Drs Carragher, Akhtar & Brindle

Updated 17 May 2017

Dr Collins and Carragher (also known as Lower Stondon Surgery) provides a range of primary medical services from its premises at 109 Station Road, Lower Stondon, Henlow, Bedfordshire, SG16 6JJ.

The practice serves a population of approximately 5,552 and is a dispensing and teaching practice. The area served is less deprived compared to England as a whole. The practice population is mostly white British. The practice serves an above average population of those aged from 40 to 60 years.

The clinical team includes one female and two male GP partners, one female salaried GP, two practice nurses and one phlebotomist. (A phlebotomist is a specialised clinical support worker who collects blood from patients for examination). The team is supported by a practice manager and five other dispensary, administration and reception staff. The practice provides services under a General Medical Services (GMS) contract (a nationally agreed contract with NHS England).

The practice is staffed with the doors and phone lines open from 8am to 6.30pm Monday to Friday. There is no lunchtime closure at the practice. There is extended opening on Mondays and Tuesdays until 7.30pm. Appointments are available from 9am to midday and 4pm to 6pm daily, with slight variations depending on the doctor and the nature of the appointment.

An out of hours service for when the practice is closed is provided by Herts Urgent Care.

Updated 17 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Collins and Carragher on 10 May 2016. The overall rating for the practice was good. However, we identified a breach of legal requirements. Improvements were needed to systems, processes and procedures to ensure the practice provided safe services. Consequently the practice was rated as requires improvement for providing safe services. The full comprehensive report from the 10 May 2016 inspection can be found by selecting the ‘all reports’ link for Dr Collins and Carragher on our website at www.cqc.org.uk.

After the comprehensive inspection, the practice wrote to us and submitted an action plan outlining the actions they would take to meet legal requirements in relation to;

• Regulation 17 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014

- good governance.

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

• Ensure that all Patient Group Directions (PGDs) are reviewed and signed by an appropriate person.

In addition, we told the provider they should:

• Ensure that policies and procedures are formally reviewed and updated at regular intervals.
• Ensure that all staff complete training updates on a regular basis.
• Consider implementing a formal process for recording meetings.

We carried out an announced focused inspection on 18 April 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach of regulation that we identified in our previous inspection on 10 May 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our key finding on this focused inspection was that the practice had made improvements since our previous inspection and were now meeting the regulation that had previously been breached.

The practice is now rated as good for providing safe services.

On this inspection we found:

• Sufficient arrangements were in place for the management of Patient Group Directions (PGDs) and they were appropriately reviewed, signed and countersigned.

Additionally where we previously told the practice they should make improvements our key findings were as follows:

• A process was in place and adhered to for the review, update and amendment of policies and procedures including Standard Operating Procedures (SOPs) used to safely dispense medicines.
• Staff had completed infection control and adult and child safeguarding training.
• During our inspection on 10 May 2016 we found there were no written records of the discussions had and decisions made at the practice’s governance meetings. During this focused inspection we looked at the minutes of five practice meetings held between June 2016 and March 2017. We saw these meetings were well attended and provided a record of the discussions had and decisions made. The staff we spoke with said on the occasions they were not present at the meetings they knew how to access the minutes and felt informed and up to date about any issues that affected them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 August 2016

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

• GP’s 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 comparable to the CCG and national averages.
• Longer appointments and home visits were available when required.
• All these patients had a named GP, patients received a medication review every six months and had a structured annual review to check that their health needs were being met.
• For patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 17 August 2016

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

• The practice provided services to families of military personnel at the local base and referred all children to the community teams and offered additional support to these families.
• 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 80% which was comparable to the CCG average of 80% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Children were always seen on the day if they had an emergency and we saw evidence to verify this on the day of our inspection.
• We saw positive examples of joint working with midwives and health visitors
• Chlamydia screening was offered to all young adults up to the age of 24 who attend the surgery for appointments.

Updated 17 August 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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• All GPs reviewed information received relating to patients daily to give continuity of care.
• The practice coordinated appointment times with the local volunteer transport scheme to ensure patients in this group were able to attend appointments.

Updated 17 August 2016

The practice is rated as good for the care ofworking-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 for appointments and prescriptions as well as a full range of health promotion and screening that reflects the needs for this age group.
• The practice offered early morning and late evening appointments, both face to face and on the telephone.

Updated 17 August 2016

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

• Performance for mental health indicators was above or comparable to the CCG and national averages.

• 83% 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 CCG and national averages of 84%.

• 92% of people experiencing poor mental health had received an annual physical health check which was above the CCG average of 87% and the national average of 88%.

• 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 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.
• There was a robust process in place to review medication and to ensure compliance for this group.
• The practice had a good communication system in place for correspondence regarding psychiatric consultations and any changes to patient medication that may be required.

Updated 17 August 2016

The practice is rated as good for the care of people whose circumstances 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.
• There was no evidence available that the practice informed vulnerable patients about how to access various support groups and voluntary organisations although the practice contacted relevant organisations to highlight patients in this group.
• The practice had carried out annual health checks for people with a learning disability.
• 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 kept a register of patients who were carers.