Tennyson House Surgery

Updated 7 July 2016

Tennyson House Surgery is in a modern, purpose-built building, with a waiting area with many facilities for patient care. Wheelchair access is available throughout the ground floor clinical areas. There is ample car parking facilities situated adjacent to the surgery with spaces for the disabled located close to the entrance. At the time of our inspection, the practice list size was approximately 9,000 patients and this list was open to new patients.

At the time of the inspection the practice had four partner GPs, two salaried GPs and a trainee GP. There are four practice nurses and two healthcare assistants (HCA). The practice manager is supported by a reception manager and a large team of receptionists and administrative staff. This practice is a training practice for GPs. All GPs took key roles in the provision of this training.

The practice is open from 8.30am Monday to Friday. The practice is open until 8.45pm on Tuesday and until 6.30pm on Monday, Wednesday, Thursday and Friday. The practice has opted out of providing GP out of hour’s services. Unscheduled out-of-hours care is provided by Primecare services and patients who contact the surgery outside of opening hours are provided with information on how to contact the service.

The practice population is higher than the CCG average for younger people and children and similar for children under four years old, older people aged over 65 years and over. Life expectancy for men and women is slightly lower than the national average.

The practice provides the following directed enhanced services:

• Extended opening hours.
• Childhood immunisations and vaccinations.
• Dementia screening.
• Flu vaccinations.

Unplanned hospital admissions avoidance.

Updated 7 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Tennyson House Surgery on 19 April 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.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice maintained appropriate standards of cleanliness and hygiene.

• 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.
• Staff used every opportunity to identify potential risks to patients’ health; they gave advice or referred to other services to support them to live healthier lives.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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 sometimes found it difficult to get through on the phone to make an appointment with a named GP.
• Urgent and same day appointments were available to be made between 8.30am and 9.30am; from 9.30am up to two days in advance appointments were available. Also routine appointments were available up to four weeks in advance.
• There was a clear leadership structure and staff felt 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.

The areas where the provider should make improvement are:

• Improve the identification of patients who are carers.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Updated 7 July 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.

• The percentage of patients with diabetes who had a foot examination and risk assessment within the preceding 12 months was 90% compared to the national average of 88%.

• Chronic disease reviews were offered at the practice or at home if the patient was housebound. Diabetes protocols were followed with a trained diabetic nurse with support from the diabetes lead doctor and COPD/asthma annual reviews and follow up appointments were actioned with a trained asthma nurse.

• 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.

Updated 7 July 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.

• 73% of patients diagnosed with asthma, on the register had an asthma review in the last 12 months which was comparable to CCG and national averages.

• The practice’s uptake for the cervical screening programme was 84%, which was higher than the CCG average of 81% and the national average of 74%.

• 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.

• Information and advice on sexual health and contraception was provided during GP and nurse appointments; the practice offered coil fitting.

Updated 7 July 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.

• Patients in this group could request appointment times suitable to accommodate for them and their carers or relatives to attend when requested.

• Patients on the practice frailty register had individual care plans that were reviewed at monthly multi-disciplinary meetings.

• Two GP partners held responsibility for two local care homes and undertook regular visits and medicines reviews.

Updated 7 July 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 offered travel immunisations and travel advice by the practice nurse.

• Students about to start university were offered the meningitis vaccination.

Updated 7 July 2016

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

• All mental health and dementia patients were offered individual care plans and any appropriate advanced care planning (IAM forms). All were invited to annual physical health reviews and the surgery followed up and called any non-attenders to encourage compliance. 80% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to other practices.

• 95% of patients with a diagnosis of schizophrenia, bi-polar disorder and other mental health disorders had an agreed care plan in place compared to the national average of 88%.

• 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 7 July 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 and those with a learning disability.

• 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.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Written information was available to direct carers to the various avenues of support available to them.

• 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.