Archived: Wivenhoe Surgery

Updated 16 July 2015

Wivenhoe Surgery is a five GP partner practice. Four full-time GP’s and one part-time GP serve approximately 8400 people who live in Wivenhoe and Arlesford. The practice holds a primary medical service (PMS) contract to provide their services.

The GPs, two male and three female, were supported by three nurses, three healthcare assistants, a team of 16 administrative assistants, secretaries, reception staff and a practice manager.

The practice is housed in a small building with limited space. There are plans in place for the practice to move to new premises in the imminent future to enable them to further develop the practice and the services it provides. Wivenhoe Surgery also has plans to become a teaching practice in the future after their move.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are available from 8.30am to 11.30am every morning and 3.30pm to 5.30pm daily. The practice did not offer extended hours, as a trial period had shown appointments were not used appropriately.

The practice has opted out of providing 'out of hours’ services which is now provided by Care UK. Patients can also contact the NHS 111 service to obtain medical advice if necessary.

Before we visited we provided comment cards for patients to complete about their experiences at the practice and reviewed the 17 that had been completed. We also spoke with partner organisations and healthcare professions in the area for their views regarding the practice.

Updated 16 July 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wivenhoe Surgery on 02 June 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing, safe, effective, caring, responsive and well-led services. It was also good for providing services for the older people, people with long term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

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

• Staff understood how to report significant events and to raise concerns. We found that action had been taken in response to safety alerts. Actions were also taken following investigations into significant events, and these were reviewed to evaluate their impact.
• Risks to patients were assessed and well administered, with evidence of action planning and learning when needed addressed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients told us they were treated with compassion, dignity and respect and the majority said they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• The majority of patients said they found it relatively easy to make an appointment with a GP and that there was continuity of care. We were told urgent appointments were available the same day.
• The practice had appropriate facilities and was equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff told us they felt supported by management.
• The practice proactively sought feedback from staff and patients, which it acted on. The practice sought feedback from patients through a patient participation group and a patient survey in relation to the services provided.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should :

• Ensure that staff members who undertake chaperoning have received suitable training and are guided by a clear chaperone policy and procedures in order to minimise risk to both patients and staff during examinations.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 July 2015

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. Longer appointments and home visits were available when needed and reception staff were able to respond to patients requests for these without checking first with the GP. All these patients had a named GP and a structured annual review to check that 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.

The recruitment of two new nurses in the last year had enabled greater provision of appointments for patients with long term conditions. The GP and nurse diabetic lead provided a comprehensive treatment facility at the practice including the initiation of insulin for type two diabetics. Carers were identified and offered appropriate support.

Updated 16 July 2015

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. 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 good examples of joint working with midwives, health visitors and school nurses.

The practice has altered their appointments system in to provide ease of access for families. The GP on duty has the flexibility to see children promptly and the ability to review again on the same day if necessary. High achievement targets for childhood immunisation reflects their values regarding childhood health promotion.

As a small town practice they looked after several members or the entire family and were able to tailor care to family needs. There were four doctors trained in minor surgery and three experienced nurses to facilitate a comprehensive minor injuries service, which supported the practice’s relatively rural setting.

The practice works closely with the local maternity services to fully support and work alongside their midwife to provide antenatal and post-natal care. The practice had three female GPs all trained in long acting reversible contraception (LARC) fitting, and two nurses able to deliver basic contraception and sexual health and contraceptive service for young people, including students from the local university.

Updated 16 July 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in Depression screening for patients aged over 75 and registered as having Coronary Heart Disease (CHD), Avoiding Unplanned Admissions, and end of life care. Staff were responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The patients had a named GP to provide consistency during their care.

The clinical team met with the local palliative care and hospice teams quarterly to discuss patients on the practice end of life register. Staff had been trained in-house to respond specifically to patient and family needs during these very difficult times. The practice had an identified GP clinical lead for end of life care. There was designated administrative support at the practice to follow-up and liaise with the clinical team for older patient issues, and the practice provided senior health checks to monitor well patients in this population group. Carers were identified and offered appropriate support.

Updated 16 July 2015

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 offered website bookable appointments in response to patient feedback, and they had increased the number of appointment slots to suit this population group. New patients were provided a health check as were patients over the age of 40, and a similar health check was available to all registered patients.

Updated 16 July 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). 100% of people experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia through their commitment to the ‘Facilitating timely diagnosis and support for people with Dementia’ DES.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. They had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia. The practice provided an in-house counselling service as well as access to further psychological therapy.

Updated 16 July 2015

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, travellers and those with a learning disability. The practice had committed to a Directed Enhanced Services (DES) in Learning Disabilities, this meant the practice identified and registered patients aged 14 and over because of their learning disabilities and provided 100% of these patients with an annual health check. A DES is a primary medical service other than an essential service that is additional, or out-of-hours. The practice had carried out annual ‘Cardiff’ health checks for all people with a learning disability on their register. The Cardiff health checks are a comprehensive screening process used to ensure patients with learning disabilities that generally have poorer health than the general population, are regularly monitored. The practice told us they did not rely solely on these checks and saw patients more regularly in response to their needs. The practice offered longer appointments for people with a learning disability. Local providers of learning disability care confirmed to us the practice gave excellent access and flexibility to their learning disability patients. They also told us from the receptionists through to the GPs all staff members displayed a real empathy in regards to their needs.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. They had told 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 and were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and who to contact to raise concerns. One of the GPs at the practice was the lead within the local CCG for safeguarding, giving them excellent oversight regarding local issues. The practice had a proactive care-advisor who the GPs referred patients to with specific non-clinical needs. The care advisor supported patients from this population group to find alternative non-clinical solutions for their issues and worked closely with the clinical team to feedback on their progress and any developments.