Bourn Surgery

Updated 3 March 2016

Bourn Surgery is situated in Bourn, Cambridgeshire. The practice provides services for approximately 5,900 patients across an area of approximately 120 square miles which surround Bourn. The practice is a dispensing practice and dispenses to over 95% of its patients. They hold a General Medical Services (GMS) contract. The practice has one male and two female GP partners, one salaried female GP and two female GP registrars. In addition to this, there is one female advanced nurse practitioner, two female practice nurses and a female health care assistant.

The practice employs a practice manager, a dispensary manager, three dispensers and a dispensary assistant. In addition a reception office manager and three reception/ administration/ secretarial staff.

The practice is part of the Cambridge Association to Commissioning Health and the Cambridge Federation of practices. One partner represented the practice on the Cambridge federation working group. The senior GP partner was the CCG Locality Clinical Lead for Cardiology and Stroke, and was a GP with special an interest in Cardiology at Addenbrooke’s Hospital. Other partners had special interests which included gynaecology, advanced contraception and care of the elderly.

The practice is a training and teaching practice, and is part of the Cambridge Deanery for the training of medical students.

The practice is open between 8am and 6pm Monday to Friday. Morning appointments are available from 8.30am to 1pm with the nurses and 9am to 11am with the GPs daily. Afternoon appointments are available with nurses and GPs from 3.30pm to 6pm. In addition, appointments are available at a rural satellite location in Great Gransden on Tuesdays for patients unable to travel to the surgery. Appointments for these surgeries are booked through the main surgery.

The practice does not provide GP services to patients outside of normal working hours such as nights and weekends. During these times GP services are provided by Urgent Care Cambridge via the 111 service.

Updated 3 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bourn Surgery on 21 January 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 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.
• Information about services and how to complain was accessible and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• 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.

We saw one area of outstanding practice:

• All of the GPs and the nurse practitioner saw incoming post, and held daily meetings to discuss patients, record patient information and action incoming correspondence. Issues were discussed with the multidisciplinary team, thus minimising error and enabling peer reflection.

The areas where the provider should make improvement are:

• Assess the suitability of the drop-off locations for the safe and appropriate storage of medicines.

• Sustain its efforts to implement and maintain an active Patient Participation Group (PPG) so that patients are able to formally contribute to the development of the practice.

• Ensure that  all waiting areas of the practice can be clearly seen by reception staff to ensure the safety and security of vulnerable patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 March 2016

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

• Nursing staff had lead roles in chronic disease management, and patients at risk of hospital admission were identified as a priority. The practice provides a full range of diagnostic services, including ambulatory blood pressure monitoring and spirometry for asthma and respiratory diseases such as chronic obstructive pulmonary disease.

• We saw that both elective and emergency referral rates were consistently below the local CCG average.

• Performance for diabetes related indicators was better when compared to the CCG and national average. The practice had achieved 98.8%, compared to the CCG average of 89.5% and national average of 89.3%.

• Longer appointments and home visits were available when needed.

• Patients with long-term conditions 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 3 March 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.

• Performance for all indicators including asthma and hypertension was better when compared to the CCG and national average with the practice achieving 100% across all other indicators.

• 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 86.2% which was above the national average of 81.9%.

• 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, health visitors and school nurses.

Updated 3 March 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.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice undertook weekly ‘ward round’ at the local residential home.

• There was also a system in place for the home delivery of patients’ medications.

Updated 3 March 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.

Updated 3 March 2016

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

• 93.3% of patients diagnosed with dementia who had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.

• 77.7% of patients experiencing poor mental health had had their care reviewed in a face to face meeting in the last 12 months.

• The practice regularly worked with multi-disciplinary teams in the case management of people 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 been involved in the setting up of a ‘Dementia Café’ at a local residential home.

• 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 3 March 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 multi-disciplinary teams in the case management of vulnerable people.

• 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 in normal working hours and out of hours.

• The practice liaised with the local drug and alcohol service for the management of patients with addiction to drugs and alcohol.