Orchard House Surgery Partnership Also known as Orchard House Surgery

Updated 17 January 2018

Orchard House Surgery is registered with the CQC to provide primary care services, which includes access to GPs, family planning, surgical procedures, treatment of disease, disorder or injury and diagnostic and screening procedures.

The practice is part of West Suffolk Clinical Commissioning Group (CCG). It is responsible for providing primary care services to approximately 10,500 patients.

It provides GP and dispensing services for patients living in Newmarket, Suffolk and the surrounding area. The practice has six GP partners (three male and three female), four salaried GPs (all female), a practice manager, a reception manager, a dispensary team with supervisor, five practice nurses of whom one was nurse manager, one associate practitioner, one healthcare assistant, three members of administrative staff and a team of five receptionists with a team leader.

The practice offers dispensing services to those patients on the practice list who lived more than one mile (1.6km) from their nearest pharmacy.

The practice is a training practice and offers training to trainee GPs (registrars), nurses and medical students. The practice also offered work placements for other roles.

The practice is open 8.30am to 8.30pm on Monday and from 8.30am to 6.30pm Tuesday to Friday. Patients can book appointments in person, via the phone and online. When the practice was closed patients were directed to the out of hour’s service provided by Care UK via the NHS 111 service.

The most recent data available from Public Health England showed the practice has a smaller number of patients aged nine to 24 compared with the national average. There are a slightly higher than average number of female patients aged 25-39 and 50-54, with the rest of the practice population in line with the England average.

Income deprivation affecting children is 12%, which is in line with the CCG average of 13% and below the national average of 20%. Income deprivation affecting older people is 13%, which is also in line with the CCG average of 12% and below the national average of 16%. Life expectancy for patients at the practice is 80 years for males and 85 years for females; these are slightly above the national expectancy of 79 years and 83 years respectively.

Updated 17 January 2018

Letter from the Chief Inspector of General Practice

This practice is rated as Outstanding overall. (Previous inspection 12/2014 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? - Outstanding

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Outstanding

People with long-term conditions – Outstanding

Families, children and young people – Outstanding

Working age people (including those recently retired and students – Outstanding

People whose circumstances may make them vulnerable – Outstanding

People experiencing poor mental health (including people with dementia) - Outstanding

We carried out an announced comprehensive inspection at Dr T R S Bailey & Partners, otherwise known as Orchard House Surgery, on 30 November 2017.

At this inspection we found:

• The practice had effective systems to manage risk so that safety incidents were less likely to happen. When they did happen, the practice learned from them and improved their processes. The practice shared outcomes of significant events with staff and other local GP practices.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The facilities and premises were appropriate for the services delivered.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it. Patient feedback on access to appointments was positive; this was supported by a review of the appointment system and data from the National GP Patient Survey.
• Staff had the skills, knowledge and experience to carry out their roles and there was a strong focus on continuous learning and improvement at all levels of the organisation.
• The practice was in line with, or above average for its satisfaction scores in the National GP Patient Survey.
• The practice was responsive to the needs of patients whose circumstances made them vulnerable. For example, it provided a postal address for travelling and homeless patients.
• The practice actively promoted equality and diversity. It identified and addressed the causes of any workforce inequality. Staff had received training and felt they were treated equally.
• Staff we spoke with told us they were able to raise concerns and were encouraged to do so. They had confidence that these concerns would be addressed.

We saw areas of outstanding practice:

• The practice maximised the use of their computer system, with a strong emphasis on its comprehensive quality improvement programme. We saw that various responses were implemented as a result of the various programmes; this included additional training, shared learning, reviews of prescribing, reviews of methodologies, amendments to appointment systems and other quality improvement outcomes. The practice implemented improvements in to day-to-day practice.

• Access to visits, telephone or physical appointments was responsive to the local population’s requirements. The practice continually monitored access; a September 2017 audit of appointment data of practices within the Suffolk Primary Care group indicated that the practice was the second highest in providing telephone services and above average in providing face to face appointments. Patient feedback was very positive.

The areas where the provider should make improvements are:

• Improve exception reporting performance, specifically for diabetes and mental health indicators.
• Review the recording and coding of medical records to ensure accurate and reflective care and treatment of patients, including patients who are carers.
• Audit infection rates on minor surgery interventions.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 23 April 2015

The practice is rated as good for the population group of people with long term conditions. The practice ran a Doctor First telephone consultation service which ensured patients had telephone access on the day to a GP and where required a face to face appointment. Emergency processes were in place and referrals made for patients in this group that had a sudden deterioration in health. When needed, longer appointments and home visits were available. A GP telephone asthma review was available for patients one evening per week. The practice employed a dedicated auditor whose role involved working closely with the Lead GP for IT. Their responsibilities included maintaining the practice’s call and recall systems ensuring that patients who had long-term conditions or required review were invited and seen at the practice in a timely way. Patients with long term conditions had a named GP and structured annual reviews to check their health and medication needs were being met. For those people with the most complex needs the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 23 April 2015

The practice is rated as good for the population group of families, children and young people. Systems were in place for identifying and following-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 high for all standard childhood immunisations. Patients told us and we saw evidence that children and young people were treated in an age appropriate way and recognised as individuals. Telephone on the day appointments were available and patients could specify when they would be available to speak with the GP. For example outside of school hours or during a coffee or lunch break. The premises were suitable for children and babies. We saw good examples of joint working with midwives and health visitors. Antenatal care was referred in a timely way to external healthcare professionals. Mothers we spoke with were very positive about the services available to them and their families at the practice. Emergency processes were in place and referrals made for children and pregnant women who had a sudden deterioration in health.

Updated 23 April 2015

The practice is rated as good for the care of older people. It was responsive to their needs. Home visits and priority for appointments (for patients who were receiving palliative care) was available and prescriptions could be delivered to their home addresses by a local pharmacy. The practice adopted the Gold Standards Framework for the treatment of people nearing the end of their lives and requiring palliative care. Multi-disciplinary team meetings took place for elderly people with complex needs. External support was signposted and made available for them to access. Elderly patients had a named GP to receive continuity of care. Home visits and telephone consultations were available. The practice was pro-active in encouraging patients to receive flu and pneumococcal vaccinations.

Updated 23 April 2015

The practice is rated as good for the population group of the working-age people (including those recently retired and students). The Doctor First telephone appointment system gave patients the opportunity to specify when they were available to speak with the GP. Appointments were available from 8am Monday to Friday and there were extended hours appointments till 8.15pm on Monday evenings. The needs of the local working age population, those working in the local horse racing industry, 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, support, counselling and screening at the practice which reflects the needs for this age group.

Updated 23 April 2015

The practice was aware of the number of patients they had registered who were suffering from dementia and additional support was offered. This included those with caring responsibilities. A register of dementia patients was being maintained and their condition regularly reviewed through the use of care plans. Patients were referred to specialists and then on-going monitoring of their condition took place when they were discharged back to their GP. Annual health checks took place with extended appointment times if required. Patients were signposted to support organisations such as the community psychiatric nurse for provision of counselling and support. The practice provided support to a local low secure health unit that provided specialist assessment, care and treatment for patients with complex mental health disorders, intellectual disabilities and behaviours that challenge. Two of the GPs alternately visited this facility weekly to provide primary care services to these patients.

Updated 23 April 2015

The practice is rated as outstanding for the population group 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 learning disabilities. Annual health checks for people with learning disabilities were undertaken and patients received annual follow-ups. Double appointment times were offered to patients who were vulnerable or with learning disabilities. All patients were able to register at the practice as temporary residents, regardless of their personal circumstances, including the homeless and members of the travelling community and be seen that day.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. Carers of those living in vulnerable circumstances were identified and offered support including signposting them to external agencies. Staff knew how to recognise signs of abuse in vulnerable adults and children. A lead for safeguarding monitored those patients known to be at risk of abuse. All staff had been trained in safeguarding and were aware of the different types of abuse that could occur. Patients were supported by staff during their visit to the practice to ensure they received the appointment and treatment they required. We saw reception staff offered support, guidance and advice to patients throughout their visit to the practice and were quick to respond to patients or visitors who needed additional assistance and support.