Courtenay House Surgery Also known as Drs Greenish, Williams & Nguyen

Updated 28 March 2018

Courtenay House Surgery provides primary medical services to approximately 6,770 patients in Hitchin, Hertfordshire. Services are provided on a General Medical Services (GMS) contract (a nationally agreed contract). The practice has one registered manager in place. (A registered manager is an individual registered with CQC to manage the regulated activities provided).

The practice serves a population with an age profile similar to local and national averages. The population is 89% White British (2011 Census data). The area served is less deprived compared to England as a whole. The practice was able to offer dispensing services to those patients on the practice list who lived more than one mile (1.6km) from their nearest pharmacy.

The practice team consists of two GP partners and three salaried GPs; three of which are female and two are male. There are three practice nurses, including a nurse who is qualified to prescribe

certain medicines, one dispenser, a practice manager, a secretary and 10 administration and reception staff members.

The practice is open to patients between 8.30am and 6.30pm Monday to Friday. Patients are able to contact an emergency telephone number for the practice between 8am and 8.30am. Appointments with a GP or nurse are available from 9am to 12pm and from 2pm to 3.20pm, and from 4.10pm to 6.10pm Monday to Wednesday. Appointments with a GP are available from 9am to 12pm and from 4.10pm to 6.10pm every Thursday and from 9am to 12pm every Friday. Emergency appointments are available daily with the duty doctor. A telephone consultation service is also available for those who need urgent advice.

The practice offers extended opening hours between 7.30am and 8am every Tuesday and Wednesday. Extended opening hours are also offered between 6.30pm and 8pm on the third Monday of each month and from 8.45am to 12pm on the first Saturday of each month.

Home visits are available to those patients who are unable to attend the surgery. The Out of Hours service is provided by Herts Urgent Care and can be accessed via the NHS 111 service.

Updated 28 March 2018

This practice is rated as Good overall. (Previous inspection February 2016 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Courtenay House Surgery on 27 February 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• Governance structures, systems and processes were effective and enabled the provider to identify, assess and mitigate risks to patients, staff and others.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The area where the provider should make improvements is:

Establish a process to ensure information about the Parliamentary and Health Service Ombudsman is provided to patients when responding to complaints, in line with NHS complaints procedures and guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 May 2016

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

• Nursing staff were trained in spirometry and patients at risk of hospital admission were identified as a priority.
• An anti-coagulation service was provided to patients at the practice on a weekly basis.
• Performance for diabetes related indicators was above the CCG and national average. The practice had achieved 94% of the total number of points available, compared to 89% locally and 89% nationally.
• 76% of patients diagnosed with asthma, on the register, had received an asthma review in the last 12 months which was comparable with the national average of 75%.
• Longer appointments and home visits were available when needed.
• All patients with a long-term condition 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.

Updated 20 May 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 potentially at risk, for example, children and young people who had a high number of A&E attendances. 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.
• Appointments were available outside of school hours and facilities at the practice were suitable for children and babies.
• We saw positive examples of joint working with midwives who held a weekly clinic at the practice.

Updated 20 May 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, this included enhanced services for end of life care.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments when required.
• Weekly visits to a local care home were carried out by named GPs for continuity of care and emergency visits were also provided when needed. A named GP carried out daily visits to people in an intermediate care unit. Staff members at these services told us that the practice was good at managing the needs of their residents and the GPs were familiar with the patients’ history. Staff members told us that the practice was very responsive to emergency visit requests and that they were happy with the service provided by the practice.
• The practice had completed 254 health checks for patients aged over 75 since October 2014, which was 50% of this population group.
• The practice worked closely with a rapid response service in place to support older people and others with long- term or complex conditions to remain at home rather than going into hospital or residential care.

Updated 20 May 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 carried out routine NHS health checks for patients aged 40-74 years.
• The practice’s uptake for the cervical screening programme was 84% which was in line with the national average of 82%. Bowel and breast screening rates were higher than local and national averages.
• The practice was proactive in offering online services such as appointment booking and repeat prescriptions services, as well as a full range of health promotion and screening that reflects the needs for this age group.
• It offered an appointment reminders using a text messaging service and appointment times were extended three mornings each week, until 8pm once a month and from 8.45am to 12pm on the first Saturday of each month.

Updated 20 May 2016

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

• 93% of patients diagnosed with dementia had their care reviewed in a face to face meeting in 2014/2015, which was higher than the national average of 86%.
• It held a register of patients experiencing poor mental health and offered same day contact.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Patients were referred to a counselling service which was provided at the practice.
• 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 20 May 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 those with a learning disability. The practice had completed 11 out of 16 learning disability health checks between 2014 and 2015.
• It offered annual health checks for people with a learning disability.
• 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.
• 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.