Archway Surgery

Updated 26 January 2017

Archway Surgery provides primary medical services to approximately 2,437 patients in an area of Hemel Hempstead. Services are provided on a Personal Medical Services (PMS) contract (a PMS contract is a locally agreed contract with NHS England).

Services are delivered to patients from one registered location; 52 High Street, Bovingdon, Hemel Hempstead, HP3 0HJ.

The practice forms part of NHSolutions, a corporate group which provides primary medical services at a number of locations across England. Executive management oversight is provided by NHSolutions which includes corporate business planning, performance monitoring and central functions such as human resource management, payroll and regular review and update of policies and processes.

The practice at Archway Surgery serves a population group with a broadly similar profile to the England average. Although the practice had 21% of their patients in the over 65 years of age range compared to the CCG average of 16% and the England national average 17%.

The area is recorded as being in the ’least deprived decile’ and therefore falls in an area of the lowest deprivation According to national data, life expectancy for male patients at the practice is 83 years, compared to the CCG average of 80 years and the national England average of 79 years. For female patients life expectancy is 86 years, compared to the local CCG average of 84 years and the England average of 83 years.

The on-site practice team consists of three GPs (two male GPs and one female GP), one practice nurse and one health care assistant (both female). The practice manager is supported by a team of staff who provide reception and administrative functions.

The practice is open between 8.00am and 6.30pm Monday to Friday, with extended hours until 8pm Wednesday evenings. Appointments with a GP, nurse or health care assistant are available during those times. Appointments are bookable up to eight weeks in advance. Emergency appointments are available daily. A telephone consultation and call-back service is also available for those who need urgent advice. Home visits are available to those patients who are unable to attend the surgery.

When the practice is closed, ‘out-of-hours’ services are provided by Herts Urgent Care. Information about the out-of-hours services was available in the practice waiting area, on the practice website and on the practice telephone answering service.

Updated 26 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Archway Surgery on 22 November 2016. Overall the practice is rated as good.

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

• The practice had a clear vision and had recognised the particular needs of patients in the community it served.
• The practice had worked to create an open and transparent approach to safety. A clear reporting system was in place for recording significant events.
• Risks to patients were identified, assessed and appropriately managed. For example, the practice implemented appropriate recruitment checks for new staff, undertook regular clinical reviews and followed up-to-date medicines management protocols.
• We saw that the staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff were supported to access development learning and routine training was provided to ensure they had the skills, knowledge and experience to deliver effective care and treatment.
• Data from the Quality and Outcomes Framework (QOF) 2015/2016 showed the practice had performed well, obtaining 99% of the total points available to them, for providing recommended care and treatment to their patients.
• Feedback from patients was consistently positive. Patients we spoke with told us they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Comments from patients on the nine completed CQC comment cards confirmed these views.
• Results from the GP Patient Survey published in July 2016 showed the practice was consistently performing higher than local and national averages.
• Information about services and how to complain or provide feedback was available in the waiting area and published on the practice website. The practice had a thorough process dealing with patient feedback. Outcomes from complaints were shared and learning opportunities identified as appropriate.
• Appointments were readily available. Urgent appointments were available the same day, although not always with the patients named or usual GP. Pre- bookable appointments were available eight weeks in advance.
• The practice had access to good facilities and modern equipment in order to treat patients and meet their needs.
• There was a clear leadership structure and we noted there was a positive outlook among the staff, with good levels of moral in the practice. Staff said they felt supported by management.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvements are as follows:

• Medication review dates should be monitored and regularly audited.
• Development work to identify and support patients who are carers to continue.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 January 2017

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.
• All these 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 closely with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice had clear protocols in place to support the treatment of patients with long term conditions. The practice held records of the number of patients with long term conditions. These patients were seen at the surgery on a regular basis and invited to attend specialist nurse-led clinics.
• The practice offered longer appointments to these patients and home visits were available when needed.
• 98% of the patients on the diabetes register had influenza immunization in the preceding 01 August 2015 to 31 March 2016, compared to local CCG average of 96% and national average of 94%. Effective arrangements were in place to ensure patients with diabetes were invited for a review of their condition.
• Nurse led clinics ensured annual reviews and regular checks for patients with asthma and chronic obstructive pulmonary disorder (COPD) were in place. The practice had clear objectives to reduce hospital admissions for respiratory conditions.
• Patients who were admitted to hospital were reviewed by the practice after discharge.

Updated 26 January 2017

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.
• 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.
• 84% of women aged between 25 - 64 years of age whose notes record that a cervical screening test has been performed in the preceding five years, was in line with the local CCG average and the national average of 82%.
• The practice provided appointments 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.
• Immunisation rates for all standard childhood immunisations were similar to local CCG averages. The practice provided flexible immunisation appointments.
• The practice supported a number of initiatives for families with children and young people, for example the practice offered a range of family planning services.
• Baby vaccination clinics and ante-natal clinics were held at the practice on a regular basis. Positive links with the community midwife team and liaison with health visitors formed a positive and collaborative approach.

Updated 26 January 2017

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. GPs were able to offer home visits to those patients who were unable to travel into the surgery. On-the-day or emergency appointments were available to those patients with complex or urgent needs.
• The practice had clear objectives to avoid hospital admissions where possible. GPs made home visits to elderly patients and ensured that patient medication was reviewed regularly and where possible other routine tests were undertaken without the need for patient admission to hospital.
• These patients had a dedicated telephone number at the practice, for use in an emergency.

Updated 26 January 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, with extended opening hours on Wednesday evenings for example.
• Data showed 64% of patients aged 60 to 69 years had been screened for bowel cancer in the last 30 months compared to 57% locally and 58% nationally.
• Data showed 73% of female patients aged 50 to 70 years had been screened for breast cancer in the last three years compared to 72% locally and nationally.
• The practice offered access to telephone consultations.
• The practice provided a health check to all new patients and carried out routine NHS health checks for patients aged 40 - 74 years.
• The practice was proactive in offering on line services such as appointment booking, an appointment reminder text messaging service and repeat prescriptions, as well as a full range of health promotion and screening that reflects the needs of this age group.

Updated 26 January 2017

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

• 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia and had received training in dementia awareness.
• For example, 89% of patients diagnosed with dementia had their care reviewed in a face-to-face meeting in the last 12 months, compared to the local CCG average of 85% and the national average of 84%.
• For patients on the dementia register, the practice had a lead member of staff with responsibility for developing and improving delivery of services for patients with mental health and health promotion.
• The practice had supported patients experiencing poor mental health about how to access support groups and voluntary organisations, with links to support services, such as counselling and referrals to the Improving Access to Psychological Therapies service (IAPT).
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 months (01 April 2015 to 31 March 2016) was 100%, with an exception reporting rate of 0%. Compared against the local CCG average of 91% (with an exception reporting rate of 9%) and the national average of 90%, with an exception report rate of 10%.
• For another measure, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01 April 2015 to 31 March 2016) was 100%, with an exception reporting rate of 0%. Compared against the local CCG average of 92% (with an exception reporting rate of 10%) and the national average of 88%, with an exception reporting rate of 13%.
• The practice had a system in place to follow up patients who had attended A&E where they may have been experiencing poor mental health.

Updated 26 January 2017

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. For example, a high number of patients registered at the practice were elderly people who lived at home alone and the practice was able to recognise how services should be adapted to support the patient’s wishes to remain independent.
• The practice offered longer appointments for patients with a learning disability.
• The practice had recorded 38 carers on their register (approximately 1% of the total patient list) and had generated positive links with carers and community groups. A member of staff had recently taken on the role of carers champion and further development work was planned.
• The practice regularly worked collaboratively with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children and the protocol to follow for reporting concerns.
• 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 had a system in place to identify patients with a known disability.