Framfield House Surgery

Updated 25 November 2016

Framfield House Surgery is located in Woodbridge, Suffolk. The practice is run by a partnership of four GPs (three female and one male). The practice employs three female and one male salaried GP, three female advanced nurse practitioners, three female practice nurses and four health care assistants. The clinical team is supported by a practice manager, a deputy practice manager, an operations manager and a practice accounts administrator. There is a team of administrative and reception staff and medical secretaries. The practice is a training practice with one associate GP trainer. The practice dispenses to around 3,000 patients and a team of dispensers work alongside the Waterton pharmacy staff, having achieved National Vocational Qualifications (NVQ) in Dispensing Services to ensure they are competent to a minimum standard equivalent to NVQ level 2 in Pharmacy Services.

The registered practice population of 11,976 are predominantly of white British background, and. the practice deprivation score is low compared with the rest of the country. According to Public Health England information, the practice age profile has higher percentages of patients over 45 to 85+ years compared to the practice average across England. It has lower percentages of patients between the ages of 20 to 44 years.

The practice is open between 8am and 6.30 Monday to Friday. Appointments are from 8.20am to 11.30am every morning and 3.30pm to 5.30pm daily. Appointments with other clinicians are available from 8am to 6.30 daily. Extended hours appointments are offered from 6.30pm to 8pm Tuesday evenings, 7.30am to 8am Wednesday mornings and from 8:30am to 12:30pm on one Saturday each month. In addition to pre-bookable appointments that can be booked up to six weeks in advance, urgent appointments are also available for people that need them. The pharmacy opening times are from 8am to 7.30pm Monday to Friday, 9am to 1pm Saturday and 10am to 12 noon Sunday. 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.

The practice holds a Personal Medical Service (PMS) contract to provide GP services which is commissioned by NHS England. A PMS contract is a nationally negotiated contract to provide care to patients. The practice offers a range of enhanced services commissioned by their local CCG: including improving patient on-line access, extended hours access and support for people with dementia. The practice is a teaching and training practice working in cooperation with other practices from the Deben Health Group.

Out of hours care is provided via the NHS 111 service.

Updated 25 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Framfield House Surgery on 11 August 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had strong and visible clinical and managerial leadership and governance arrangements. Staff felt supported by management and 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. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 November 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.
• Performance for diabetes related indicators was better in comparison to CCG and the national average with the practice achieving 99% across each indicator, eight percentage points above CCG averages and ten percentage points above national averages. However the rate of exception reporting for some indicators was higher than both CCG and national average. For example; the percentage of patients with diabetes, on the register, with a diagnosis of nephropathy (clinical proteinuria) or micro-albuminuria who were treated with an ACE-I (or ARBs) exception reporting was 15%, this was six percentage points above the CCG average and seven percentage points above the national average.
• 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.
• Flu vaccination rates for the 2015 to 2016 flu campaign for the over 65s were 75%, and at risk groups 93%.

Updated 25 November 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. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 96% to 98%, which was comparable to the CCG average of 95% to 98% and five year olds from 94% to 99%, which was comparable to the CCG average of 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.
• The practice’s uptake for the cervical screening programme was 80%, which was comparable to the CCG average of 76% and the national average of 74%. There was a policy to offer telephone reminders for patients who did not attend for their cervical screening test. The practice demonstrated how they encouraged uptake of the screening programme by using information in different languages and for those with a learning disability and they ensured a female sample taker was available. 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 practice provided additional services for young people through its relationship with a local boarding school. The practice provided medical services through weekly term time clinics and annual health checks for boarding students. The practice liaised with the school nurse as well as providing training events for teaching staff, such as anaphylaxis training and sexual health talks for students. The practice had written and implemented a policy for the school concerning the outbreak of infectious diseases in a school community.

Updated 25 November 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 people, and offered home visits and urgent appointments for those with enhanced needs. All home visits were triaged by a clinician to prioritise visits and ensure appropriate and timely intervention.
• The practice would contact all patients after their discharge from hospital to address any concerns and assess if the patient needed GP involvement at that time.
• The practice offered health checks for patients aged over 75.
• 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 was part of the Deben Health Group and worked in cooperation with local practices in providing care plans for vulnerable and/or patients with complex needs at risk of hospital admission. The practice was a teaching and training practice working in cooperation with other practices from the Deben Health Group.
• The practice provided weekly and as required medical services by named GPs to five local care homes.
• The practice provided a delivery service for medicines for those patients who were housebound. 

Updated 25 November 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 encouraged its patients to attend national screening programmes for bowel and breast cancer screening. Figures published by Public Health England show that 66% of the practice’s target population were screened for bowel cancer in 2014/2015 which was above the national average of 58%. The same dataset showed that 82% of the practice’s target population were screened for breast cancer in the same period, compared with the national screening rate of 72%.

Updated 25 November 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 better in comparison to CCG and the national average with the practice achieving 97% across each indicator, six percentage points above CCG and four percentage points above national averages. However the rate of exception reporting for some indicators was higher than both CCG and national average. For example; the percentage of patients on lithium therapy with a record of lithium levels recorded in the preceding four months, exception reporting was 20%, this was ten percentage points above the CCG average and eleven percentage points above the national average.
• The practice had identified 101 patients on the mental health register of which all had been invited to attend for an annual health check on their month of birth with 82 attending for review in the previous 12 months. The practice continued to encourage attendance for review and patients were contacted by text or letter and then by telephone if they do not respond. Of the 95 patients on the practice dementia register 69 patients had attended for a health check in the previous 12 months.
• The practice 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.
• The practice provided weekly and as required medical services by named GPs to patients with a diagnosis of dementia that lived in two local nursing homes.
• The practice facilitated weekly clinics held by the Improving Access to Psychological services (IAPT) and the Community Mental Health Team (CMHT). We were told this enabled the support of patients who needed step up/step down care, in addition this ensured support to patients whose diagnosis or referral pathway was unclear.
• The practice also facilitated a number of outreach services as needed for those patients who were unable to travel to clinics. These included a clinical psychologist specialising in children and families.

Updated 25 November 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 had identified 37 patients with a learning disability on the practice register, 34 had been offered a health check and 30 had received a health check in the previous 12 months. The remaining four patients were scheduled appointments. The practice provided one hour appointments for patients for a learning disability review.
• 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.