Papworth Surgery

Updated 4 May 2016

Drs Cronk Newton and Tan provide General Medical Services to approximately 7,021 patients. The practice area comprises of the village of Papworth and 13 surrounding villages. The surgery is situated in a purpose built health centre and has a dispensary/pharmacy with the practice dispensing to 40% of its patient list.

The practice provides treatment and consultation rooms on the ground floor with ramp access and automatic doors. Parking is available. The practice is a Royal College of General Practitioners (RCGP) spotter practice, this ensured that the practice reported any trends and a timely picture of consultations by diagnosis to the RCGP research and surveillance centre. This data provided the RCGP, public health England and the Department of Health with early warnings of changes in the incidence of common illnesses presenting to GP surgeries. This was particularly important for illnesses such as influenza like-illness and incidence rates for acute illness. The practice was an accredited eastern region clinical research network practice and an accredited teaching and training practice.

The practice has a team of five GPs. Three GPs were partners which meant they hold managerial and financial responsibility for the practice. In addition to this, there is one salaried GP, one GP retainer and two GP registrars.

There is a team of practice nurses, which includes one nurse practitioner and one nurse prescriber, two practice nurses and a phlebotomist who run a variety of appointments for long term conditions, minor illness and family health.

There is a practice manager who is supported by an office manager, a dispensary manager and a practice administrator. In addition there are two dispensers and a team of non-clinical administrative, secretarial and reception staff who share a range of roles, some of whom are employed on flexible working arrangements. There is an integrated pharmacy on site with a superintendent pharmacist which dispenses medicines and provides a range of pharmacy services.

The practice provides a range of clinics and services, which are detailed in this report, and operates between 8.30am to 12.30pm and 1.30 to 5.30pm Monday to Friday. Appointments are from 9am to 12noon every morning and 3.30pm to 5.30pm daily. Extended surgery hours are offered from 6.30pm to 8pm every Monday (these days are adjusted for bank holidays). In addition to pre-bookable appointments with GPs, nurses and healthcare assistants that can be booked up to six weeks in advance at reception, on-line and by telephone, urgent appointments are also available for people that need them. Telephone appointments are available with each GP and telephone sessions are available with the duty GP with an early home visiting opportunity for patients with the duty GP (we were told the practice recorded 25% of GP contacts by telephone). In addition the practice provides a daily morning nurse led minor illness clinic Monday to Friday to provide quick access to appointments for patients.

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 4 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Cronk Newton and Tan also known as Papworth Surgery on 8 March 2016. Overall the practice is rated as good.

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, and addressed. Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles 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.
• 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 areas of outstanding practice:

• The practice was able to provide intra-ocular tests for glaucoma screening within the practice following the donation of equipment from a patient and the relevant GP training. The practice had undertaken 25 tests for patients in the previous year.

• The practice had a named nurse who undertook annual health reviews for patients with a learning disability and provided consistency of care by carrying out smears, doing blood tests and generally being a point of contact for patients with a learning disability and their families. Of the 20 patients on the practice learning disability register, 16 had received a face to face review of their care plans in the previous 12 months.The practice had access to a range of easy read health information including videos, health leaflets, support organisations and healthy food and exercises. The learning disability nurse used easy read books and picture learning material obtained from the local learning disabilities team.Additionally the practice diabetic lead nurse used these for healthy eating and exercise advice when reviewing learning disabilities patients with diabetes and the respiratory disease lead nurse when reviewing learning disability patients with asthma and chronic obstructive pulmonary disease.

• GPs provided telephone numbers and home visits for patients on palliative or end of life care at weekends and bank holidays. In addition GPs provided peer support to each other and nursing staff through daily meetings to review care and treatment.

The areas where the provider should make improvement are:

• Record verbal complaints in order to ensure shared learning.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 May 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 supported the CCG ‘transforming primary care initiative’ to help reduce hospital bed blocking whereby patients were transferred into a local rehabilitation facility.

• QOF performance for long term conditions such as asthma and diabetes was above or in line with CCG and national averages with the practice achieving 100% across all QOF indicators.

• 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.

• GPs provided daily home visits for patients on palliative or end of life care including weekends, bank holidays and Christmas day. All GPs had remote access software which ensured they were able to access patient information when the practice was closed to ensure continuity of care and treatment.

Updated 4 May 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.

• 100% of patients diagnosed with asthma and on the Asthma register, had an asthma review in the last 12 months from 2014 to 2015.

• 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 85.33% which was comparable to the national average of 81.83%. The practice uptake for patients aged 60-69, screened for bowel cancer in last 30 months was 60%, compared to the CCG average of 59% and the national average of 58%. The practice uptake for female patients screened for breast cancer in the last 36 months at 73% was comparable to the CCG average of 72.3% and national average of 72.2%.

• 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 4 May 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.

• One GP assisted in the setting up of a local day centre 23 years ago and remained chair of the management committee. This provided a centre for older patients to attend where they could pay a fee for a lunch and social activities. The practice told us they supported the centre with minor fund raising and liaised closely with the day centre staff.

Updated 4 May 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 4 May 2016

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

• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the preceding 12 months from 2014 to 2015, which is above the national average.

• The practice had identified 33 patients who were experiencing poor mental health on their register, 23 of these patients had received a face to face review of their care in the previous 12 months. We saw that the remaining 10 were scheduled for review where appropriate.

• 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.

• 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 4 May 2016

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

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• Of the 20 patients on the practice learning disability register, 16 had received a face to face review of their care plans in the previous 12 months, with the remaining patients scheduled for a review in the near future. The practice had a named nurse who undertook annual health reviews for patients with a learning disability and provided consistency of care by carrying out smears, doing blood tests and generally being a point of contact for patients with a learning disability and their families. Of the 20 patients on the practice learning disability register, 16 had received a face to face review of their care plans in the previous 12 months. The practice had access to a range of easy read health information including videos, health leaflets, support organisations and healthy food and exercises. The learning disability nurse used easy read books and picture learning material obtained from the local learning disabilities team. Additionally the practice diabetic lead nurse used these for healthy eating and exercise advice when reviewing learning disabilities patients with diabetes and the respiratory disease lead nurse when reviewing learning disability patients with asthma and chronic obstructive pulmonary disease.

• 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.