Archived: Combs Ford Surgery

Updated 8 September 2016

Combs Ford Surgery is semi-rural practice situated in Stowmarket and serves the population of Stowmarket as well as some of its surrounding villages within a five mile radius. The practice provides an on-site dispensing service for any of its patients living more than one mile away from a pharmacy / chemist.

The practice is run by two full time female GP partners. The practice employs one female salaried GP and one male salaried GP, two full time clinical nurse practitioners, one full time emergency care practitioner, three senior nurses, two health care assistants as well as the practice manager, business manager, finance manager, two medical secretaries and a team of reception /administration, cleaners and maintenance staff. In addition there were two dispensary managers and a team of dispensers. The practice is a teaching practice.

The practice holds a Personal Medical Service (PMS) contract to provide GP services to a population of 9,606 patients, which is commissioned by NHS England. A PMS contract is a nationally negotiated contract to provide care to patients. The practice deprivation score is in-line compared with the rest of the country. According to Public Health England information, the practice age profile is also in line with the average across England.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are from 8.15am to 12.30pm every morning and 2pm to 5.45pm daily. There are also midday appointments with one GP, to ensure patients could access the surgery during lunchtime. Extended hours appointments are offered on Wednesday evenings from 6.30pm to 7.45pm. In addition to pre-bookable appointments that can be booked up to twelve weeks in advance, urgent appointments are also available for people that needed them. We were told rapid access appointments are available for those patients requiring urgent medical review for new acute conditions or deteriorating chronic conditions. The practice takes part in the Suffolk Federation GP+ scheme which offers routine appointments outside of opening hours. The practice is able to book appointments for patients with this service.

Out-of-hours care is provided by CareUK via the NHS111 service.

The practice has undergone a period of huge change in the past two years. Previously a five GP partner practice. Following the retirement of a number of long serving and key staff the patient list at the practice was closed in May 2015 in agreement with NHS England, due to high demand in the area and low doctor-patient ratio. 

Updated 8 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Combs Ford Surgery on 9 June 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.

• 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.
• 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.
• 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 proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

• The practice encouraged teenagers to notify them of their mobile telephone numbers to ensure the practice could contact them directly rather than contact their parents’ details should they wish to keep aspects of their medical records confidential.
• The practice provided support to needle phobic young people to undergo school vaccinations at the practice if they found vaccinations stressful.

The areas where the provider should make improvement are:

• Ensure there is a regular programme of two cycle audits undertaken by clinicians.
• Ensure fridges containing vaccines are not over stocked and temperature throughout the fridge can be accurately monitored.
• Ensure the process for security of dispensary keys is reviewed and monitored.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 September 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The practice used the information collected for the Quality and Outcomes Framework (QOF) to monitor outcomes for patients (QOF is a system intended to improve the quality of general practice and reward good practice). Data from 2014/2015 showed that performance for diabetes related indicators was 97%, which was above the 7 percentage points above the CCG average and 8 percentage points above the national averages.
• 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 and care professionals to deliver a multidisciplinary package of care.
• The practice employed an emergency care practitioner who was responsible along with the GPs for home visits. Clinical staff met with district nursing teams at patients’ homes where required.

Updated 8 September 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.
• Immunisation rates were in-line with local averages for all standard childhood immunisations. For example, vaccination rates for children ranged from 94% to 99%, compared against a CCG average ranging from 95% to 98%. Vaccination rates for children aged two to five years old ranged from 88% to 99% compared to the CCG average ranging from 93% to 97%.
• 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.
• 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, health visitors and school nurses. The midwife provided antenatal clinics once a week from the practice. Reception staff routinely arranged appointments for patients who were newly pregnant with the midwives outreach clinic.
• The practice provided support to needle phobic young people to undergo school vaccinations at the practice if they found vaccinations stressful.
• The reception team encouraged awareness with teenage patients, to ensure the practice could access their personal mobile numbers rather than contact their parents’ details should they wish to keep aspects of their medical records confidential.
• Staff undertook annual Lesbian, Gay, Bisexual,Transgender (LGBT) training on transgender awareness and understanding to support patients.
• In 2015 the practice received an award for the most condoms distributed by a small surgery.

Updated 8 September 2016

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

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure were above local and national averages.
• The practice ensured it prioritised care for their older patients and offered proactive, personalised care to meet the needs of older people. Care plans were in place for older patients with complex needs. All patients had a named GP.
• The practice looked after 120 older patients living in a local nursing home. An allocated lead GP undertook ward rounds three times a week and visits when required.

Updated 8 September 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 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 uptake for patients aged 60-69, screened for bowel cancer in last 30 months was 63%; this was in-line with the CCG average of 63% and the national average of 58%. The practice uptake for female patients screened for breast cancer in the last 36 months was 81% which was above the CCG average of 80% and national averages of 72%.
• The practice offered minor surgery on site. This included cryotherapy, coil and contraception implants. The practice took part in a local ‘condom scheme’ enabling the issue of condoms from school age young people to 24 years.
• The practice facilitated a room weekly for a physiotherapy assessment services at the practice. The physiotherapist offered advice and direction to any patient who felt that physiotherapy was an alternative to a GP appointment. They were also able to assess and advice patients on the most appropriate action such as self-referral to a physiotherapist.

Updated 8 September 2016

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

• Of the 135 patients diagnosed with dementia on the practice dementia register, 93 had their care reviewed in a face to face meeting in the previous 12 months (69%).
• The practice achieved 91% for mental health related indicators in QOF, which was in-line with CCG averages and 2% below the national averages. The rate of exception reporting for these indicators was consistently lower than both the CCG and national averages. Of the 101 patients on the practice mental health register, 88 had received an annual health review (87%) in the previous twelve months April 2015 to March 2016. There was a practice mental health lead nurse who 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 had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia. Staff had attended dementia awareness training and the practice had invited the Stowmarket Dementia Action Group to address a staff training session.
• The practice held a shared care agreement with Turning Point a drug and alcohol service. The practice provided a room each month at the surgery to enable the service to meet vulnerable patients and prevent the cost and travel to Ipswich, thereby increasing the likelihood of attendance.
• The practice engaged a counsellor who offered a course of sessions to support patients with mental health needs.
• In addition a link worker from the Norfolk and Suffolk Mental Health Trust attended the surgery each month where the practice facilitated a room for them to see patients.

Updated 8 September 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.
• Patients who were vulnerable were referred to and read coded under a particular term of reference to ensure staff were aware of their needs. Patients, carers and families were encouraged to use the term to ensure vulnerable patients needs were identified when contacting the surgery and patient confidentiality was not breached.
• The practice offered longer appointments for patients with a learning disability. Of the 76 patients with a learning disability on the practice learning disability register, 53 (70%) had received an annual health review in the previous twelve months.
• 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 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 had developed an easy read pre-health review document for patients who have a learning disability. This used words and pictures in an easy read format to help patients with a learning disability to better understand and respond to questions about their health, illness, lifestyle and treatments.
• The practice held a shared care agreement with Turning Point a drug and alcohol service. The practice held review meetings with Turning Point to ensure cohesive working. The practice provided a room each month at the surgery to enable the service to meet vulnerable patients and prevent the cost and travel to Ipswich, thereby increasing the likelihood of attendance.