Priors Field Surgery

Updated 9 February 2017

Priory Fields Surgery is situated in a semi-rural area and covers Sutton and the nearby villages and provides services for approximately 6000 patients . The practice dispenses medicines to patients that are eligble, we included the dispensary in our inspection.

• The practice has three GP partners and two salaried GPs (four female and one male). There are, three practice nurses, and three healthcare assistants. There is a team of reception and administration staff who support the practice manager. The practice also dispenses medicines and employs four dispensary staff.

• The practice holds a General Medical Services (GMS) contract and is a teaching practice and teaches second, third and fourth year medical students from Cambridge University.   

• The most recent data provided by Public Health England showed that the patient population has a lower than average number of patients up to the age of nine and 20 to 39 compared to the England average. The practice had a higher than average number of patients aged between 45 to over 85 compared to the England average. The practice is located within an area of lower deprivation.

• The practice is open between 8am to 6:30pm Monday to Friday. Out of hours GP services were provided by Herts Urgent Care through the 111 service. The practice dispensary was open between 8.30am to 6.30pm Monday to Friday.

• The practice provides a range of services including maternity and midwifery, family planning, chronic disease management and phlebotomy

Updated 9 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Priors Field Surgery on the 26th October 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 and a comprehensive range of risk assessments had been carried out.
• 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 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.

The areas where the provider should make improvements are:

• The practice should continue to proactively identify carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 February 2017

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

• Specialist nurse led clinics were available for patients with asthma, COPD and diabetes.

• Medication reviews and protocols had been integrated into the practice medical system to ensure that GP and nurse reviews were offered.

• Referral and liaison with the community nurse specialist for patients with chronic health conditions were monitored.

• Patients were able to self-refer to the ‘Improving Access to Psychological Therapies (IAPT) service.

• Weekly clinical meetings took place to discuss specific cases including patients with long term health conditions and those with complex needs.

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

• The practice used the information collected for the Quality and Outcomes Framework (QOF) to monitor outcomes for patients. (QOF is a system intended to improve the quality of general practice and reward good practice). Data from 2015/2016 showed that performance for diabetes related indicators was 100% which was 9.5% above the CCG average and 10% above the CCG average.Exception reporting was 9.5% which was below the CCG average of 13% and the national average of 11%.

• Longer appointments and home visits were available when needed.

• Patients with long term conditions had a named GP and a structured annual review to check their health and medicine 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.

• Team meetings between the lead GP and lead nurse took place to discuss those patients with diabetes who attended for annual review, and a diabetes specialist nurse ran a monthly clinic to support patients with more complex diabetic needs.

• A medicine review protocol had been integrated into the medical system to ensure patients receiving treatments from long term conditions were offered reviews with an appropriate clinician, either a GP or nurse.

Updated 9 February 2017

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

• The practice promoted antenatal wellbeing including telephone contact to women eligible for flu vaccinations and pertussis vaccinations.

• Childhood well-being leaflets and booklets were available in the practice waiting room.

• Family planning services including emergency contraception were available.

• The practice offered sexual health advice, including chlamydia screening. All children were automatically given a same day appointment.

• 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 in line with the CCG and national average for all standard childhood immunisations.

• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 82% which comparable to the local average of 82% and the national average of 82%.

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

Updated 9 February 2017

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

• All patients over the age of 75 had a named GP to promote continuity of care. This was incorporated in the practice systems for administration, including letters, result, patient’s queries, appointments and home visits.

• The practice worked with the JET (joint emergency teams) services, together with the multi-disciplinary team, for the assessment and support of patients to avoid unnecessary hospital admissions.

• Home visits were arranged early in the day in order that the practice could determine the best course of action for each request, and arrange support as soon as possible. Gps carried out home visits to patients unable to attend the surgery for their flu vaccination and offered home visits and urgent appointments for those with enhanced needs.

• Patients on the admissions avoidance register, once discharged from hospital, were contacted by the practice within three days of the receipt of the discharge summary.

• Multidisciplinary team meetings took place monthly to discuss patients with complex needs, end of life care, resuscitation decisions and patients requiring palliative care. These meetings were attended by the community matron, district nurse, multi-disciplinary team coordinator, palliative care nurse and all GPs within the practice.  Comprehensive practice specific templates were set up on the practice medical system to capture date. Quarterly meetings also took place to reflect upon and improve outcomes for patients receiving palliative care.

Flu vaccinations were offered and supported by the district nursing team

Updated 9 February 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.

• Text reminders were sent for appointments.

• The practice website had links to promote lifestyle changes and self-care.

• NHS health checks were offered and the results were given to patients in a written format with lifestyle advice and referral for support and onward management if required.

Updated 9 February 2017

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

The results taken from the 2015/2016 QOF achievement showed that:

• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was 2% above the CCG average and 3.4% above the national average. Exception reporting was 5% which was below the CCG average of 11% and the national average of 8%.

• 100% of patients with mental health problems had received an annual physical health check which was 6.% above the CCG average and 7% above the national average. Exception reporting was 8% which was below the CCG average of 13% and the national average of 11%.

• Longer appointments were available for patients with dementia, mental health needs and learning disabilities.

• 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.

• Information was available for patients experiencing poor mental health on 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.

Updated 9 February 2017

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

• 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 worked with patients with substance abuse including alcohol dependence.

• All staff were trained in child protection and safeguarding vulnerable adults.

• 100% of patients with learning disabilities had received an annual review.

• Multi-disciplinary team meetings took place to include case management of vulnerable groups.

• Information on various support groups was made available with leaflets in the waiting room and on the website.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.