Archived: Dr Corina Ciobanu Also known as Haverfield Surgery

Updated 20 July 2016

Dr Corina Ciobanu (also known as Haverfield Surgery) situated in Kings Langley, Hertfordshire is a GP practice which provides primary medical care for approximately 3,300 patients living in Kings Langley and surrounding areas of Abbotts Langley, Bovingdon, Chipperfield and Hemel Hempstead.

Dr Corina Ciobanu provide primary care services to local communities under a General Medical Services (GMS) contract, which is a nationally agreed contract between general practices and NHS England for delivering primary care services. The practice population is predominantly white British along with a small ethnic population of Polish and other Eastern European origin. The practice has higher than average working age population.

The practice has one female principal GP. The practice regularly employ a male and a female locum GP. The clinical team was supported by a practice nurse and a Health Care Assistant (HCA). There is a practice manager who is supported by a team of administrative and reception staff. The local NHS trust provides health visiting and community nursing services to patients at this practice.

The practice operates from a Grade II listed building known as Haverfield dating back to 1747. The structure and layout of the building presented many challenges including space limitations and little scope for extensions or structural alterations. The practice is actively seeking to relocate to a purpose built building. Patient consultations and treatments take place on ground level. There is a free public car park near the surgery with adequate disabled parking available.

The practice is open Monday to Friday from 8am to 6.30pm except on Monday Tuesday and Thursday when the practice is open until 7pm. The practice offers a variety of access routes including telephone appointments, on the day appointments and advance pre bookable appointments.

When the practice is closed services are provided by Herts Urgent Care via the 111 service.

Updated 20 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Corina Ciobanu on 28 April 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 been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had adequate facilities and was equipped to treat patients and meet their needs. However as the practice operated from a listed building, the structure and layout of the building presented many challenges including space limitations and little scope for extensions or structural alterations.
• 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:

• Follow through the measures implemented to increase the uptake of 40–74 years NHS health checks.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 July 2016

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

• Nursing staff supported by the principal GP had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators were in the main comparable to the clinical commissioning group (CCG) and national averages. For example, the percentage of patients with diabetes, on the register, who had influenza immunisation in the preceding 12 months (01/04/2014 to 31/03/2015), was 99% where the CCG average was 94% and the national average was 94%.

• 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 more complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• The practice worked proactively to identify and care for patients with long-term conditions. For example it provided in-house ECG monitoring, anticoagulant service as well as a phlebotomy service.

Updated 20 July 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 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.

• The practice’s uptake for the cervical screening programme was 81%, which was comparable to the CCG average of 75% and the national average of 74%.

• Family planning and contraceptive advice was available.

• The practice provided a variety of health promotion information leaflets and resources for this population group. For example the discreet provision of chlamydia testing kits.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• Priority appointments were available for those children on the child protection register.

• We saw positive examples of joint working with midwives and health visitors.

Updated 20 July 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.
• All patients over 75 had a named GP.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice had identified older patients at high risk of admissions to hospital (patients with multiple complex needs, and involving multiple agencies) and worked with the Dacorum Holistic Health Care Team to coordinate their care.
• The practice provided a vaccination service for the housebound.

Updated 20 July 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 health checks to all new patients and carried out routine NHS health checks for patients aged 40-74 years.

• The practice offered evening appointments between 6.30pm and 7pm every Monday Tuesday and Thursday for working patients and others who could not attend during normal opening hours.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs of this age group.

Updated 20 July 2016

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

• The practice offered annual reviews to all patients on the mental health register which included physical checks.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The percentage of patients with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months (01/04/2014 to 31/03/2015) was 80% where the CCG average was 85% and the national average was 84%.

• The practice was proactive in supporting patients with dementia and we saw that one member of staff undertook cognitive assessments.

• Performance for mental health related indicators was comparable to local and national averages. For example, the percentage of patients with diagnosed psychoses who had a comprehensive agreed care plan was 100% where the CCG average was 92% and the national average was 88%.

• 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 A&E and emergency where they may have been experiencing poor mental health.

• The practice followed up each patient that was discharged from hospital with a diagnosis dementia.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 20 July 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.

• 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.

• The practice held regular review meetings involving district nurses, GP’s and the local palliative care nurses for people that require end of life care and those on the palliative care register.

• 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 identified patients who were also carers and signposted them to appropriate support.