Thaxted Surgery

Updated 27 April 2016

The Thaxted Surgery is located in the village of Thaxted, Essex. The practice provides services for 7300 patients living in predominantly rural areas of Thaxted, Dunmow and Saffron Walden. The practice holds a General Medical Services (GMS) contract and provides GP services commissioned by NHS England and West Essex Clinical Commissioning Group. A GMS contract is one between GPs and NHS England and the practice where elements of the contract such as opening times are standard.

The practice population is slightly lower than the national average for younger people and children under four years, and for those of working age and those recently retired, and slightly higher for older people aged over 75 years. Economic deprivation levels affecting children, older people and unemployment are lower than the practice average across England. However there are pockets of economic and social deprivation. Life expectancy for men and women are similar to the national averages. 71% of the practice population of working aged patients are in paid employment or full time education compared to the national average of 60%. The percentage of patients who are unemployed is 1.6% which is significantly lower than the national average of 6.2%.

At 48% the practice patient list has a slightly lower than the national average for long standing health conditions which is 54% and they also have lower disability allowance claimants. The practice has a slightly higher percentage than the national average of patients living in care homes at 0.7% compared to 0.5% nationally.

The practice is managed by four GP partners and the practice manager who hold financial and managerial responsibility. In total two male and four female GPs are employed. The practice also employs two salaried GPs, two practice nurses and two health care assistants. A practice manager is also employed and is supported by an assistant practice manager and a team of reception and administrative staff.

The practice is open between 8am and 6.30pm on weekdays and receptionists are available during this time. Morning GP and nurse appointments are available between 8.30am and 11.30am, and afternoon appointments are available between 3.30pm to 5.30pm. The practice offers emergency same day appointments between 11.50am and 5.30pm each weekday. The practice is also open on alternate Saturday mornings between 8.30am and 12pm and provides a range of pre-booked GP, nurse and health care assistant appointments.

The practice has opted out of providing GP out-of-hours services. Unscheduled out-of-hours care is provided by PELC through the NHS 111 service and patients who contact the surgery outside of opening hours are provided with information on how to contact the service.

Updated 27 April 2016

We carried out an announced comprehensive inspection at The Thaxted Surgery on 18 November 2015. Overall the practice is rated as good. The practice is rated as good for each of the domains and all of the population groups.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Learning from when things went wrong was widely shared with staff through meetings and discussions. People affected by safety incidents were offered an explanation and an apology.
• There were systems for assessing and managing risks. There were systems for assessing risks including risks associated with medicines, premises, fire, equipment and infection control.
• The practice fire alarm system was linked to and triggered by a number of smoke detectors within the practice. There were no other systems for raising an alarm in the event of an outbreak of fire (such as in case of fire break glass fire alarm).
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Clinical audits and reviews were carried out to make improvements to patient care and treatment.

• Staff performance was appraised and any further training needs had been identified and planned.

• 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 available and easy to understand. Complaints were investigated and responded to appropriately and apologies given to patients when things went wrong or their experienced poor care or services.
• 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.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider Should:

• Review the procedures for raising an alarm in the event of an outbreak of fire within the practice.

• Review the checking procedures for medicines within the dispensary so that they are checked more frequently to identify when medicines have expired.

• Maintain copies of the appropriate checks including employment references are carried out when staff are employed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 April 2016

The practice is rated as good for the care of people with long-term conditions. GPs and nursing staff had lead roles in chronic disease management and provided a range of clinics including asthma, diabetes and chronic obstructive pulmonary disease (COPD). The practice performance for the management of these long term conditions was similar to or higher than other GP practices nationally.

• Patients had access to appointments for structured health care reviews and monitoring for long term conditions.

• GPs had specialist interests in a number of long term conditions including heart failure, respiratory conditions and diabetes.

• Regular clinical audits were carried out to improve outcomes for patients with one or more long term condition.

• Appointments were flexible and available on Saturdays.

Updated 27 April 2016

The practice is rated as good for the care of families, children and young people. Appointments were available outside of school hours.

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. Regular meetings were held with other health care professionals to coordinate care for children who were at risk.

Immunisation rates were similar to or higher than other GP practices 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.

Information and a range of sexual health and family planning clinics were available.

Updated 27 April 2016

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

• Medicines dispensing was provided where needed and medicines could be delivered to patients in their homes where this was appropriate.

• Home visits for seasonal flu vaccinations were provided as required.

• Weekly home visits were made to review those patients who lived in local care homes.

• Vulnerable elderly patients and those who were nearing end of life had access to GPs via mobile telephone if needed and these patients were supported so that they could remain and be cared for at home to reduce unplanned hospital admissions.

Updated 27 April 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 had increased the number of nurse appointments to improve access to patients for routine health checks and the treatment of minor illnesses.

The practice was proactive in offering online services including on-line appointment. The practice offered a full range of health promotion and screening that reflects the needs for this age group including NHS health checks.

Updated 27 April 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice had a lead GP with specialist training in mental health and they oversaw the arrangements for supporting these patients. Regular meetings were held with other healthcare professionals to coordinate the care and treatment for patients with mental health conditions.

The practice worked closely with local mental health organisations and advised patients experiencing poor mental health about how to access various support groups and voluntary organisations. Local counsellors were able to use the premises so that patients did not have to travel elsewhere for this service.

It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with autism, mental health needs and dementia.

Updated 27 April 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 patients with a terminal illness and those with a learning disability. The practice proactively promoted annual health checks for patients with learning disabilities and carried out home visits for these reviews as needed.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. This helped to ensure that patients whose circumstances made them vulnerable were supported holistically and that patients who were at a higher risk of unplanned hospital admissions were supported to and treated in their home.

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.