Archived: Little Bushey Surgery

Updated 10 September 2015

Little Bushey Surgery is a general practice that provides primary medical care for just over 6,000 patients who live in the town of Bushey, Hertfordshire and the surrounding area.

The practice operates from premises in California Lane, Bushey, Hertfordshire, WD23 1EZ.

According to Public Health England, the patient population is predominantly white British with a higher than average percentage of women patients aged between 40and 49 year as compared with the rest of England and a higher population aged over 65 years. There is a less than average percentage of patients in the age range 20 to 39 years.

Little Bushey Surgery has four GPs, three of whom are partners in the practice. There are two practice nurses who run a variety of clinics as well as a health care assistant.

There is a practice manager and a team of eight non-clinical, administrative and reception staff who share a range of roles, some of whom are employed on flexible working arrangements.

The practice provides a range of clinics and services, which are detailed on their web-site and commented upon throughout this report, and operates generally between the hours of 8am and 6.30pm, Monday to Friday. There are additional hours from 7am to 8am on Monday and Wednesday mornings. Generally, appointments are available between 8.30am and 11am and then again between 3.30pm and 6pm. Telephone consultations are also available after the morning surgery hours.

The practice does not provide their own out-of-hours service and so, outside of practice hours, primary medical services are accessed through the out-of-hours provider, Herts Urgent Care.

There have been no previous concerns in relation to this practice historically.

Updated 10 September 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Little Bushey Surgery on 03 March 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, responsive and well-led services. It also provided a good service for mothers, babies, for children and young people, for the working-age population and those recently retired as well as for people experiencing poor mental health.

The practice was outstanding for providing caring services. It was also outstanding for providing services for older people, for people with long term conditions and for people whose circumstances may make them vulnerable.

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.
• The practice used proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, it was the only practice in the area that proactively monitored the care of patients with cardio-vascular conditions through regular testing and treatment known as a level four anti-coagulant service.
• The practice’s approach to patients with coronary heart disease (CHD) had resulted in fewer admissions for CHD compared with the CCG and the rest of England.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet people’s needs.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the National Patient Survey.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.
• Practice staff had been consulted about and had contributed to the development of the practice’s mission statement to provide safe, patient-centred care.
• Staff were given responsibility for key aspects of the practice’s work with patients with designated champions for bereavement, vulnerable families and carers.

We saw some areas of outstanding practice including:

• The practice’s proactive and dynamic approach to quality monitoring was highly effective giving rise to on-going change and improvement. This was demonstrated by action that the practice had taken to reduce emergency admissions to hospitals. They had done this by making additional locum appointments available during the winter months. This initiative resulted in fewer admissions to hospital of older people and people with long term conditions compared to local and national averages. The practice had been influential in enabling the rest of the clinical commissioning group (CCG) to take this up and this had also resulted in a corresponding reduction in emergency admissions across the CCG area.
• The practice was outstanding for its caring culture as demonstrated by data from the National Patient Survey, patient interviews and views expressed on comment cards. Survey data showed the practice was rated higher than other practices in the area and in England for all aspects of caring practice, with some areas being rated as significantly higher.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 September 2015

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

The practice used a holistic, dynamic and proactive quality monitoring process to improve patient outcomes involving the use of benchmarking data, peer discussions on individual cases, clinical audits and strategic clinical direction. The latest available data showed the practice was performing highly compared to others in the Clinical Commissioning Group (CCG) and the rest of England, significantly so for outpatients referrals and admissions to hospital for long term conditions such as cancer and respiratory illnesses.

The practice’s proactive approach to monitoring the care and treatment of patients with long term conditions led to better outcomes for those patients. This was particularly the case for patients with coronary heart disease (CHD). Data showed that, whilst there was higher prevalence of patients with CHD compared to the CCG and the rest of England, the prevalence of patients suffering heart failure and the prevalence of patients admitted to hospital for CHD was lower.

Data showed good outcomes for patients with diabetes in relation to blood pressure monitoring and retinal screening.

GPs were named leads for chronic disease management. Nursing staff were supported by a robust clinical supervision process. Longer appointments and home visits were available when needed. 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 such as the local virtual ward service.

Updated 10 September 2015

The practice is rated as good for the care of families, children and young people.

A vulnerable families champion was 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 emergency department attendances. Immunisation rates were comparable with other practices for all standard childhood immunisations.

Children and young people were treated in an age-appropriate way and were recognised as individuals. Appointments were available outside of school hours and the premises were suitable for children and babies. There was effective joint working with midwives, health visitors and school nurses. The practice had recently carried out a safeguarding audit and had improved their practice as a result.

Updated 10 September 2015

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

Nationally reported data showed that admissions to hospital for conditions commonly found in older people such as cancer, diabetes and chronic respiratory conditions, were fewer than the averages for the Clinical Commissioning Group (CCG) and nationally. This reflected the practice’s proactive approach to monitoring the care and treatment of these patients. Data for the practice was significantly better for patients with coronary heart disease. This was reflective of the practice’s advanced monitoring and treatment service for patients at risk of cardio-vascular conditions, the only service of its type in the CCG locality.

The practice worked with multi-disciplinary teams to support the care of older people, including those patients who were at risk of hospital admissions and those who were receiving end-of-life care. Patients were referred to a local community navigator service to help them gain access to local support services. Patients at risk of unplanned hospital admissions had their care co-ordinated by a named GP. Some patients were referred to a ‘virtual ward’ service, a local health and social care multi-disciplinary service aimed at providing a pathway that supported people to stay in their own homes. The practice discussed the evolving individual needs of their registered patients receiving the virtual ward service on a weekly basis.

Longer appointments and home visits were available for older patients and those living with dementia.

The practice had implemented a winter pressure initiative aimed at providing additional locum appointments during winter months to support those patients most at risk of hospital admissions. The data available showed that there was a fall in the number of admissions during this period. The practice had been influential in enabling other practices in the locality and the other three localities in the CCG area in receiving additional funding to support the initiative throughout the area.

Updated 10 September 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, such as extended hours between 7am and 8pm twice weekly. 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.

Updated 10 September 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Ninety-five percent of people experiencing poor mental health had received an annual physical health check; 97% in relation to those living with dementia. 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.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It 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.

Updated 10 September 2015

The practice is rated as outstanding 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. It carried out annual health checks for people with a learning disability. The practice’s vulnerable families’ champion ensured that children living in travelling communities were called in for childhood immunisations and that any missed appointments were followed up. Longer appointments were available for people with a learning disability and patients with complex health needs.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations such as through a community navigator service. 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’s medicine audits had led to management plans for patients receiving specific medicines that required close monitoring and for more effective decision making in relation to patients prescribed with non-steroidal anti-inflammatory drugs.