The Elms Medical Practice

Updated 10 May 2016

The Elms Medical Practice provides primary medical services, including minor surgery, to approximately 14,700 patients from premises at 5 Stewart Road, Harpenden, Hertfordshire. The practice premises are modern and purpose built and services are provided on a General Medical Services (GMS) contract.

The practice serves a lower than average population of those aged between 20 to 34 years, and higher than average population of those aged between 40 to 54 years. The population is 94% White British (2011 Census data). The area served is less deprived compared to England as a whole.

The practice team consists of eight GP partners and two regular locum GPs. Seven GPs are female and three GPs are male. There are four practice nurses, one minor illness nurse, a physician associate, one health care assistant, a team of secretaries, a practice manager, 11 receptionists and a team of administration staff.

The practice is open to patients between 8am and 6.30pm Monday to Friday. Appointments with a GP are available from 8.30am to 12pm and from 3.30pm to 6.30pm. The practice offers extended opening hours between 7am and 8am every Friday, between 6.30pm and 8pm every Monday and from 8.30am to 11.30am on the third Saturday of each month.

Emergency appointments are available daily with the duty doctor. A telephone consultation service is also available for those who need urgent advice. Daily minor illness clinics are provided by the nurses. Home visits are available to those patients who are unable to attend the surgery. 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 on the practice website and telephone line.

Updated 10 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Elms Medical Practice on 3 March 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.
• Patients said they found it easy to make an appointment with urgent appointments available the same day.
• 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 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 May 2016

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 practice held regular cardiovascular and respiratory clinics.
• The practice was proactive in providing a comprehensive annual review for patients with diabetes. Performance for diabetes related indicators was above the local Clinical Commissioning Group (CCG) and national averages.
• The practice nurses were trained in minor illness and the management of long term conditions and held minor illness clinics on a daily basis.
• 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 10 May 2016

The practice is rated as good for the care of families, children and young people.

• The practice’s uptake for the cervical screening programme was 94% which was above the national average of 82%.
• Ultrasound scans were performed at the practice by local consultant radiologists. Regular clinics were held on the premises for patients from the local area.
• The practice had dedicated pages on their website for children and young people. It offered free condoms at reception for all teenagers, irrespective of where they were registered, and had chlamydia self-test kits available in the patient toilets.
• 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.
• 77% of patients diagnosed with asthma, on the register, had received an asthma review in the last 12 months which was comparable with the national average of 75%.
• 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.
• 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, health visitors, a local nursery and a children’s centre.

Updated 10 May 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 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 five local care homes were carried out by named GPs for continuity of care and emergency visits were also provided when needed.
• The practice completed annual reviews for patients aged over 75 and started offering over 75 health checks in January 2016.
• 77% of patients aged 65 and over had received a flu vaccination in 2014/2015.
• 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.

Updated 10 May 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.
• It carried out routine NHS health checks for patients aged 40-74 years.
• The practice was proactive in offering online services such as appointment booking and repeat prescriptions services, as well as a full range of health promotion and screening that reflects the needs for this age group.
• The practice provided an electronic prescribing service (EPS) which enables GPs to send prescriptions electronically to a pharmacy of the patient’s choice.
• Patients could contact the surgery using an email address advertised in the practice and on the practice website.
• It offered an appointment reminder text messaging service and appointment times were extended one morning and one evening each week and from 8.30am to 11.30am on the third Saturday of each month.

Updated 10 May 2016

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

• 86% of patients diagnosed with dementia had their care reviewed in a face to face meeting in 2014/2015, which was comparable with the national average.
• The practice worked closely with a local mental health service which offered appointments to patients at the practice between Monday and Friday.
• Regular visits to five local care homes were carried out by named GPs for continuity of care and emergency visits were also provided when needed.
• It held a register of patients experiencing poor mental health and offered regular reviews and same day contact.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• There was close working with the local community mental health team and patients were referred to a counselling service which was provided at the practice twice weekly.
• 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.
• Performance for mental health related indicators was above the local Clinical Commissioning Group (CCG) and national averages.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 10 May 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.
• A named GP worked with a local substance misuse keyworker and provided monthly clinics for patients.
• It offered annual health checks for people with a learning disability.
• The practice held a register of carers. There was a nominated carers’ champion who promoted a carers pack which included information and advice about local support groups and services available.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• It had told 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.