Rushbottom Lane Surgery

Updated 16 October 2017

Rushbottom Lane Surgery also known as Dr Khan & Partners situated at 91 Rushbottom Lane, Benfleet, Essex is a GP practice which provides primary medical care for approximately 12,034 patients living in Benfleet and the surrounding areas.

Rushbottom Lane Surgery provide primary care services to local communities under a General Medical Services (GMS) contract, which is a nationally agreed contract between general practices and NHS England. The practice population is predominantly white British along with a small ethnic population of Asian and Eastern European origin.

The practice currently has six GPs partners and two other GPs (four males and four females). There are two advanced nurse practitioners and three practice nurses who are supported by a health care assistant and an associate practitioner. There are two practice managers who are supported by a deputy and a team of administrative and reception staff. There is a pharmacist employed by the practice. The local NHS trust provides health visiting and community nursing services to patients at this practice.

The practice provides training to doctors studying to become GPs. Additionally the practice facilitates the training of nurses, managers, administrative staff and work experience students. The practice operates out of a two storey building. Patient care is provided on both floors with lift access available to the upper floor. There is a car park outside the surgery with adequate disabled parking available.

The practice is open between 8am until 6.30pm Monday to Friday. On Monday evenings the practice is open until 7.30pm. On Thursday mornings the practice is open from 7am. On Saturday Sunday and Bank Holidays access to a GP is available from 10am until 3pm and in the evening from 7pm until 9pm. The Saturday Sunday and Bank Holidays service is provided by the local GP healthcare alliance and patients are advised which practice to attend when they booked the appointment.

When the practice is closed services are provided by Integrated Care 24 Limited via the 111.

Updated 16 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rushbottom Lane Surgery also known as Dr Khan & Partners on 30 August 2017. Overall the practice is rated as good. Previously during a comprehensive inspection on 23 February 2016 this practice was rated as requires improvement for providing safe services.

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.
• All staff had received an appraisal within the last 12 months.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect.
• 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 GP and there was continuity of care, with urgent appointments available the same day.
• The practice had systems to support carers.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a leadership structure and staff felt supported by management.
• The practice proactively sought feedback from staff and patients, which it acted on.
• The practice was aware of and complied with the requirements of the duty of candour.

• The practice had collaborated with the Castle Point and Rochford Clinical Commissioning Group (CCG) and as part of the Benfleet Consortium of five local GP practices had developed a new approach to managing patients with a long term condition. A team consisting of a pharmacist, emergency care practitioner and an advanced nurse practitioner aimed to proactively manage patients at their preferred place of residence, this consisted of managing their ongoing care when needed, both long term and emergency with access to a GP if needed. This project which commenced a few months ago will be evaluated with a view to wider implementation across Castle Point and Rochford CCG.

The areas where the provider should make improvement are:

• Complete the review of the immunisation status of clinical and non clinical staff and ensure a documented process to evidence compliance.
• Undertake a review of practice policies and procedures so they are personalised reflecting local arrangements.
• Continue to monitor the recently introduced systems to monitor the use of blank prescription forms and pads.
• Continue to identify and support carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 October 2017

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

• GPs supported by nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• There was a recall system in place to coordinate long term condition management.

• Performance for diabetes related indicators was comparable to the local and national averages. The practice achieved 83% of available points, with 7% exception reporting, compared to the CCG average of 82%.

• The practice had collaborated with the Castle Point and Rochford Clinical Commissioning Group (CCG) and as part of the Benfleet Consortium of five local GP practices and developed a new approach to managing patients with a long term condition. A team consisting of a pharmacist, emergency care practitioner and an advanced nurse practitioner aimed to proactively manage patients at their preferred place of residence, this consisted of managing their ongoing care when needed, both long term and emergency needs with access to a GP if needed.

• The practice held a register of pre-diabetic patients who status was monitored annually by a blood test and followed up if abnormal.

• The practice provided on site pulse oximetry (measurement of the oxygen level in blood and the heart rate), 24 hour blood pressure monitoring, 24 hour electrocardiogram (ECG), routine and urgent ECGs and spirometry.

• The practice offered annual structured chronic kidney disease clinics.

• There was a system to identify patients at risk of hospital admission that had attended A&E or the out of hours service and these patients were regularly reviewed to help them manage their condition at home.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met.

• For patients with more complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice identified at an early stage patients who may need palliative care as they were approaching the end of life. It involved patients in planning and making decisions about their care, including their end of life care. Palliative care was coordinated with the palliative care nurse and district nurse through monthly palliative care Gold Standard Framework meetings. Information was passed to the out-of-hours team for continuity of care on a weekly basis.

Updated 16 October 2017

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

• There were systems 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 accident and emergency (A&E) attendances.

• Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

• The practice’s uptake for the cervical screening programme was 85%, compared to the CCG average of 86% and the national average of 81%.

• Teenage girls registered with the practice were offered immunisation against the human papilloma virus (HPV) which offered protection against cervical cancer.

• There was a dedicated young person’s notice board in reception area which contained sexual health information including on how to access the local sexual health clinics.

• The practice offered family planning including the management of intrauterine system and related screening such as chlamydia screening.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 16 October 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

• Patients over 75 had a named accountable GP and were offered the over 75 health check.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• For the housebound patient the practice monitored essential wellbeing, medicine compliance and current health needs including through home visits if needed.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• The practice had identified patients at high risk of admissions to hospital (patients with multiple complex needs, and involving multiple agencies) and worked with community services in planning support. 92% of these patients had a care plan created or reviewed in the past 12 months and their care plans were available to other professionals through the shared electronic records system.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. For example eligible older people were offered flu and shingles vaccines.

• The advanced nurse practitioners visited housebound patients to undertake dementia screening and other monitoring such as blood pressure monitoring.

• The practice supported patients registered with the practice who lived in local care homes.

Updated 16 October 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.

• This population were given priority appointments focussed on early morning and late afternoon. On Thursday mornings the practice was open from 7am. On Monday evenings the practice was open until 7.30pm.

• On Saturday, Sunday and Bank Holidays access to a GP was available from 10am until 3pm and in the evening from 7pm until 9pm for pre-bookable appointments. This additional service was provided by the local GP healthcare alliance and patients were advised which practice to attend when they booked the appointment.

• The practice provided a ring back service by a duty GP or a nurse at the patient’s request where appropriate which supported patients who were unable to attend the practice during normal hours.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs of this age group.

• The practice had enrolled in the Electronic Prescribing Service (EPS). This service enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.

• 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 16 October 2017

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

• The practice carried out advance care planning for patients living with dementia.

• The percentage of patients diagnosed with dementia whose care plan has been reviewed in a face-to-face review in the preceding 12 months was 70%.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• The percentage of patients with diagnosed psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 88% compared with the CCG average of 79%.

• The practice regularly worked with multi-disciplinary teams including the community dementia nursing team, district nurses, long term conditions team, care coordination team and social services in the case management of patients experiencing poor mental health, including those living with dementia.

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access a number of support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended A&E where they may have been experiencing poor mental health.

• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 16 October 2017

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

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care. Palliative care was coordinated with the palliative care nurse and district nurse through monthly palliative care Gold Standard Framework meetings. Information was passed to the out-of-hours team for continuity of care on a weekly basis

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients including when they move out of area so an appropriate hand-over can be given to the new practice.

• The practice had information available for vulnerable patients about how to access support groups and voluntary organisations.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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 identified patients who were also carers and signposted them to appropriate support. The practice’s computer system alerted GPs if a patient was also a carer.  The practice had identified 110 patients as carers (approximately 1% of the practice list). The practice had identified a carer’s champion who provided information and directed carers to the various avenues of support available to them.