Saxmundham Health

Updated 22 April 2022

• The name of the registered provider is Saxmundham Health and is located at Lambsale Meadows, Saxmundham, Suffolk. IP17 1DY
• The practice is registered to provide the regulated activities of diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury.
• The practice area covers Saxmundham and the surrounding villages. The practice offers health care services to approximately 9,556 patients.
• The practice website is https://www.saxmundhamhealth.nhs.uk
• There are two GP Partners at the practice (one male and one female) and six salaried GPs (three female and three male).
• The practice clinical team also includes two advanced nurse practitioners, a mental health nurse and nurse consultant. There are two pharmacists, a paramedic, three practice nurses, three health care assistants, who also undertake phlebotomy and a phlebotomist.
• The practice manager is supported by an assistant practice manager, who is also the finance lead. The administration team, which includes secretaries and clinical administrators, is led by a data management administration lead. A team of seven care navigators are led by a care navigator lead and there are three front of house assistants. In the dispensary, there are dispensary joint team leads, and dispensers.
• The practice offers dispensing services to those patients on the practice list who live more than one mile (1.6km) from their nearest pharmacy. The practice and dispensary are open between 8am to 6.30pm Monday to Friday.
• The practice opens at 8am to 6.30pm every day with extended opening on Tuesdays and Thursdays at 7.30am until 7pm. Due to the enhanced infection prevention and control measures put in place since the COVID-19 pandemic and in line with the national guidance, most GP appointments were telephone consultations.
• Patients could book evening and weekend appointments with a GP through Suffolk GP+ (Suffolk GP+ is for patients who urgently need a doctor’s appointment or are not able to attend their usual GP practice on a weekday.)
• Out-of-hours GP services are provided by Suffolk GP Federation C.I.C., via the NHS111 service.
• According to Public Health England, the patient population has a higher proportion of patients aged 65 years and above compared to the practice average across England, with a significantly higher than average number of patients aged 65 to 69. Income deprivation affecting children and older people is lower than the practice average across England, but in line with the local average. Male life expectancy is 79 years for men, which is the same as the England average. Female life expectancy is 85 years for women, which is above the England average of 83 years.

Updated 22 April 2022

We carried out an announced desk based review of Saxmundham Health on 5 April 2022 Overall, the practice is rated as Good

Set out the ratings for each key question

Safe - Good

Effective -Not inspected

Caring - Not inspected

Responsive - Not inspected

Well-led - Not inspected

Following our previous inspection on 18 October 2019 the practice was rated good overall and for effective, caring, responsive and well-led key questions but requires improvement for providing safe services:

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Saxmundham Health on our website at www.cqc.org.uk

Why we carried out this /review

This desk-based review was to follow up on the breach of regulation and areas where the provider ‘should’ improve which were identified at our previous inspection. We found the required improvements had been made and the practice is now rated as good for providing safe services.

How we carried out the review

Throughout the COVID-19 pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our reviews differently.

This review was carried out in a way which enabled us to review the information without a site visit. This was with consent from the provider and in line with all data protection and information governance requirements.

This included

• Conducting staff interviews using video conferencing
• Requesting evidence from the provider

Our findings

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as Good for providing safe services

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• The practice had addressed the concerns identified in the previous report.
• Recruitment checks were carried out in accordance with the regulations.
• There were formal and recorded competency checks for staff to ensure they were competent to undertake their duties. This included a review of consultations, group supervision and case discussions. Additional recording in medical records was used to document where nursing or other staff had undertaken joint consultations or had sought advice from GPs.

In addition, in our previous report we identified the provider should:

• Review the process for recording and the distribution of prescription forms to ensure an effective audit trail. We saw systems and processes to ensure prescription forms were kept safe had been improved and sustained.
• Continue to work to reduce the likelihood of reoccurrence of significant events particularly in relation to the dispensary. At this inspection the practice provided clear evidence of events being recorded, actions identified and taken, and learning shared.
• Continue work to ensure the summarising of patient records is timely and effective. The practice had taken steps to reduce any significant backlog of patient’s medical records summarises. They had employed additional staff to enable this to happen.
• Take action to improve the uptake of all childhood immunisations. During this inspection we found despite the COVID-19 pandemic the practice had improved their performance. According to the public health data 1 April 2020 to March 2021, two out of five domains were above the 90% target rate. The other three were slightly below the 90% target rate. The practice team had completed a comprehensive review which they planned to do annually. A review had been undertaken on 1 and 22 June 2021 and covered all aspects including responsibilities of the GPs and nurses, overall management and clinical responsibility.
• Continue work to improve the review of patients diagnosed with cancer. The practice employed a nurse consultant who undertook reviews of patients with a diagnosis of cancer, they had completed 98% of all reviews. The practice had despite the COVID -19 pandemic also improved their performance for patients attending their appointments for the national cervical cancer screening programme.

Area of outstanding practice;

At our last inspection we told the provider they should continue work to monitor quality outcomes for people with long term conditions and those experiencing poor mental health, including dementia.

At this inspection we found the provider had improved and regularly reviewed the care of these vulnerable patients. This included additional meetings to review data, which led to improved recall systems, care in patients own homes, information for patients on their website, and coding of medical records.

Following the identification of reduced resources in the community to support patients experiencing poor mental health or dementia they employed additional staff such as a nurse specialising in mental health who had been employed for six sessions per week. This equated to approximately 50 appointments per week giving extra support for patients who were experiencing poor mental health or those who required review of their medicines such as anti-depressants. The practice told us, despite the COVID-19 restriction they had undertaken 75% of complete annual reviews for patients with dementia and their carers, with many taking place in the patient’s own home where they were less anxious and more comfortable. The practice had worked with other organisations such as ‘Dementia together’ and carried out an audit of their premises to ensure they were doing all they could to accommodate patients who could become more confused with different surroundings. The practice had also developed a pilot project with the Green Light Trust who help patients with poor mental health, low moods, or addictions to change their lifestyles by communing with nature rather than medication. Some of the practice nursing team were undertaking an academic study to show the positive outcomes of this work. The practice had worked with their PPG to help reduce social isolation and have activities such as a regular film club organised.

The practice told us they recognised that in particular during the COVID-19 pandemic patients found it harder to maintain healthy lifestyles. The lead GP formed a group called SHIFT (Saxmundham Health Intermittent Fasting Team) and has educated and supported patients to make changes. As a result of this work they have recorded positive outcomes for patients with some losing a significant amount of weight and having reduced or no longer needing medication to help their diabetes.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care