The Hawthorns Surgery

Updated 26 April 2017

The Hawthorns Surgery provides services to approximately 8,500 registered patients. The practice has a General Medical Services (GMS) contract and offers enhanced services for example; various immunisation and learning disabilities health check schemes. Care is provided to patients living in residential and nursing home facilities and a local hospice.

The practice has a below average number of patients aged 10-44 years, and an above average number of patients aged 50 – 59 years and patients aged over 75 years. There are a higher than average percentage of patients with long standing health conditions. The practice has a lower number of children and older people affected by deprivation than the national average although it is slightly higher than the clinical commissioning group average.

Care and treatment is delivered by five GP partners and one salaried GP (five male, one female). The practice employs a team of one nurse practitioner, three practice nurses, and three phlebotomists. GPs and nurses are supported by the practice manager, an IT manager and a team of reception and administration staff.

The practice is a GP training practice and supports qualified doctors who are completing their specialist GP training.

The practice is open from 8.00am to 6.30pm Monday to Friday and offers extended hours appointments from 6.30pm to 7.10pm on Mondays. Patients requiring a GP outside of normal hours are advised to call NHS 111 where they will be directed to the most appropriate out of hours service.

Services are provided from:

The Hawthorns Surgery

1 Oxford Road

Redhill

RH1 1DT

Updated 26 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Hawthorns Surgery on 25 February 2016. The overall rating was good. During the inspection we found breaches of legal requirements and the provider was rated as requires improvement under the safe key question. Following this inspection the practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:-

• Ensuring that there is regular testing of water supply temperatures in order to minimise the risk of exposure of staff and patients to Legionella bacteria.
• Ensuring the timely review of all documents, patient reports and correspondence received by the practice in order to promote safe outcomes for patients.

The full comprehensive report on the 25 February 2016 inspection outcome can be found by selecting the ‘all reports’ link for The Hawthorns Surgery on our website at www.cqc.org.uk.

An announced focused inspection was carried out on 28 March 2017. This inspection was to verify if the practice had carried out their action plan to meet the legal requirements in relation to the breaches in regulations that we had identified in our previous inspection on 25 February 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At our previous inspection on 25 February 2016, we rated the practice as requires improvement for providing safe services as water temperatures were not being monitored in accordance with the Legionella risk assessment and correspondence received by the practice was not being actioned in a timely manner. At this inspection we found that the practice had completed their action plan and the practice is now rated as good for providing safe services.

Our key findings at this inspection, 28 March 2017 were as follows:

• Water temperatures were being monitored regularly in accordance with the Legionella risk assessment.
• The practice had implemented a system to ensure there was clear responsibility for handling correspondence and to ensure that it was reviewed and dealt with in a timely manner.

At our previous inspection on 25 February 2016, we also found that the arrangements for the storage of clinical waste awaiting collection could be improved.

During our inspection 28 March 2017 we saw;

• The practice had improved the arrangements for clinical waste to ensure that it was stored securely prior to collection.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 July 2016

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

• GP Partners and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. 
• Nationally reported data showed that some outcomes for long-term conditions were comparable with national averages. For example, the percentage of patients with diabetes in whom the last IFCC-HbA1c was 64mmol or less in the preceding 12 months was 82.19% compared with a national average of 80.4%.
• Longer appointments and home visits were available when needed.
• Patients received a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 8 July 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.
• Nationally reported data showed that patient treatment outcomes were comparable with national averages. For example, 71.4 % of patients with asthma, on the register, had an asthma review in the preceding 12 months compared to a national average of 72%
• 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.
• 84.9% of eligible female patients had a cervical screening test compared to the national average of 81%.
• The practice offered daily telephone triage appointments with the duty GP.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice participated in health promotion programmes aimed at reducing sexual health risks, including contraception and safe sex advice and screening for sexually transmitted diseases. Coil fitting services were provided.
• The practice worked closely with community midwives who ran regular ante-natal clinics from the practice. 

Updated 8 July 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 patients and offered home visits and urgent appointments for those with enhanced needs. Home visits were usually undertaken by the patient’s named GP in order to ensure continuity of care.
• The practice had appointed a care plan co-ordinator who worked closely with the GPs to monitor patients at high risk of unplanned admissions and to ensure timely review of care plans.
• The practice provided care and support to patients who were resident in nearby nursing and residential homes.
• The practice held monthly multi-disciplinary meetings and held strong links with the community matron, district nursing staff and hospice nurses.

Updated 8 July 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 offered extended hours appointments on one evening each week and on Saturday mornings for working patients who could not attend during normal opening hours.
• 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 8 July 2016

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

• Performance for mental health related indicators was comparable with or above the national averages: the percentage of those patients with schizophrenia, bipolar affective disorder and other psychoses who had a record of their alcohol consumption in the preceding 12 months was 95.83% compared with a national average of 92.4%; 79.52% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, compared with a national average of 83%.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• 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 and worked closely with the dementia community matron.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice implemented self-referral pathways to Improving Access to Psychological Therapies services to enable patients to gain access to help and support.
• 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.

Updated 8 July 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 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 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.