Hardwicke House Also known as Hardwicke House Group Practice

Updated 5 May 2017

The practice area covers the town of Sudbury and extends into the outlying villages. There are five surgery sites, and medicines are dispensed from three of these. The practice offers health care services to around 23000 patients and has consultation space for GPs and nurses as well as extended attached professionals including midwives, physiotherapists, and staff from services such as a sleep apnoea clinic. Hardwicke House is the practice where the administrative functions for the practice are managed. The practice holds a Personal Medical Service (PMS) contract with the local CCG, and is a training practice providing education to medical students.

• There are seven GP Partners and seven salaried GPs at the practice (eight female and six male GPs). There are three healthcare assistants, one nurse practitioner, and six practice nurses. A team of sixteen dispensary trained staff support the medicines manager.
• A team of 40 administration and reception staff support the management team. The practice manager is support by a deputy manager and an IT manager. Each branch site has a manager.
• The practice is open between 8am and 6.30pm Monday to Friday; extended hours are available on Saturday mornings each week.
• If the practice is closed IC24 provide emergency care, patients are asked to call the NHS111 service or to dial 999 in the event of a life threatening emergency.
• The practice demography is similar to the national average but each practice site has its own demography within their immediate area.

• Male and female life expectancy in this area is in line with the England average at 80 years for men and 84 years for women.

Updated 5 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hardwicke House on 3 October 2016. The practice was rated as good overall, and requires improvement for providing safe services as improvements were needed to ensure that medicines were managed appropriately. The full comprehensive report on the 3 October 2016 inspection can be found by selecting the ‘all reports’ link for Hardwicke House on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 18 April 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 3 October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice is now rated as good overall and good for providing safe services.

Our key findings were as follows:

• Standard operating procedures which govern the dispensing of medicines were comprehensive and available at all dispensing sites. Effective standard operating procedures and log books for the recording of the destruction of medicines, including controlled drugs (medicines that require extra checks and special storage requirements because of their potential for misuse) had been produced and implemented.
• Systems and processes were in place to ensure that medicines, including vaccines, were stored within the recommended temperature range and medicines were checked for expiry dates. However the refrigerator thermometer was not being reset in line with guidelines in the dispensary at Hardwicke House. A standard operating procedure was submitted following the inspection to address this.
• The practice held appropriate emergency medicines which were checked regularly and were all in date.
• Patient group directives for the nursing staff had been signed and were up to date.
• A system was in place to ensure the practice management team had oversight of staff training and that staff were informed of updates and changes within the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 October 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. All patients with diabetes were seen for six monthly reviews.
• 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.
• Appointments were offered at the branch sites to ensure that patients who had difficulty in travelling could access routine follow up.

Updated 25 October 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 in line with the national averages 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 the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors, and school nurses.
• A full range of contraceptive care was offered at all sites including long acting contraceptives. Saturday appointments were available.    

Updated 25 October 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 proactively cared for patients who lived in care homes and undertook regular visits.
• Patients could be seen at any of the five practices, enabling patients to attend the one most convenient to them.
• The practice provided appointments on a Saturday for patients with complex dressing needs. This ensured that patient’s dressings were changed timely to aid healing and better outcomes.

Updated 25 October 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. Emails from patients for administration purposes were managed effectively, they did not offer this for clinical care at this time, as the governance systems are complex, and we were told that they are working towards this in the future.
• The practice offered appointments on Saturday mornings for GPs, nurses and health care assistants enabling patients that could not attend during the weekdays to access appointments.
• Smoking cessation and NHS health checks were encouraged. The practice had over 1000 checks and 89% of these had been completed.
• Telephone appointments were available for those that wished to seek advice in this way.

Updated 25 October 2016

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

• The practice had 302 patients diagnosed with dementia on the register. 62% of these patients had received an annual review. Many of the remaining 28% lived in care homes and had GP reviews throughout the year. The reviews included advance care planning.
•  The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice had told patients experiencing poor mental health about how 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. GPs demonstrated that they managed complex patients with care plans and continuity of care.

Updated 25 October 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• There was a lead GP and the practice held a register of patients living in vulnerable circumstances including homeless people, travellers, and 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 various support groups and voluntary organisations.
• The practice staff had received training, and 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 lead GP undertook regularly training and update sessions for GPs and practice staff.