Framlingham Surgery

Updated 12 September 2016

Framlingham Surgery is located in Framlingham near Woodbridge in Suffolk. There is also a branch surgery at Earl Soham.

The practice is run by a partnership of five GPs (two female and three males). The practice employs one female salaried GP, three practice nurses including the team lead and three health care assistants. The clinical team is supported by a practice manager, a business manager and a finance manager. There is an audit officer and team of thirteen administrative, secretarial and reception staff. The practice dispenses to around 5,600 patients and employs eight dispensers including a dispensing team lead to provide this service.

The registered practice population of 9,200 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 between ten to 19 years and over 45 years and over compared to the practice average across England. It has lower percentages of patients under the age of nine and between the ages of 20 to 39 years.

The practice is open between 8.30am and 6pm Monday to Friday. Appointments are from 9am to 11.20am every morning and 3pm to 5pm daily. Extended hours appointments are offered at the main surgery from 7am to 8.30am and 6pm to 7.30pm on Monday. The branch surgery is open from 8.30 am to 6pm on Monday and 8.30am to 1pm Tuesday to Friday. GPs are on call via the practice telephones between 8am and 8.30am and 6pm to 6.30pm Monday to Friday. In addition to pre-bookable appointments that can be booked up to eight weeks in advance, telephone and urgent appointments are also available for patients that need 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.

The practice holds a General Medical Service (GMS) contract to provide GP services which is commissioned by NHS England. A GMS contract is a nationally negotiated contract to provide care to patients. In addition, the practice also offers a range of enhanced services commissioned by their local CCG: including minor surgery, facilitating timely diagnosis and support for people with dementia and extended hours access. The practice is a teaching practice and an accredited research practice working in cooperation with other practice from the Deben Health Group.

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

Updated 12 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Framlingham Surgery on 17 May 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.
• Feedback from patients about their care was consistently positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Data from the National GP Patient Survey published in January 2016 showed that patients rated the practice higher than others for several aspects of care.
• 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 well 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 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. 30 minute appointments were provided for reviews. One nurse was undertaking a diploma in asthma to further support patient care. All patients with long term conditions were offered annual reviews, those with more complex needs were supported by their named GP. Nurses also provided domiciliary visits to housebound patients with long term conditions
• 79% of patients with diabetes listed on the practice register, had received a blood pressure reading that was 140/80 or less in the preceding 12 months. This was above the CCG and national average of 78%.
• 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.
• One GP took part in Cardiology clinics in liaison with Ipswich hospital, (as did another GP in regards to Urology before the service was closed last year). Clinicians reported this was a good resource for all clinicians to seek advice on management of these conditions.
• The practice undertook monthly multi-disciplinary (MDT) meeting for those vulnerable patients, with complex medical or social needs, or at risk of hospital admission, in addition the practice held monthly MACGOLD meetings (for the review of patients with a diagnosis of cancer) involving doctors, practice nurses, district nursing team, social services and community matron.
• The practice was part of a primary care research network (PCRN). Currently research included a Norfolk Diabetes study to help improve early diagnosis and management of diabetes mellitus.

Updated 12 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.
• 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.
• 88% of patients with asthma listed on the practice register had received an asthma review in the preceding 12 months (April 2014 to March 2015). This was higher than the CCG average of 74% and national average of 75%.
• The practice’s uptake for the cervical screening programme was 88%, which was above the CCG average and the national average of 82%. The practice reported the uptake for the period April 2015 to March 2016 had been 91%. However at the time of the inspection this information had not been validated. There were failsafe systems in place to ensure results were received for all samples sent for the cervical screening programme and the practice followed up women who were referred as a result of abnormal results.
• Appointments were available outside of school hours and the premises were suitable for children and babies. The practice took part in the Suffolk Federation GP+ scheme which offered routine appointments outside of opening hours.
• We saw positive examples of joint working with midwives, health visitors and school nurses. The practice provided medical cover for a local private boarding school during term time. Midwifery clinics were provided weekly at the practice. A private room was provided for breastfeeding mothers who wished to use it.
• The practice engaged with the Ipswich and East Suffolk Clinical Commissioning Group Youth Forum to encourage better support and engagement for medical services for young patients.
• The practice provided annual sexual health awareness talks to a local school. In addition one nurse prescriber held a Diploma in Faculty of Sexual Health and offered a full range of sexual health and contraceptive services to all age groups.

Updated 12 September 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 clinical 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 facilitated monthly clinics with Age UK at the surgery. 45 minute appointments were provided for any patient or carer to attend where guidance on support and advice on services to aid care were provided.
• The practice worked in cooperation with local practices in providing care plans for vulnerable and/or with complex needs at risk of hospital admission.
• The practice in conjunction with the local Round Table group offered to all patients over 75 the message in a bottle system (a container held typically in a fridge or freezer in a patients home with all relevant personal and medical information in the event of an emergency), to help reduce hospital admission through better access to emergency information.
• The practice provided weekly and ad-hoc medical services by named GPs to nursing and residential homes.
• The practice provided a weekly GP surgery at Laxfield Guildhouse for those patients unable to travel to the main practice. In addition a member of the dispensary team attended these clinics to dispense repeat medicines already prepared for those patients unable, due to transport or mobility issues, to travel to the surgery to collect them. A member of the dispensary team also delivered repeat medicines to a local sheltered accommodation when necessary.

Updated 12 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 encouraged its patients to attend national screening programmes for bowel and breast cancer screening. The bowel cancer screening rate for the past 30 months was 64% of the target population, which was above the CCG average of 63% and the national average of 58%.The breast cancer screening rate for the past 36 months was 82% of the target population, which was also above the CCG average of 80% and above the national average of 72%.
• Appointments were available before and after usual working hours as well as during the day. Telephone appointments were available in addition to on-line appointments and repeat prescription requests, on-line prescription enquiries and emails.
• Three GPs provided minor surgery and joint injections to reduce unnecessary travel to distant clinics.

Updated 12 September 2016

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

• 76% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months (01/04/2014 to 31/03/2015), which was below the CCG average of 85% and national average of 84%. We saw that 80% of patients diagnosed with dementia had been reviewed since 01/04/2015 to 31/03/2016.
• 97% of patients experiencing poor mental health had their care reviewed in the last twelve months (01/04/2014 to 31/03/2015). This was above the CCG average of 85% and national average of 88%. We saw that 90% of patients experiencing poor mental health had been reviewed since 01/04/2015 to 31/03/2016.
• 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 ad hoc medical services by named GPs to patients with a diagnosis of dementia who lived in two local nursing homes.
• The practice facilitated weekly clinics held by the primary care mental health liaison worker. 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 the Suffolk Wellbeing counselling service as needed for those patients who were unable to travel to clinics.

Updated 12 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.
• The practice offered longer appointments for patients with a learning disability with a named GP for each patient. We saw that of the 27 patients on the learning disability register 20 had received a review in the previous twelve months, of the remaining seven, four had declined an annual review, one was scheduled an appointment and two were due to be invited for 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.
• A member of the dispensary team also delivered repeat medicines to a local sheltered accommodation when necessary.