Archived: Bluebell Surgery Also known as Dr Rajan Thoppil Kuriakose

Updated 4 February 2016

Bluebell Surgery is situated on the outskirts of Colchester, Essex. The practice is one of 44 practices in the North East Essex Clinical Commissioning Group. The practice holds a General Medical Services contract with the NHS. There are approximately 3400 patients registered at the practice.

The practice is a single-handed male GP surgery that employs a part-time regular locum female GP. They are supported by two practice nurses, a practice manager, and three administrative and reception members of staff. Support staff members at the practice work a range of hours including full and part-time.

The practice opening hours are 8am to 6.30pm Tuesday, Thursday, Friday and 8am to 7.30pm Monday and Wednesday. The surgery doors are closed between 12.30pm and 1.30pm although the telephone line remains open for patient calls.

The practice has opted out of providing 'out of hour’s’ services to their own patients which is now provided by Care UK, an ‘Out of hours’’ healthcare provider. Patients can also contact the NHS 111 service to obtain medical advice if necessary.

The practice is registered to provide the following regulated activities: diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures, and treatment of disease, disorder or injury. They hold directed enhanced services (DES’s); a DES is a service which requires an enhanced level of service provision above what is required under their core contracts. They hold DES’s for; the childhood vaccination, immunisation scheme, influenza and pneumococcal immunisations, extended hours access, minor surgery, patient participation, and remote care monitoring.

This practice has not been inspected previously by the Care Quality Commission.

The practice website was comprehensive and gave patients access to; on line repeat prescription requests, appointment booking, and the ability to update their details if needed. There was information regarding the opening times and the services available, and the patient reference group work. The website encouraged patients to give their feedback with regards to the practice service, and an A-Z healthcare guide and useful links to live well. This information was up to date and had been reviewed.

Updated 4 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bluebell Surgery on 17 November 2015. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• Staff knew how to raise concerns, and report safety incidents. Information about safety was recorded, monitored, and reviewed to identify trends or recurring themes.

• Risks to patients were assessed on a daily basis, well managed and reviewed to identify any trends or recurring themes.

• Patient care was planned and provided in a way that reflected best practice and recommended current clinical guidance.

• Staff had received training appropriate for their roles and further training had been encouraged, recognised and planned.

• Patients told us they were treated well with consideration, dignity and respect and involved in the decisions about their care and treatment. All the patients we spoke with on the day told us it was a friendly, family orientated practice and all the staff were caring and helpful.

• Information regarding how to complain about the practice was available to patients in a leaflet and on the website this was easy to understand and comprehensive.

• The practice staff members had received training regarding safeguarding children and vulnerable adults and knew who to contact with any concerns.

• The practice was adequately equipped to treat patients and meet their requirements. The equipment had been checked and maintained to ensure is was safe for use.

• The practice had a Patient Participation Group (PPG) that supported the practice offering their opinions regarding suggestions for practice improvement.

The leadership structure at the practice was well-established and all the staff members we spoke with told us they felt supported in their working roles by both the practice manager and the GPs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 February 2016

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

• Clinicians within the practice held lead roles in the management the of chronic disease. Patients at risk of hospital admissions were identified and provided a robust care plan.

• The practice scored higher than national average scores for diabetes related indicators in most areas with the exception of one indicator. This related to the number of diabetic patients who had their cholesterol measured in the preceding 12 months. This was significantly lower than national average rates with the practice scoring 60.87% compared with the national average of 81.6%. The practice told us that due to their small register this had a big impact on the practice percentages. We were assured they were looking at improving this for the future.

• Longer appointments and home visits were available for this population group when needed.

All patients with long-term conditions had a named GP and an annual review to check their health and medicine needs were being met. For people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. We saw evidence this was taking place.

Updated 4 February 2016

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

• This was the largest proportion of the practice demographics. They had developed a number of systems and processes to ensure they were proactive for this population group.

• The practice checked and followed-up children living who may be at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were high for all standard childhood immunisations.

• Patients told us their children were treated and spoken with in an age-appropriate manner and recognised as individuals.

• Cervical screening data for eligible women registered at the practice was in line with national average scores. The practice scored 80.13% compared to the national average of 81.88% (2014-2015).

• A variety of appointments were available outside school hours and the premises were suitable and had been adapted for children and babies. We saw that the GPs were as flexible as possible to enable children to be seen promptly and review them on the same day if needed.

• We saw excellent examples of joint working with midwives, health visitors and school nurses. Working closely with the local maternity services, supporting and working alongside the midwives to provide antenatal and post-natal care.

• Communication with the Health Visitor team was accessible on a daily basis due to them working in the same building to assist with any circumstances regarding families.

• One of the GPs was trained in minor surgery and worked alongside the nurses to provide this service within the surgery. This provided patients treatment closer to home and, reduced the waiting time in preference to secondary care.

A female GP attended the surgery once a week that could offer intrauterine contraceptive fitting and the nurses were able to deliver basic contraception care. They offered sexual health and contraceptive advice and service for young people.

Updated 4 February 2016

The practice is rated as good for the care of older people.

• The practice had a very small population of older patients which enabled the team to engage with them fully, and offer a proactive, personalised care to meet their needs.

• Home visits were offered and urgent appointments for those with enhanced needs.

• The practice used the admission avoidance scheme to ensure patient care plans were formalised for many older patients.

• Senior health checks were undertaken to provide preventative health care for this population group.

GPs had built strong relationships with older patients and their families over time. They felt able to offer and anticipate problems and deal with them without raising undue concern for the patient or families involved.

Updated 4 February 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 their services.

• The practice offered flexible continuity of care to ensure they were accessible for this population group.

• Extended hours on the Monday and Wednesday evening sessions gave greater access to the practice working population.

• The practice offered online services to book appointments and request repeat prescriptions. They also provided a full range of health promotion and screening that reflected the needs of this age group.

Health checks were offered to those over 40 and a similar health check was available to all registered patients.  The practice told us they had a good uptake for these checks.

Updated 4 February 2016

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

• Mental health related data we hold shows the practice achieved higher than national average scores for these patients. For example the practice scored 100% for the number of face to face reviews performed for patients diagnosed with dementia compared with the national average rate of 83.8%.

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

• It 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.

• It had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• The practice also had a procedure to see patients within this population group more regularly in response to their needs

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

Updated 4 February 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice had a register of patients living in vulnerable circumstances including, travellers, those in residential care and those with a learning disability.

• Longer appointments were offered to vulnerable people and those with a learning disability.

• The practice worked with multi-disciplinary teams in the case management of vulnerable people.

• Vulnerable patients were told how to access various support groups and voluntary organisations.

• Staff knew how to recognise the signs of abuse in vulnerable adults and children. Staff members were also aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and who to contact when needed.

Patients had access to a GP care-advisor at the practice to help them with any queries or issues they had when claiming benefits.