Archived: Over Surgery

Updated 24 February 2017

Over surgery is located in Over, Cambridgeshire. The practice is run by four GP partners (two female and two male). At the time of our inspection the practice supported the training of two GP registrars (these are fully qualified doctors who are training to become a GP). The practice employs three female practice nurses and one female health care assistant. The clinical team is supported by a practice manager and a team of administrative, secretarial and reception staff. There is a hybrid dispensary/pharmacy on site and the practice dispenses to approximately 40% of its patient population. The dispensary/pharmacy is managed by two pharmacists who are supported by a team of six dispensing and counter staff.

According to Public Health England information, the practice age profile has higher percentages of patients aged 44 to 69 years compared to the practice average across England. It has lower percentages of patients aged 20 to 40 years. Income deprivation affecting children and older people is lower than the local area and the practice average across England.

The practice is open between 8am and 6pm Monday, Tuesday, Thursday and Friday, and from 8am to 1pm Wednesdays. The practice is closed on Wednesday afternoons. Extended hours appointments are available from 7am to 8am on Monday and Wednesday mornings. Appointments are on average from 9am to 11.30am every morning and 2pm to 4.30pm daily. 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/dispensary is open from 8am to 1pm and 2pm to 6pm on Monday, Tuesday Thursday and Friday. Wednesday opening hours are from 8.30am to 2.30pm. Prescriptions can be requested on-line, by post, fax or the surgery post box.

The practice holds a General Medical Service (GMS) contract to provide GP services to approximately 4,855 registered patients, 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: facilitating timely diagnosis and support for people with dementia and extended hours access. The practice is a teaching and training practice and undertakes regular research with the Primary Care Research Network to support medical research.

Out-of-hours care is provided by Herts Urgent Care through the NHS 111 service

Updated 24 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Over Surgery on 24 November 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.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• 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.
• Feedback from patients about their care was 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 July 2016 showed that patients rated the practice in line with, or above , others for most 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.
• 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.
• There was a clear leadership structure and staff felt well supported by management.
• 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 24 February 2017

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). The most recent published results were 99% of the total number of points available, with a 9% exception reporting rate which was two percentage points below the CCG average and one percentage point below the national average (exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects). We saw that exception reporting across all indicators was generally in line with local and national averages.
• Longer appointments and home visits were available when needed.
• 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.

Updated 24 February 2017

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.

· Childhood immunisation rates for the vaccinations given were high when compared to CCG/national averages. For example, childhood immunisation rates for the vaccinations given were comparable to CCG/national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 94% to 100% which was above the CCG average of 70% to 95% and five year olds from 90% to 97% which was comparable to the CCG average of 88% to 95%.

• 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 85%, which was above the CCG and the national average of 82%. There was a policy to offer telephone reminders for patients who did not attend for their cervical screening test.
• 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.

Updated 24 February 2017

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.
• The practice worked closely with the multi-disciplinary team, out-of-hours and the nursing team to ensure proactive palliative care planning.
• 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.

Updated 24 February 2017

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 66% of the target population, which was above the CCG average of 59% and the national average of 58%.The breast cancer screening rate for the past 36 months was 75% of the target population, which was also above the CCG average of 74% and the national average of 72%.
• Patients had access to appropriate health assessments and checks. These included health checks for new patients and NHS health checks for patients aged 40–74. Since April 2015 the practice had sent out 370 invitations with 171 patients attending for a health check. The practice also facilitated health checks for older patients who were not reviewed as part of other chronic disease checks. The practice uptake for NHS health checks for patients over 75 years since April 2016 was 62%, with 341patients invited and 212 undergoing a health check. Appropriate follow-ups for the outcomes of health assessments and checks were made, where abnormalities or risk factors were identified.

Updated 24 February 2017

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

• The percentage of patients experiencing poor mental health who had a comprehensive, agreed care plan documented in the record in the preceding 12 months (01/04/2014 to 31/03/2015) was 92%, which was above the CCG average of 87% and the national average of 88%.
• The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months (01/04/2014 to 31/03/2015) was 95%, which was above the CCG and the national average of 84%.

• 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.

Updated 24 February 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• We saw that since April 2016 the practice had completed 22% of health checks for patients with a learning disability with invitations sent to the remaining patients. The practice offered longer appointments for patients with a learning disability.
• Treatment room doors were colour coded throughout the practice to assist patients who were unable to read, staff advised patients which colour door they required on arrival.
• 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.