Hersham Surgery

Updated 3 July 2017

Hersham Surgery is based in a purpose built property in Hersham village in Walton On Thames, Surrey. The practice has a General Medical Services (GMS) contract with NHS England. (GMS is one of the three contracting routes that have been available to enable commissioning of primary medical services). The practice is part of NHS North West Surrey Clinical Commissioning Group (CCG).

At the time of our inspection there were approximately 8,000 patients on the practice list. The practice has a higher than average number of patients aged over 65 years and a slightly higher than average number of patients from birth to nine years. The practice has a lower than average number of patients aged 10 to 34 years old. The practice has a highest number of patients aged over 65 years in the CCG. The practice provides care and treatment to the residents of a large retirement village as well as several other large residential and nursing homes. The practice also has a lower than average number of patients with long standing health conditions. Deprivation amongst children is low when compared to the population nationally. Deprivation among older people is higher than the CCG average but still low when compared to the population nationally. Overall the practice is in the second least deprived decile nationally.

There are five GP partners (three male and two female) and the practice had increased their attempts to recruit a salaried GP. They are supported by two practice nurses, a clinical pharmacist, three phlebotomists, a practice manager, a deputy practice manager, a reception manager and a team of clerical and reception staff. Hersham Surgery is a training practice, it takes supernumerary registrars who are qualified doctors completing their specialist training as GPs.

The practice is open between 8am and 6.30pm Monday to Friday and does not offer extended hours appointments. When the practice is closed patients are advised to call NHS 111 where they will be given advice or directed to the most appropriate service for their medical needs.

The service is provided from the following location:

• The Surgery, Pleasant Place, Walton On Thames, Surrey KT12 4HT.

Updated 3 July 2017

Letter from the Chief Inspector of General Practice

At our previous comprehensive inspection at Hersham Surgery in Walton On Thames, Surrey on 20 September 2016 we found a breach of regulations relating to the provision of safe services. The overall rating for the practice was good. Specifically, the practice was rated requires improvement for the provision of safe services and good for the provision of effective, caring, responsive and well-led services. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Hersham Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 19 June 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 in September 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We found the practice had made improvements since our last inspection. Using information provided by the practice we found the practice was now meeting the regulations that had previously been breached. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well-led services.

Our key findings were as follows:

• We saw the practice had reviewed existing arrangements and all clinical staff had suitable and appropriate indemnity insurance. Indemnity insurance is used for professional negligence claims, or allegations of malpractice, received against a member of staff in the course of their professional duties.

• Revised recruitment policies and processes had been adopted which reflected national guidance. For example, supporting recruitment documentation that was missing during the September 2016 inspection was now all recorded and documented correctly including registration with the appropriate professional body.

• The practice had reviewed and updated the practice governance framework. This included a review of policies and procedures. Furthermore, as part of the governance review, updated guidance had been sent to all staff to increase awareness of where policies were stored.

• Further steps had been taken steps to increase privacy and confidentiality in an upstairs area of the practice. Awareness of the importance of confidentiality has been discussed with all practice staff and continued to be regularly reviewed including in-house observations.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 1 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.
• 88% of patients with diabetes, on the register, in whom the last was 64 mmol/mol or less in the preceding 12 months was higher than the Clinical Commissioning Group (CCG) average of 80% and the England average of 78%.
• 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 GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice have recently employed a clinical pharmacist whose role would involve managing the medicines of patients with long term or complex conditions.

Updated 1 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 were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively 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.
• 81% of eligible female patient’s notes recorded that a cervical screening test had been performed in the preceding five years which is comparable with the CCG average of 80% and the England average of 81%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives and health visitors.

Updated 1 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 with GPs and nurses and urgent appointments for those with enhanced needs.
• The practice provided weekly surgeries at the retirement village.

Updated 1 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 was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• The practice offered electronic prescribing which allowed the patient to choose a pharmacy for their prescription to be sent to which could be close to their place of work.

Updated 1 March 2017

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

• The practice provided weekly surgeries at a dementia unit.
• 95% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the CCG average of 85% and the England average of 84%.
• 100% of patients with severe and enduring mental health problems had a comprehensive care plan documented in their records within the last 12 months which is comparable to the CCG average of 92% and the national average of 89%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients 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.
• The practice had a system in place to follow up patients who had attended accident and emergency 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.
• The practice hosted a psychology counselling service. This ensured patients could access this service in a community setting.

Updated 1 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 homeless people, travellers and those with a learning disability.
• 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.
• The practice provided a separate waiting area for patient who wish to maintain their privacy.