Archived: Dr Michael John Heber Also known as Cobtree Medical Practice

Updated 11 February 2016

Dr Michael John Heber, also known as the Cobtree Medical Practice is a GP practice located in the village of Sutton Valance Kent. It provides care for approximately 2500 patients. The practice is in a rural area.

There are two GP partners and a retained GP, one male and two female. There are two practice nurses, both female, one being a regular locum nurse.

The age of the population the practice serves is close to the national averages. There are marginally more young people (aged less than 18 years) and slightly more older people (aged over 64 years). Income deprivation and unemployment are low being about half and one sixth of the national figures respectively. About five percent of the practice’s patients come from the traveller community.

The practice has a general medical services contract with NHS England for delivering primary care services to local communities. The practice offers a full range of primary medical services and is able to provide pharmaceutical services to those patients on the practice list who live more than one mile (1.6km) from their nearest pharmacy premises. The practice is not a training practice.

The practice is open between 8am and 6.30pm Monday to Friday. There is an evening surgery until 7.45pm on Tuesdays. Appointments are from 9am to 1pm and 2.15pm until 5.30pm.

The surgery building is a converted detached house with consulting and treatment rooms on the ground floor and administrative rooms upstairs.

The practice has opted out of providing out-of-hours services to their own patients. This is provided by Integrated Care 24. There is information, on the practice building and website, for patients on how to access the out of hours service when the practice is closed.

Updated 11 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Michael John Heber on 3 November 2015. Overall the practice is rated as outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Opportunities for learning from internal and external incidents were maximised.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. There were monthly multidisciplinary meetings. The practice had used software to identify patients with conditions which might otherwise have been missed.

• Feedback from patients about their care was positive and was consistently significantly better than local and national feedback.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet people’s needs. For example in their professional interactions with a local nursing home and the local independent school.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example in the way that services were made available to members of the traveller community.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

There was an area of practice where the provider should make improvements:

• The practice should check and reconcile the controlled drugs register

We saw several areas of outstanding practice including:

• The GP was available to staff from the local nursing home both out of hours and at weekends for advice on avoiding admission to hospital or end of life care.

• GPs gave their personal contact telephone numbers to patients who were dying at home and were contactable in the event of a crisis.

• The practice used a wide range of information and specialist software to review the effectiveness of its care and treatment.

• The practice had written up several anonymised cases where patients, who wished to die at home, had been supported to do so. These had been presented as significant events so as to share best practice.

• Data showed that patients rated the practice higher, for the caring and the responsive aspects of its services, than all the local and national averages.

• Governance and performance management arrangements were under constant review. The practice actively sought out and used data from wide range of sources.

• The practice had proactively recruited patients to the patient participation group so that it was truly representative of the practice demographic.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 February 2016

The factors that led to the practice being rated as outstanding overall applied to all the population groups, therefore the practice is rated as outstanding for the care of patients with long-term conditions.

The practice is rated as outstanding for the care of patients with long-term conditions. Such patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

The patient outcomes for the practice were high when compared to neighbouring practices in the Clinical Commissioning Group. In 17 of 19 common conditions the practice had achieved 100% of the clinical measures regarded as best practice for the treatment of those conditions. Diabetic admissions and complications were lower than the average for the locality. GPs identified patients at risk of hospital admission as a priority. The practice had lower than average admission to Accident and Emergency (A&E) across all these areas

The practice had used specialist software to review patient care, as a result patients had been identified with long term conditions who might otherwise have been missed. There had been no diagnoses of patients with cancer made in A&E, nationally about a quarter of such patients were diagnosed in A&E.

Longer appointments and home visits were available when needed.

Updated 11 February 2016

The factors that led to the practice being rated as outstanding overall applied to all the population groups, therefore the practice is rated as outstanding for the care of families, children and young people.

There were systems 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 90% or more for all standard childhood immunisations. This was despite the fact that there was a substantial proportion of children from the traveller community who are historically difficult to reach with these services. Where families missed an appointment for a vaccination the practice followed this up by telephone.

Appointments were available outside of school hours and the premises were suitable for children and babies. The practice had negotiated the return of antenatal clinics to the practice, a service much valued by the affected patients. The practice had bettered the national and local results for the cervical cancer screening programme on average over the last decade.

The practice served the needs of boarders at a nearby school, there was drop in-clinic weekly and access to emergency contraception, for patients registered at the practice and others who were not. Both GPs had included adolescent learning modules in their recent training. There were GPs trained in family planning and reproductive healthcare and competent in coil insertion.

There was an adolescent patient as a member of the patient participation group.

Updated 11 February 2016

The factors that led to the practice being rated as outstanding overall applied to all the population groups, therefore the practice is rated as outstanding for the care of older patients.

The practice offered proactive, personalised care to meet the needs of older patients. It looked after 25 high dependency beds at the local nursing home. Staff there had the GPs telephone number and were able to contact the GP at weekends to discuss end of life care or measures to prevent admission to hospital where this was appropriate. All the patients at the home have detailed care plans with an emphasis on avoiding unplanned admission to hospital.

There were monthly integrated care meetings involving health and social care which supported information sharing about vulnerable, elderly or housebound patients. In many practices these meetings are held every three months. GPs gave their personal contact telephone numbers to patients who were dying at home and were contactable in the event of a crisis.

Repeat prescriptions were available over the telephone for older or housebound patients, who did not have, or who were not confident in using, the on-line repeat service.

It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. Two staff members visited the housebound elderly to administer influenza vaccinations.

Updated 11 February 2016

The factors that led to the practice being rated as outstanding overall applied to all the population groups, therefore the practice is rated as outstanding 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 had developed a “one stop shop” for diabetic patients that reduced the number of appointments those patients needed to attend. This impacted particularly on working age patients.

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.

Updated 11 February 2016

The factors that led to the practice being rated as outstanding overall applied to all the population groups, therefore the practice is rated as outstanding for the care of patients experiencing poor mental health (including people with dementia).

The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice had raised its rate of diagnosis of dementia to one of the highest levels in the local clinical commissioning group after recognising that its performance had been weak in this area. Thirteen out of 16 patients (81%) had had their care reviewed in a face to face consultation. In four of the last eight years this had been 100% of patients. All the staff at the practice had become “dementia friends”, learning more about the condition and how to help patients and their families struggling with it.

In 2014 and in 2015 94% of mental health patients had a care plan, agreed between them, their family and/or carers as appropriate and the GP. Between 2007 and 2013 the percentage of patients with such a care plan had been better than both the national and local averages by between 7% and 15%.

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.

There was a patient with a long term mental health condition on the practice’s patient participation group.

Updated 11 February 2016

The factors that led to the practice being rated as outstanding overall applied to all the population groups, therefore the practice is rated as outstanding for the care of patients whose circumstances may make them vulnerable

The practice held a register of patients living in vulnerable circumstances such as those from the traveller community or those with a learning disability.

There was a representative from the traveller community on the patient participation group, who had been very active in improving understanding about the needs of that community. The practice responded to these needs by being readily available to see patients without a previous appointment particularly at the beginning or end of the sessions.

It had carried out annual health checks for all patients with a learning disability. It offered longer appointments for people with a learning disability. The practice identified that there were a number of East European farm workers registered with them and had translation services available if needed.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations.