Hedingham Medical Centre

Updated 7 September 2017

Hilton House surgery in Halstead is a dispensing practice based in rural Essex and provides medical services to a patient base of approximately 3,400, covering the rural areas around the Hedinghams and Yeldhams. There is a small car park adjacent to the surgery for use by staff and patients.

They hold surgeries at their main surgery at Hilton House and a branch surgery in Great Yeldham. There are four part time GPs in total (one male and three female) and they are supported by two practice nurses, a healthcare assistant and three dispensing staff. The part time practice manager is supported by a team of administration and reception staff.

The practice age profile identifies 25% of their patient list were aged between 65 and 74 years of age compared to a CCG average of 19% and a national average of 17%. The percentage of patients with long term conditions was 61% compared to a CCG average of 52% and a national average of 53%.

The practice delivers commissioned services under the General Medical Services (GMS) contract. It offers direct enhanced services for meningitis provision, the childhood vaccination and immunisation scheme, facilitating timely diagnosis and support for people with dementia, influenza and pneumococcal immunisations, learning disabilities, minor surgery, patient participation, rotavirus and shingles immunisation and unplanned admissions.

Appointments are available at both locations for patients and they open at a variety of hours during the week. On any one day patients can book appointments at either one of the surgeries. There are no late night or early morning surgeries.

In general, appointment times range from between 8.30am to 1pm and 2.30pm to 6.30pm throughout the week. When surgeries are not taking place, the practice is open for patients to discuss issues and book appointments by speaking to reception staff. There is a GP on site at all opening times.

The Hilton House practice is open between 8.30am to 1pm and 4pm to 6.30pm Tuesday, Wednesday and Friday and on Monday and Thursday between 8.30am to 1.30pm. The branch surgery is open Monday and Thursday from 2.30pm to 4.30pm. During times when surgeries are not taking place, the practice has an ‘on-call’ system where GPs would cover emergencies and any other matter that cannot be dealt with in the routine surgeries. Dispensing opening times were the same as the surgery times.

In addition to pre-bookable appointments that could be booked up to one month in advance, urgent appointments are also available for people that need them. When the practice is closed patients can contact Primecare, the out of hours provider, who provide services from 6.30pm until 8am on weekdays and from 6.30pm on Fridays until 8am on Mondays, and also during Public Holidays.

Updated 7 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hilton House Surgery on 27 January 2016. The overall rating for the practice was requires improvement and the practice was rated as requires improvement for providing safe, effective, responsive and well-led services and good for caring. We issued the provider with a requirement notice for improvement. The full comprehensive report on the January 2016 inspection can be found by selecting the ‘all reports’ link for Hilton House Surgery on our website at www.cqc.org.uk.

We then carried out a further comprehensive inspection on 11 May 2017. This inspection was undertaken to re-rate the practice and to ensure that the improvements identified at the January 2016 inspection had been actioned. Overall, the practice is now rated as good.

Our key findings were as follows;

• The practice had improved their system of governance and made considerable improvements since our last inspection in January 2016.

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. Learning was being cascaded to staff.
• The practice had undertaken risk assessments across a range of areas that protected patients and staff.
• Medicine management was effective, including the monitoring of patients prescribed high-risk medicines.
• Medicine and patient safety alerts were managed effectively and changes of treatment made where required.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• A staff induction system was now in place. Staff received adequate supervision and appraisal.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment. Data had generally improved since July 2016 although there was improvement still required in relation to patient satisfaction over telephone access and the opening hours of the surgery.
• The practice had identified a high number of carers and provided them with support and guidance and an assessment of their needs.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice responded to the needs of their patient population and provided services accordingly.
• 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 governance at the practice had improved and the practice performance in the Quality and Outcomes Framework remained consistently high.

The areas where the provider should make improvement are:

• Continue to improve patient satisfaction in relation to access to the practice by phone and the opening hours of the surgery.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 September 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health. These patients were on a register and a multi-disciplinary package of care was provided. This included patients who were resident in care homes.

• Patients with long-term conditions received regular health reviews. Data from the Quality and Outcomes Framework (QOF) reflected that the practice performed consistently well for these patients.

Updated 7 September 2017

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

• Staff had received training in safeguarding children and two GPs were identified as leads in this area. We found there were effective systems to identify and follow up children who were at risk.

• Immunisation rates were relatively high for all standard childhood immunisations.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice worked with midwives, health visitors and school nurses to support this population group.

• The practice had emergency processes for acutely ill children and young people through the provision of an ‘on call’ GP duty system provided by GPs at the practice during opening hours.

Updated 7 September 2017

The practice is rated as good for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns. Patients who were frail or vulnerable were monitored and reviewed regularly.

• The practice offered proactive, personalised care to meet the needs of the older patients 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.

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. They were pro-active in providing these patients with their preferred place of care. Multi-disciplinary meetings were held with a range of other healthcare professionals in attendance.

• Staff had received safeguarding training for vulnerable adults.

Updated 7 September 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations 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 7 September 2017

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

• The practice carried out advance care planning for patients living with dementia and offered longer appointments.

• The practice had an effective system for monitoring repeat prescribing for patients receiving medicines for mental health needs and followed published guidance.

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

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

• Most of the clinical staff had received training in the Mental Capacity Act 2005.

Updated 7 September 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 homeless people, travellers and those with a learning disability.

• Longer appointments were routinely provided for this population group to ensure consultations were thorough.

• End of life care was delivered in a coordinated way, which took into account the needs of those whose circumstances may make them vulnerable. A register was in place that identified patients nearing the end of their lives and those who were frail and vulnerable.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients, including those patients in care homes.

• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations. The practice had identified 3.2% of patients who were carers and provided them with support.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.