Archived: Dr F Rowe & Partners Also known as Howard House Surgery

Updated 18 February 2016

Howard House Surgery is located in Orwell Road in Felixstowe, a seaside town on the East Coast. The practice serves a population where older people are more highly represented than the national average. Currently the practice has 7200 registered patients. The practice employs 3 GP partners, 3 salaried GPs, a long term locum, 2 practice nurses, 2 nurse practitioners,2 health care assistants, and a management and administration team of 13 staff. Patients can see both male and femals GPs at this practice.

The practice is open between 8am and 8pm Mondays and Tuesdays and between 8am and 6.30pm Wednesdays, Thursdays and Fridays. Appointments are from 8.30am to 4pm daily. Extended hours surgeries are offered until 8.00pm Mondays and Tuesdays.

Additional GP appointments are available on weekday evenings, weekends and bank holidays through ‘GP +’. These appointments are at the Riverside Clinic in Ipswich, weekdays 6.30pm - 9pm, weekends & bank holidays 9am - 9pm. Outside of these hours, patients are asked to contact NHS 111 service for advice.

Updated 18 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr F Rowe & Partners on 7 January 2016. Overall the practice is rated as good.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

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. There was scope to improve and extend learning from significant events.

• 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, and clinicians had lead areas of responsibility.

• Patient records were of a particularly high standard due to methodical and consistent use of readcodes.

• Feedback from patients about their care was consistently and strongly positive.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• The practice used clinical audits to review patient care and took action to improve services as a result.

• Management of the practice formulary was strong and enabledpractice staff to support patients to manage their medicines in a safe and effective way.

• Patients said they were able to make appointments which suited them. Urgent appointments were 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 sought feedback from staff and patients, which it acted on.

We saw one area of outstanding practice:

• The practice had appointed a Medicines Management Lead and this staff member had adopted a particularly robust system which ensured that patients received the medicines they needed in a safe and effective way. Extensive work around the practice formulary had been undertaken. The electronic prescribing system had been adopted comprehensively and resulted in patients being able to access medicines in a convenient way. An effective system was in place to ensure that newly registered patients could access their medicines in a safe way. A robust system was in place to ensure that GPs were alerted when reviews for patients taking high risk medicines were due. There was clear and effective oversight of hypnotic and sedative prescribing. The practice had adopted a particularly robust approach to ensuring that not only MHRA (Medicines Health and Regulatory Authority) alerts but also MHRA safety updates were disseminated to staff and acted upon.

However there were areas of practice where the provider should make improvements:

• There was scope to improve and extend learning from significant events. The practice should also consider whether some complaints merit investigation as a significant event in order to maximise learning.

• There was scope to improve the information provided by screen in the waiting room so thatpatients could better access and understand it.

• Doctors’ bags should not contain medicines already prescribed to a patient, unless intended only for use by that named patient.

• There was scope to improve the management of blank presciption forms and to ensure that an audit trail of usage was maintained.

• Nurse meetings should be minuted in order to provide future reference and for sharing with absent staff. Likewise, outcomes from mutli-disciplinary team meetings should be recorded in patient notes.

• Ensure that patients with depression are correctly read coded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 February 2016

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

• All patients with a long-term condition had a named GP and nursing staff had lead roles in chronic disease management. For those patients with the most complex needs and associated risk of hospital admission, the practice team worked with health and care professionals to deliver a multidisciplinary package of care.

• Nursing staff have received training to equip them to deliver both diabetic reviews and asthma care appointments.

• Indicators to measure the impact of the management of diabetes were higher than local and national averages. Performance for the diabetes related QOF indicator was above the CCG and national average with the practice achieving 95.3%, which was 4.9% above the CCG average and 6.1% above national average.

• QOF indicator results for asthma were higher than CCG and national averages at 100%.

• Patients on the practice long term condition register were invited to a structured annual review to check that their health and medicine needs were being met. Patients were followed up where they did not attend.

Updated 18 February 2016

The practice is rated as good for the care of families, children and young people.

• Urgent appointments were available every day to accommodate children.

• 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, or did not attend for planned hospital appointments on more than two occasions. Effective liaison was in place between the practice and the health visiting team.

• Immunisation rates were in line with local and national averages for all standard childhood immunisations. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 86.3% to 100% and five year olds from 90.3% to 96.8%.

• 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 81.9% which was in line with the national average of 81.8%.

• The midwife holds an antenatal clinic at the surgery on Tuesday afternoons and parent craft classes one evening a week.

• The GPs provided an enhanced service to fit coils and contraceptive implants. These were undertaken by one of the GPs during sexual health sessions at Felixstowe Community Hospital.

• A clinic provided access to support with contraception.

Updated 18 February 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. Care plans were in place for older patients with complex needs.

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

• The practice provided primary medical services to residents living in local care homes. A CCG led initiative was in place to facilitate visits to patients in residential care by a Nurse Practitioner.

• Patients over 75 were able to attend the practice for annual health checks and were proactively supported to attend.

• The flu vaccination rate for over 65s was 70.98% which was comparable to CCG and national averages.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure were in line with or above local and national averages.

Updated 18 February 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. This included good access to appointments including telephone consultations.

• The practice participated in the Suffolk Federation access pilot called ‘GP+’ and made appointments available outside core hours.

• Health promotion and screening was provided that reflected the needs for this age group.

Updated 18 February 2016

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

• The dementia diagnosis rate was above the CCG and national average. It carried out advance care planning for patients with dementia. Monthly dementia clinics were provided for patients and their families.

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

• The practice had told patients experiencing poor mental health and patients with dementia about how to access various support groups and voluntary organisations. Leaflets were available in the waiting area on a range of services available for patients and carers.

• The practice told us that QOF data had not been submitted in 2013/14 and that the practice was therefore still on the back foot with regard to 2014/15 QOF results. We therefore reviewed the most recent information available and saw that a mental health register was in place and that regular reviews & care plans were in place for these patients. There was a clear system for monitoring patients on lithium therapy. There were also improved figures for recording of alcohol consumption for patients on the mental health register.

• We found that there were coding issues regarding depression assessments and the practice stated that improved GP staffing levels will address this gap.

Updated 18 February 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. Homeless people could register with the practice.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people and informed patients 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 provided good care and support for end of life patients. Patients were kept under close review by the practice in conjunction with the wider multi-disciplinary team.

• The practice had carried out annual health checks for people with a learning disability, and 32% had attended so far in 2015/16. The remaining patients were being contacted to arrange a health check. The practice offered longer appointments for people with a learning disability.