New Road Surgery

Updated 30 March 2017

New Road Surgery situated in Croxley Green, Rickmansworth, Hertfordshire is a GP practice which provides primary medical care for approximately 10,432 patients. There is branch, the Church Lane Surgery, situated at the nearby village of Sarratt. The practice maintains one patient list and patients can consult at any of the above locations. We did not inspect the Church lane branch at this time. However we inspected the dispensary situated at this branch. Together they provide primary medical care to the residents living in Croxley Green, Sarratt and surrounding areas.

New Road Surgery provides primary care services to local communities under a General Medical Services (GMS) contract, which is a nationally agreed contract between general practices and NHS England. The practice population is predominantly white British along with a small ethnic population of Asian and Afro Caribbean origin.

The practice has five GPs partners (two female and three male). There are three other salaried GPs (all females). There is a senior practice nurse and five practice nurses who are supported by two health care assistants (all females). There is a practice manager who is supported by a deputy and a team of administrative and reception staff. The local NHS trust provides health visiting and community nursing services to patients at this practice.

The practice provides training to doctors studying to become GPs (who are called GP Registrars).

New Road Surgery is a dispensing practice and has a dispensary at the Church lane branch which is open from 8am to 12 noon Monday to Friday. There is a dispenser who is supported by a lead GP for medicine management.

Patient consultations and treatments take place on ground level. There is a car park outside the surgery with adequate disabled parking available.

The practice is open Monday to Friday from 8am to 6.30pm. On Monday and Thursday the practice offers extended evening opening till 8pm. On the first and third Saturday of each month the practice is open between 7.50am and 10am. There are a variety of access routes including telephone appointments, on the day appointments and advance pre bookable appointments.

When the practice is closed services are provided by Herts Urgent Care via the 111 service.

Updated 30 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at New Road Surgery on 7 and 15 December 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. However some aspects of managing infection control risks needed strengthening.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Most staff had received an annual appraisal in the past 12 months.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day.
• The practice had established systems to support carers.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a leadership structure and staff felt supported by management.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Complete the infection control action plan as per the agreed completion dates paying particular attention to the immunisation status of staff with front line patient duties.

• Consider ways of improving the breast screening uptake.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 March 2017

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

• GPs supported by nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The practice provided specialist clinics and nurses for diabetes, chronic obstructive pulmonary disease (COPD), asthma, and anticoagulation.

• There was a system to identify patients at risk of hospital admission that had attended A&E or the out of hours service and these patients were regularly reviewed to help them manage their condition at home.
• Performance for diabetes related indicators were comparable to the CCG and national average. For example, the percentage of patients with diabetes, on the register, in whom the last blood pressure reading showed good control (in the preceding 12 months) was 78%, where the CCG average was 77% and the national average was 78%.
• 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 care professionals to deliver a multidisciplinary package of care.
• The practice held regular review meetings involving district nurses, GPs and the local palliative care nurses for people that required end of life care and those on the palliative care register.

Updated 30 March 2017

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 within target 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.
• The practice’s uptake for the cervical screening programme was 81%, which was comparable to the CCG average of 82% and the national average of 81%. 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 and health visitors.
• The practice provided a variety of health promotion information leaflets and resources for this population group. For example, smoking cessation, sexual health immunisations and obesity where patients could have access to dedicated slimming programmes through third party services.
• The practice offered a range of contraceptive services including sub dermal implants and contraceptive coils.
• The practice offered referrals to family planning and related screening such as chlamydia screening.

Updated 30 March 2017

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.
• All patients over 75 had a named accountable GP.
• All these patients were offered an over 75s health check.

• The practice had identified 2% of the frailest patients at high risk of admissions to hospital (patients with multiple complex needs identified under the Proactive Care Programme) and worked with community services in planning support.

• The practice reviewed care of nursing home patients who had recently had a hospital admission and adjusted their care plans accordingly including adding them to the patients at high risk of admissions to hospital.

• The practice offered domiciliary phlebotomy services for patients unable to travel to hospital.

• There was a home flu vaccination service during the flu vaccination season.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice supported a local care home and visited twice weekly to provide healthcare for the residents.

Updated 30 March 2017

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.

• The practice was open till 8pm on Monday and Thursday. On the first and third Saturday of each month the practice was open from 7.50am until 10am.

• As part of Watford Care Alliance (a hub of local practices) patients could also access a GP at the weekend, on a Saturday between 9am and 1pm and 3pm and 7pm and on a Sunday between 9am and 1pm.
• The practice provided a ring back service by a duty GP or a nurse at the patient’s request where appropriate.
• The practice offered the Men ACWY vaccine to young teenagers and 'fresher' students going to university for the first time to protect them against meningitis (an inflammation of the lining of the brain) and septicaemia (blood poisoning).

• Online services were available for booking appointments and request repeat prescriptions.

• The practice had enrolled in the Electronic Prescribing Service (EPS). This service enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.

• The dispensary at the branch situated at the nearby village of Sarratt was open from 8am to midday, Monday to Friday which enabled patients to collect medication without excessive travel demands.

Updated 30 March 2017

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

• 74% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average.

• The practice offered annual reviews to all patients on the mental health register which included physical checks.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice in conjunction with other practices in the locality participated in the “twiddle muffs” knitting project to help some patients with dementia overcome their restless hands and keep them occupied.

• The practice had told patients experiencing poor mental health about how to access support groups and voluntary organisations including the community drugs and alcohol team.

• Patients had access to onsite counselling and cognitive behavioural therapy (CBT) sessions provided by the local mental health trust.

• The practice had a system in place to follow up patients who had attended A&E 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 30 March 2017

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 was given the Purple Star award by Hertfordshire County Council in recognition of services to help people with learning disabilities.

• 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 support groups and voluntary organisations.

• The practice held regular health visitor liaison and multi-disciplinary team meetings to discuss the care needs of specific patients.

• 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 identified patients who were also carers and signposted them to appropriate support. The practice’s computer system alerted GPs if a patient was also a carer.  The practice had identified 145 patients as carers (1.4% of the practice list). The practice had a designated carers’ champion who provided information and directed carers to the various avenues of support available to them. This included referral to Carers in Hertfordshire which supported people in their caring role. The practice offered annual health checks vaccinations and flexibility of booking appointments to carers.