Dr Shaun Conway Also known as Hingham Surgery

Updated 6 December 2016

Dr Shaun Conway also known as Hingham Surgery is located in Hingham, Norfolk. The practice is run by one full time male GP. The practice employs one full time male salaried GP and three female and one male part time salaried GP, two female practice nurses and two female health care assistants. The clinical team is supported by a practice manager and a team of administrative, secretarial and reception/dispensing staff. The practice dispenses to approximately 52% of its patient population.

According to Public Health England information, the practice age profile has higher percentages of patients over 45 years compared to the practice average across England. It has lower percentages of patients aged 0 to 5 and 15 to 44 years.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are from 8.10am to 12midday every morning and 1.40pm to 6pm daily. Nurse appointments are available from 8am to 6pm Monday to Friday. Extended hours appointments are offered with GPs from 7.30 to 8am Monday to Friday, with appointments at 7.40am and 7.50 am daily. In addition to pre-bookable appointments that can be booked up to six weeks in advance, urgent appointments are also available for people that need them. Patients are able to speak to a GP before and after each surgery. Patients are not restricted to booking into designated clinics and the practice endeavours to accommodate patients’ needs at other times.

The practice holds a General Medical Service (GMS) contract to provide GP services to approximately 5,829 registered patients, which is commissioned by NHS England. A GMS contract is a nationally negotiated contract to provide care to patients. In addition, the practice also offers a range of enhanced services commissioned by their local CCG: facilitating timely diagnosis and support for people with dementia and extended hours access.

Out-of-hours care is provided by IC24 through the NHS111 service

Updated 6 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Shaun Conway also known as Hingham Surgery on 27 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. However the practice had not risk assessed access to the dispensary.

• 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 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.

We saw one area of outstanding practice;

• The practice was proactive in identifying patients with caring responsibilities. A member of the patient participation group (PPG) provided monthly carer support group meetings at the practice to offer support and guidance

The areas where the provider should make improvement are:

• The practice should review aspects of the management of the dispensary, including formally risk assess the practice’s decision not to limit access to the dispensary to those who are involved in the dispensing process, recording of checks taken to ensure medicine are within the expiry date and to identify errors that should be raised as significant events.
• There was scope to improve the processes in place to check medicines following alerts and recalls of medicines, to ensure systems were robust and all alerts were logged and acted upon.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 December 2016

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.
• 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 2014/2015 showed that the performance for diabetes related indicators was better than the local and national averages with the practice achieving 96%; this was 6 percentage points above both the local and national averages. The rate of exception reporting was in line with the local and national averages
• Longer appointments and home visits were available when needed.
• 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 had administered flu vaccinations to 60% of patients who were deemed at risk during the 2015 to 2016 flu vaccination clinics.

Updated 6 December 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. Childhood immunisation rates for the vaccinations given were high when compared to CCG/national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 73% to 100% which was comparable to the CCG average of 68% to 97% and five year olds from 74% to 100% which is comparable to the CCG average of 71% to 97%.

• 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 87%, which was above the CCG average of 84% and the national average of 82%. There was a policy to offer written and telephone reminders for patients who did not attend for their cervical screening test.
• 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, health visitors and school nurses. The practice nurses had undergone training to support the local contract for School Readiness Health Checks for children under five prior to attending school. These were undertaken at the time of the child’s pre-school vaccinations to identify any potential health concerns.

Updated 6 December 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.
• The practice worked closely with the multi-disciplinary team, out-of-hours and the nursing team to ensure proactive palliative care planning.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure were above local and national averages.
• The practice looked after patients living in local nursing homes. GPs undertook regular visits and visited patients as and when required.
• The practice had administered flu vaccinations to 78% of patients aged over 65 years old during the 2015 to 2016 flu vaccination clinics.

Updated 6 December 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 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.

• The practice encouraged its patients to attend national screening programmes for bowel and breast cancer screening. The bowel cancer screening rate for the past 30 months was 66% of the target population, which was above the CCG average of 65% and above the national average of 58%.The breast cancer screening rate for the past 36 months was 81% of the target population, which was also above the CCG average of 80% and the national average of 72%.
• Patients had access to appropriate health assessments and checks. These included health checks for new patients and NHS health checks for patients aged 40–74. The practice had achieved a 46% uptake for NHS health checks for the year 2014/2015 and an increased 69% uptake for the year 2015/2016.

Updated 6 December 2016

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

• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were generally higher than the clinical commissioning group (CCG) and national averages.
• The percentage of patients diagnosed 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 94%; this was above the CCG average of 86% and the national average of 84%. At the time of our inspection the practice had invited 46 patients identified as having dementia for a health check, of these 41 had a care plan in place and had undergone a review. The practice referred patients to various support services as required.
• The percentage of patients experiencing poor mental health who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015) was 89% this was below the CCG average of 90% and the national average of 88%. Of the 30 patients identified as experiencing poor mental health on the practice register, 27 has received a health check in the past twelve months with appointments scheduled for the remaining patients.
• 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.

Updated 6 December 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 homeless people, travellers and those with a learning disability. The practice had identified 16 patients with a learning disability on the practice register. 14 of these patients had received a health check with invitations sent to the remaining two patients. The practice provided these patients with an easy read pre-health review document. This used words and pictures in an easy read format to help patients with a learning disability to better understand and respond to questions about their health, illness, lifestyle and treatments. This ensured GPs had the basic and necessary information about the patient and their symptoms prior to their health review.
• 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.

• 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.
•  One member of the patient participation group (PPG) provided carer meetings at the practice once a month. These provided support and guidance to carers.