Verulam Medical Group

Updated 24 November 2016

Verulam Medical Group (also known as Colney Medical Centre) situated in London Colney, St. Albans, Hertfordshire is a GP practice which provides primary medical care for approximately 4,200 patients. A branch of this practice the Bricket Wood Medical Centre is located at St Lukes Church, The Crescent, Bricket Wood. The practice maintains one patient list and patients can access either practice. We did not inspect the Bricket Wood Medical Centre branch at this time. Together they provide primary medical care to the residents of London Colney and Bricket Wood and surrounding areas.

Verulam Medical Group provides primary care services to local communities under a General Medical Services (GMS) contract, which is a nationally agreed contract between general practices and NHS England. The practice population is predominantly white British along with a significant ethnic population of Bangladeshi, Italian, and Portuguese origin.

The practice has three GP partners (two male and one female). There is a practice nurse. Practice management is shared between the three GP partners who are supported by a team of administrative and reception staff. The local NHS trust provides health visiting and community nursing services to patients at this practice.

Patient consultations take place at ground and first floor levels and there is a lift available. There is onsite parking available including for those patients with mobility issues.

The practice is open Monday Friday from 8am to 6.30pm except on Thursday when the practice is open until 8.30pm. The practice offers a variety of access routes including telephone appointments, on the day appointments and advance pre bookable appointments.

When the practice is closed services are provided by Herts Urgent Care via the 111 service.

Updated 24 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Verulam Medical Group on 5 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.
• 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 they were involved in their care and decisions about their treatment.
• Data from the national GP patient survey showed the practice was performing broadly in line with the local and national averages. However the scores in some areas related to patient experience during consultation with a GP were lower than local and national averages.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a 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.

The areas where the provider should make improvement are:

• Continue to monitor and ensure improvement to national patient survey results.

• Continue to seek and support patients who are also carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 November 2016

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

• Nursing staff supported by the GP had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The practice assessed needs and delivered care in line with relevant and current evidence based guidance and standards For example we saw that the practice used the NICE pathway for the management of hypertension which was referenced in the patient’s records.

• Performance for diabetes related indicators was comparable to the CCG and national average. For example, the percentage of patients with diabetes, on the register, in whom the last blood glucose reading showed good control in the in the preceding 12 months (01/04/2014 to 31/03/2015), was 72%, compared to the CCG and national average of 78%.

• Longer appointments and home visits were available when needed.

• 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 with relevant health and care professionals to deliver a multidisciplinary package of care.

• The Practice offered on-site phlebotomy services.

• The Practice offered influenza, pneumococcal, and shingles vaccinations to eligible patients through a call and recall system.

• Where possible, locally commissioned ‘closer to home’ community clinics were used to refer patients with long term conditions for specialist care. For example the community diabetic service and the community respiratory service which enabled the patient to receive care nearer to their home.

Updated 24 November 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. 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.

• The practice’s uptake for the cervical screening programme was 78%, which was comparable to the CCG average of 83% and the national average of 82%. 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 and health visitors.

• The practice provided a variety of health promotion information leaflets and resources for this population group for example the discreet provision of chlamydia testing kits and sign posting to Sexual Health Hertfordshire.

• Young patients were signposted to ‘YouthTalk’, which offered a safe place where young people could attend for counselling and support.

Updated 24 November 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.

• Patients over 75 had a named accountable GP.

• All these patients were offered an over 75 health check.

• 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 Community Nursing Team and coordinated care at home.

• The practice had identified older patients at high risk of admissions to hospital (patients with multiple complex needs, and involving multiple agencies) and worked community services in planning support.

• The practice provided an at home vaccination service for the housebound.

• Housebound patients had access to a domiciliary phlebotomy service provided by the local community trust.

• The practice had enrolled in the Electronic Prescribing Service (EPS). This service enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.

• The practice worked with local pharmacies and arranged the delivery of medicines to the housebound.

• The Practice promoted external domiciliary services for housebound patients. For example the visiting optician service.

Updated 24 November 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 offered late evening appointments on Thursday till 8.30pm for working patients and those who could not attend during normal opening hours.

• The practice provided telephone consultations at the patient’s request where appropriate.

• The practice offered pre bookable appointments up to six weeks in advance which could be booked in person by telephone or online.
• The practice offered NHS Health checks smoking cessation advice and travel immunisations.
• The practice had enrolled in the Electronic Prescribing Service (EPS). This service enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.

Updated 24 November 2016

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

• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was above the national average.

• The practice offered annual reviews to all patients on the mental health register which included physical checks.

• 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 including to the local Improving Access to Psychological Therapies (IAPT) services and to the counselling services available through the Wellbeing Team provided by the local mental health trust.

• 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.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 24 November 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 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 support groups and voluntary organisations.
• The practice held regular health visitor liaison and multi-disciplinary team meetings to discuss the care needs of specific patients.
• The practice held regular review meetings involving district nurses, GP’s and the local palliative care nurses for people that require end of life care and those on the palliative care register.
• 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.
• The practice identified patients who were also carers and signposted them to appropriate support.