Baldwins Lane Surgery

Updated 24 December 2015

Baldwins Lane Surgery provides a range of primary medical services from premises at 266 Baldwins Lane, Croxley Green, Rickmansworth, Hertfordshire, WD3 3LG. The practice served a population of 4,054 patients at the time of our inspection. The practice serves a slightly above average population of those aged from 10 to14, 45 to 54 and 60 and over. There is a lower than average population of those aged from 0 to 9 and 20 to 34. The population is almost completely white British with no notable ethnic communities. The area served is less deprived compared to England as a whole.

The clinical team consists of one male and three female GP partners, one male and one female trainee GP, one nurse and one healthcare assistant. Trainee GPs are qualified doctors training to become GPs. All clinical staff work part-time. The clinical team is supported by a practice manager, four reception staff and a secretary. The practice holds a GMS contract for providing services. This is a training and teaching practice. There are two medical students who attend the practice on Mondays, but we did not meet either of them.

The practice is open between 8am to 1pm and 2pm to 6.30pm Monday to Friday. Appointments are from 8.30am to 11am every morning and 3.30pm to 6pm daily. Extended hours are offered from 6.30pm to 8.30pm on the first Monday of the month, from 6.30pm to 7pm every Wednesday and three Thursdays a month. Emergency appointments are available from 8am to 8.30am and 6pm to 6.30pm Monday to Friday at the practice. The practice is also part of the Watford Care Alliance which enables its patients to receive seven day access to routine GP care. The Watford Care Alliance is a collaboration of GP practices in the West Hertfordshire area which enables patients to have seven day access to routine GP care. An out of hours service is provided by Hertfordshire Urgent Care via the NHS 111 service.

Updated 24 December 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Baldwins Lane Surgery on 14 October 2015. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Systems were in place to identify and respond to concerns about the safeguarding of adults and children.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• 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.
• Patients said they found it easy to access appointments, with urgent appointments available the same day.
• The practice appeared clean and infection control procedures were adhered to.
• There was a clear leadership structure and staff felt supported by management.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure they met patients’ needs.

However, there were areas of practice where the provider needs to make improvements.

Importantly the provider should:

• Ensure that staff have an awareness of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards appropriate to their roles.

• Ensure staff are facilitated to complete role specific training and maintain up to date records of training in regard to safeguarding vulnerable adults and children and infection control in accordance with their practice policies.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 24 December 2015

The practice is rated as good for the care of people with long-term conditions. With 18% of their practice population in this group, GP led clinics were in place for the review of these patients. These reviews resulted in a personalised care plan with agreed goals for their health and wellbeing. Patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. Patients with diabetes and those with multiple needs were reviewed annually and were offered an interim review at six months. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multi-disciplinary package of care.

Updated 24 December 2015

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 who were at risk. Immunisation rates were 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. Appointments were available outside of school hours and the premises were suitable for children and babies. There was a flu clinic for children held on a Saturday and during the half term break. Staff demonstrated a clear understanding of safeguarding children from the risk of harm or abuse. The practice computer system clearly identified and alerted staff of those children who were subject to a child protection plan or who were living in care. Extended clinics were available for childhood immunisations on Saturdays and during school holidays.

Updated 24 December 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. It was responsive to the needs of older people. It offered home visits including flu vaccines and diabetic reviews. Same day urgent appointments were also available for older people and those with multiple needs. The practice offered proactive, personalised care to meet the needs of the older people in its population. For example, the practice contacted patients with dementia to remind them of appointments. Patients we interviewed in this group provided positive feedback about the service and care provided by the practice.

Updated 24 December 2015

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. There were extended clinic times available for people at work. The practice was proactive in offering online services for appointment booking and was registered with the electronic prescription service (EPS), reflecting the needs for this age group. Extended clinics encompassed the provision of cervical screening, flu vaccinations and long term conditions (such as diabetes) reviews with GPs and the nurse. Phlebotomy clinics for patients were also available seven days a week. Phlebotomy is the taking of blood for analysis at a laboratory.

Updated 24 December 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Of the 32 people on the dementia register 75% had received an annual review. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. There was a lead GP for dementia care. The practice offered a ring back reminder service for patients with dementia, where reception staff would call these patients to remind them of their appointments.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. There was a counselling service available in the practice. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. The GPs at the practice had undergone training in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DOLS) and demonstrated a good understanding of the principles of these two pieces of legislation relating to consent. Whilst some of the other staff did not have the same depth of knowledge, the staff we spoke with were able to identify the basic principles and told us they would speak to a GP if they were concerned about an individual patient.

Updated 24 December 2015

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 those with a learning disability. There were 12 people on the learning disability register of which 42% had attended an annual review. Longer appointments were available if needed for people in this group. The practice worked with multi-disciplinary teams in the case management of vulnerable people, including the Living Well Team in Hertfordshire (a service that ensures patients with complex health and social care needs receive joined up care). There was a counselling service available in the practice. It had told 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. There was a carers’ register and plans for the health care assistant to become the carers’ champion.