Knebworth and Marymead Medical Practice

Updated 25 September 2017

Knebworth and Marymead Practice provides a range of primary medical services to the residents of Knebworth and the surrounding area. The practice has a main location at Knebworth Surgery, Station Road, Knebworth, Hertfordshire, SG3 6AP and a branch practice at Marymead Medical Practice, 18 Spring Drive, Marymead, Hertfordshire, SG2 8AZ. Both sites were visited as part of the inspection. The practice has a registered manager in place. (A registered manager is an individual registered with CQC to manage the regulated activities provided).

The practice population is ethnically diverse and covers an average age range. National data indicates the area is one of low deprivation; however, the practice informed us there were some areas of deprivation within the practice boundary. The practice has approximately 12,000 patients who can see GPs at both sites. Services are provided under a General Medical Services contract (GMS), this is a nationally agreed contract with NHS England.

The practice is led by four GP partners, three male and one female with the support of a practice manager. The nursing team consists of a nurse practitioner, a nurse prescriber, two practice nurses and a health care assistant. There is a practice manager, a deputy practice manager and a team of reception and administrative staff.

The practice is an accredited training practice. The practice is open between 8am and 6.30pm Monday to Friday. Extended opening hours appointments with GPs and nurses are offered from 7am to 8am and 6.30pm to 8.30pm on Tuesdays and Thursdays.

When the practice is closed out-of-hours services are provided by Herts Urgent Care and can be accessed via the NHS 111 service.

Updated 25 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced focused inspection at Knebworth and Marymead Medical Practice on 23 August 2017. This was to check that improvements had been made following the breach of legal requirement we identified from our comprehensive inspection carried out on 8 November 2016. During our inspection in November 2016 we identified a regulatory breach in relation to;

• Regulation 12 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014

- safe care and treatment.

This report only covers our findings in relation to the area requiring improvement as identified on inspection in November 2016. You can read the report from this comprehensive inspection, by selecting the 'all reports' link for Knebworth and Marymead Medical Practice on our website at www.cqc.org.uk.

The area identified as requiring improvement during our inspection in November 2016 was as follows:

• Ensure appropriate management of infection prevention and control to ensure standards are consistently met.

In addition, the practice were told they should:

• Carry out regular fire drills.
• Continue to monitor and ensure improvement to patient survey results for example in relation to overall experience and opening hours.

Our focused inspection on 23 August 2017 showed that improvements had been made. The practice is now rated as good for providing safe services. Our key findings across the areas we inspected were as follows:

• The practice had taken steps to ensure infection prevention and control met the required standards. Systems and processes had been improved and the infection control lead kept up-to-date with best practice.
• The practice were now following their fire safety protocol and held fire drills on a six monthly basis. We saw evidence to confirm a fire drill had taken place at both premises in March 2017.
• Staff worked closely with the patient participation group and the practice regularly reviewed and discussed their patient survey results. The practice had an action plan in place and had increased their clinical capacity, reviewed their appointment booking system and had made improvements to their telephone system. The latest National GP Patient Survey results published in July 2017 showed the practice had improved in several areas. For example, 79% of patients described the overall experience of this GP practice as good compared to the local average of 81% and national average of 85%. This was an increase of 14% when compared to the National GP Patient Survey results published in July 2016. 72% of patients were satisfied with the practice’s opening hours compared to the local average of 72% and the national average of 76%. This was an increase of 10% when compared to the National GP Patient Survey results published in July 2016.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 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.
• Performance for diabetes related indicators was above the CCG and national averages. The practice achieved 92% of available points, with 11% exception reporting, compared to the CCG average of 89%, with 9% exception reporting and the national average of 90%, with 12% exception reporting.
• 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 maintained a register of patients requiring palliative care and held regular meetings with Macmillan nurses, district nurses and the Home First nurses to review the care and support needed.

Updated 27 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. For example, 99% of children aged one year received their full course of recommended vaccinations.
• The practice’s uptake for the cervical screening programme was 82%, which was comparable to the CCG average of 80% and the national 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.
• Chlamydia screening was available opportunistically for patients aged 15 to 24 years of age.

Updated 27 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 and urgent appointments for those with enhanced needs.
• The practice supplied GP cover to residents in three local care homes that included twice-weekly ward rounds.
• Annual health checks were offered to all patients over 75 years of age. They had completed 960 out of 1211 checks, the equivalent of 79%.

Updated 27 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. The practice encouraged patients to attend cancer screening programmes that reflects the needs for this age group. For example, 74% of females, aged 50-70 years, were screened for breast cancer in last 36 months compared to the CCG average of 72% and the national average of 73% and 62% of patients, aged 60-69 years, were screened for bowel cancer in last 30 months compared to the CCG average of 60% and the national average of 58%.

• The practice offered extended opening hours on Tuesdays and Thursdays. This was especially useful for working patients who were unable to attend during normal opening hours.

Updated 27 March 2017

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

• 75% 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 national average of 84%.
• Performance for mental health related indicators was above the CCG and national average. The practice achieved 100% of available points, with 11% exception reporting, compared to the CCG average of 93%, with 12% exception reporting and the national average of 93%, with 11% exception reporting.
• 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 support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended A&E 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.

Updated 27 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 and those with a learning disability. There was a lead GP for the care of patients with learning disabilities.
• 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 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 had identified 172 patients as carers, which equated to approximately 1.5% of the practice list. There was a carers lead and a carers noticeboard in the waiting area with written information to direct carers to the avenues of support available to them.