Schopwick Surgery

Updated 26 April 2017

Schopwick Surgery is a two-site GP service. Services are provided from the following main location and the branch practice. Patients can attend either of the two locations. We visited the main practice during this inspection:

Schopwick Surgery (the main practice)

Everett Court

Romeland

Borehamwood

Hertfordshire

WD6 3BJ

Bushey Practice (the branch practice)

Windmill Street

Bushey

WD23 1NB

It has a clinical team of eight GP partners, three GP registrars and one salaried GP. This includes seven female GPs and five male GPs. Three practice nurses and a healthcare assistant are available and a team of 17 receptionists and eight administrators provide non-clinical support.

The practice is readily accessible for people who use wheelchairs and by parents with pushchairs. A portable hearing loop system is available and there are quiet waiting facilities for patients who find the main waiting area can cause anxiety. Private space is available for breast-feeding.

The practice services a patient list of 12,878 and is in an area of very low deprivation. Of the patient list, 48% are living with a long-term condition and 58% are in paid employment or full time education.

This is a teaching and training practice, including for foundation level and specialty trainee doctors, medical students from two universities and student nurses.

Appointments are from 8.30am to 6.30pm Monday to Friday. Saturday morning appointments are available on alternate weeks and the service offers Sunday flu clinics. The practice offers commuter appointments from 7am on demand and after-school appointments from 6.30pm to 8pm two evenings per week.

We previously carried out an inspection in August 2013, when we judged the practice as ‘compliant’ according to our inspection criteria at the time.

Updated 26 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Schopwick Surgery on 19 December 2016. Overall the practice is rated as outstanding.

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 and the practice sought to continually improve processes.
• 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.
• 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 invested significant resources into improving and expanding access. This included the provision of extended opening times and an innovative virtual surgery.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear 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.
• Clinical staff proactively shared decision making with patients. This meant patients had input into their condition management plans as a strategy to help empower them to improve their health.
• There was a consistent, overarching focus on health promotion and educating patients to live healthier lives as part of a collaborative relationship. A dedicated carers’ champion and resource centre, and bi-annual healthy living events helped to embed this in practice and there was evidence of improved patient outcomes as a result.
• The practice was proactive in providing palliative care and support for patients in line with the national Gold Standards Framework. This was one example of a substantial range of multidisciplinary relationships and initiatives that the practice proactively sought to develop to meet the needs of its patients.
• There was a focus on continuous learning and improvement at all levels within the practice. The practice team was forward thinking and part of local pilot schemes to improve outcomes for patients in the area.
• An innovation lead GP was in post who provided support to staff to improve patient care and reduce health inequalities in the local population. Recent innovations had been rewarded and recognised by national bodies, which was indicative of the commitment and passion of the practice team.

We found areas of outstanding practice:

• A GP acted as the dedicated lead for IT development and patient engagement through social media. The virtual surgery provided patients with direct access to health advice and guidance and enabled them to get a fast response from a GP for non-urgent conditions.
• The practice had been recognised nationally for its innovative work in supporting carers and in developing a community navigators programme. This led to the practice staff being awarded a Health Service Journal Value in Health Care Award in 2015. In addition, the housebound project was recognised by the Royal College of General Practitioners (RCGP) and staff were selected to present their work at the annual conference in 2016.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 26 April 2017

The practice is rated as good for the safe, effective and caring domains and outstanding for responsive and well-led. The practice overall is rated outstanding, which includes services for this population group:

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. A GP partner was the clinical lead for patients with long-term conditions and maintained a register of patients that ensured patients received continuity of care.
• Staff used templates and registers to provide timely and structured care, including proactive reviews.
• The practice performed significantly better than national and Clinical Commissioning Group averages in the Quality Outcomes Framework in three clinical domains relating to long term conditions.
• Longer appointments and home visits were provided for patients along with a range of extra services, including a virtual clinic that offered advice and guidance on condition management.
• 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.

Updated 26 April 2017

The practice is rated as good for the safe, effective and caring domains and outstanding for responsive and well-led. The practice overall is rated outstanding, which includes services for this population group:

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk. This included children and young people who had a high number of emergency hospital attendances and those who were known to be affected by health inequalities.
• Immunisation rates were similar to national and Clinical Commissioning Group averages for standard childhood immunisations.
• Children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. This included new mother and baby focused reviews and targeted meetings with foster carers and looked after children.
• 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 proactively encouraged family registrations to ensure holistic care.

Updated 26 April 2017

The practice is rated as good for the safe, effective and caring domains and outstanding for responsive and well-led. The practice overall is rated outstanding, which includes services for this population group:

• The practice offered proactive, personalised care to meet the needs of the older people in its population. The practice had been recognised by the Royal College of General Practitioners for its work in developing a housebound patient visiting service.
• A carers’ champion was in post who provided a single point of access for advice and same-day appointments. This service had been recognised with a Health Service Journal Value in Health Award in 2016.
• The practice was responsive to the needs of older people, and offered home visits, urgent appointments and extended appointments.
• Two GPs and a receptionist provided dedicated support to local nursing homes that included same-day appointments and continuity of care.
• The practice facilitated multidisciplinary palliative care that included advance care planning in line with the national Gold Standard Framework.

Updated 26 April 2017

The practice is rated as good for the safe, effective and caring domains and outstanding for responsive and well-led. The practice overall is rated outstanding, which includes services for this population group:

• 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. This included a range of extended hours, a virtual clinic access and the flexibility to be seen in either of the available practices.
• The practice was proactive in offering a full range of health promotion and screening that reflected the needs for this age group. This included screening for prediabetes, atrial fibrillation and chlamydia.
• A travel vaccination service and ‘catch-up’ vaccination service was offered.
• This population group were targeted with a bi-annual healthy living event that provided patients with access to specialist health organisations.

Updated 26 April 2017

The practice is rated as good for the safe, effective and caring domains and outstanding for responsive and well-led. The practice overall is rated outstanding, which includes services for this population group:

• The practice was the lead organisation in the Clinical Commissioning Group for mental health and dementia.
• 86% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was better than the national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• Each patient had a structured annual mental health review and Lithium monitoring.
• The practice carried out advance care planning for patients with dementia.
• The practice supported patients experiencing poor mental health to access various support groups and voluntary organisations.
• 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, such as through the use of a dedicated patient resource room for patient support meetings.

Updated 26 April 2017

The practice is rated as good for the safe, effective and caring domains and outstanding for responsive and well-led. The practice overall is rated outstanding, which includes services for this population group:

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• A lead GP for learning disabilities was in post and provided annual reviews, safeguarding reviews and health checks.
• 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, including independent advocates.
• The practice informed 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.
• Regular carers clinics were offered that enabled carers to meet each other and receive guidance and support from staff as a group.