registered patients and patients with an Essex postcode.

Updated 23 February 2017

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 dispensing services.
• They provided vaccination and blood pressure checks at community facilities for the convenience of their patients.
• Leg ulcer treatments and wound dressings were conducted by their trained tissue viability nurse at the practice.
• The practice worked in partnership with the care coordinator to ensure patients are contacted regularly and upon discharge from hospital.
• The practice ensured patients had appropriate care packages included helping patients to arrange home help and meals to be delivered.

Updated 23 February 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practiced held telephone consultations daily for the convenience of patients unable to attend the practice and conducted seasonal vaccination clinics on a Saturday morning.
• The practice offered online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• The patient participation group operated a virtual patient group to engage with those unable to commit to attend meetings.
• Patients were able to receive travel vaccinations available on the NHS and private vaccinations including yellow fever.
• Cryotherapy was provided at the practice but it was not a funded service.

Updated 23 February 2017

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

• The practice achieved above the national average for their management of patients with poor mental health. For example, 97% of their patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in their records within the last 12 months.
• The practice achieved above the national average for the percentages of their patients diagnosed with dementia receiving a face to face review within the preceding 12 months. They achieved 94% in comparison with the CCG average 86% and the national average of 84%.

• The practice performed dementia screening and conducted advance care planning for patients with dementia.
• The practice used depression screening tools and 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 accident and emergency services.
• The practice actively engaged with their patients and families living with dementia. They supported their patient participation group (PPG) to hold monthly dementia parties at the local hall, a practice nurse attended and answered questions from patients and carers. The PPG invited specialist speakers for example from respite holiday groups.
• The practice staff had been trained as dementia friends to assist in identifying and supporting their patients better. They had redecorated their waiting area to be dementia friendly. They had enhanced the lighting of the waiting area and purchased lighter chairs to assist patients in differentiating between items and it is intended to put them at ease. They displayed pictures and clearer signage for patients.
• Patients and their family members were offered longer appointments to discuss concerns. Carers were coded on their patient record systems and offered appropriate vaccinations and health checks. The practice held monthly dementia clinics facilitated by the Alzheimer’s and dementia support worker where 40 minute appointments were available. All patients with dementia had been written to and informed of the range of services provided at the practice. The practice also provided home visits for those unable to attend but who had expressed an interest.

Updated 23 February 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. The nursing team attended community facilities and traveller sites to support patient vaccinations, blood test and health screening.
• The practice offered longer appointments for patients 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.