Angel Hill Surgery

Updated 18 January 2018

The Angel Hill surgery is situated in the centre of Bury St Edmunds, Suffolk. The practice provides services for approximately 14,100 patients. It holds a Personal Medical Services contract with NHS West Suffolk.

According to Public Health England, the patient population has a lower number of patients aged below 45 and a higher number of patients aged 60 and over in comparison to the practice average across England. It has a considerably higher proportion of patients aged 65 to 69 and females aged over 85 compared to the practice average across England. Income deprivation affecting children and older people is lower than the practice average across England and slightly lower compared with the local area.

The practice has seven GP partners working 5.5 whole time equivalent (two male and five female) and three salaried GPs (one male, two female). There are five practice nurses and two health care assistant. The practice also employs a practice manager, a deputy practice manager, an accounts clerk, a cleaner, a dispensary manager and a team of reception, administration and dispensary staff, as well as three secretarial staff.

The practice is open from Monday to Friday 8am to 6.30pm and between 8.30am and midday on Saturday. Out-of-hours care is provided by Care UK via NHS 111.

The practice is a training practice and teaches GP registrars (qualified doctors who were training to become GPs). Two of the partners are trainers. There were two GP registrars at the practice at the time of our inspection.

Updated 18 January 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Angel Hill Surgery on 4 October 2016. The practice was rated as good for providing caring and responsive services, requires improvement for providing effective and well led services and inadequate for providing safe services. Overall the practice was rated as requires improvement. The full comprehensive reports on the 4 October 2016 inspection can be found by selecting the ‘all reports’ link for Angel Hill Surgery on our website at www.cqc.org.uk.

We carried out an announced comprehensive inspection at Angel Hill Surgery on 26 June 2017.The practice was rated as good for providing effective, caring, responsive and well led services and requires improvement for providing safe services. Overall the practice was rated as good. The full comprehensive reports on the 26 June 2017 inspection can be found by selecting the ‘all reports’ link for Angel Hill Surgery on our website at www.cqc.org.uk.

We undertook a desk based inspection on 8 January 2018 to check they had followed their action plan and to confirm they now met legal requirements in relation to the breaches identified in our previous inspection on 26 June 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good, and good for providing safe services.

Our key findings from this inspection were as follows:

• The practice used a local taxi company to provide a medicine delivery service to housebound patients. The practice had undertaken a risk assessment and had appropriate policies and monitoring in place.
• Medical equipment had been calibrated and the practice had a system to alert them when this needed to be completed again.
• The arrangements for the security of the dispensary ensured that medicines were kept secure and only accessible to authorised staff. The practice was based in a listed building and architect plans had been submitted to the council planning office, and a response was being awaited by the practice, in order to further improve the security of the dispensary.
• The practice had continued to explore improvements to the arrangements for the security of the dispensary to ensure medicines were kept secure and accessible only to authorised staff.
• Infection control training had been completed by all staff, including dispensary staff.
• There was an effective and embedded process for reviewing, sharing and acting upon all National Institute for Health and Care Excellence (NICE) evidence based guidance within the practice. Lead clinicians were responsible for discussing evidence based guidance at educational meetings and we saw evidence to demonstrate this. The practice regularly audited that NICE evidence based guidance was being implemented.

The areas where the provider should make improvement are:

• Continue to explore improvements to the arrangements for the security of the dispensary to ensure medicines are kept secure and accessible only to authorised staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 July 2017

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

• Nursing staff had lead roles in long term condition management and patients at risk of hospital admission were identified as a priority. Nurse led clinics were held, which were supported by a GP before and after the clinic. A diabetes specialist nurse undertook a monthly clinic for patients with more complex needs.
• 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). Data from 2015/2016 showed that performance for diabetes related indicators was 95%, which was comparable to the CCG average of 96% and above the England average of 90%. Exception reporting for diabetes related indicators was 13% which was the same as the CCG average and the England average of 12% (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). 2016/2017 unverified data from the practice showed that performance for diabetes indicators was 98%.
• Longer appointments and home visits were available when needed.
• All patients, including those with complex needs 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.
• The practice held a register of housebound patients and a GP visited those with long term conditions to ensure these were managed effectively.

Updated 14 July 2017

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

• The practice normally registered whole families with one GP of choice.
• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk. The practice met monthly with health visitors and social workers to identify vulnerable families with young children.
• Immunisation rates were in line with or above the CCG and England averages for most standard childhood immunisations. Where these were below standard, the practice was aware and had taken steps to improve uptake.
• 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 offered a full range of contraception services and chlamydia screening.
• Appointments were available outside of school hours. Books and toys were available for children and breast feeding facilities were available for nursing mothers.
• Expectant mothers were seen by the GP and a 30 minute six week check appointment was undertaken after their child was born.
• A paediatrician held a monthly clinic at the practice and attended the morning coffee meetings when they were available. They also provided educational sessions to the clinical staff twice a year.

Updated 14 July 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.
• GPs provided home visits to patients living in the 13 nursing and residential homes covered by the practice.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis, dementia and heart failure were above the local and national averages.
• One of the GPs at the practice had developed a local service directory for older adults, which detailed local organisations that offered support to the elderly.
• A geriatrician occasionally attended the multidisciplinary meetings held by the practice.

Updated 14 July 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.
• Appointments were available from 8am to 6.30pm on weekdays, with extended hours until 7pm on Tuesday, Wednesday and Thursday, and between 8.30am and midday on Saturday. The Saturday slots were for pre-bookable appointments only, but some urgent slots were reserved in case of patients attending the practice unannounced. When we viewed the practice website we saw that the extended opening times were not advertised. The practice advised that when they had advertised this service, this had led to an increase in complaints from patients as they did not offer a full service to patients during this time.
• The practice had imminent plans to offer early telephone consultations one morning a week and earlier pre-bookable appointments on Saturdays.
• Patients were able to book evening and weekend appointments with a GP through Suffolk GP+ (Suffolk GP+ is for patients who urgently need a doctor’s appointment, or are not able to attend their usual GP practice on a weekday.)
• 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. Unlimited telephone consultations were also available.
• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 77%, which was below the local and national averages of 82%. The practice had worked to increase uptake and unverified data provided by the practice showed that the uptake rate was now 81%.

Updated 14 July 2017

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

• Patients had a named GP who was responsible for coordinating their care. All results, post and appointments were directed towards their GP, which resulted in improved coordination and consistency for patients.
• 77% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was in line with the CCG average of 79% and national average of 78%. 2016/17 unverified data provided by the practice showed that performance had improved to 79%.
• 71% of patients experiencing poor mental health had a comprehensive care plan, which was below the CCG average of 74% and the national average of 78%. 2016/17 unverified data provided by the practice showed that performance had improved to 95%.
• The practice worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• A mental health link worker held a weekly clinic at the practice and attended the daily coffee meetings on these days.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 14 July 2017

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 housebound patients and those with a learning disability.
• The practice had 67 patients on the learning disability register. 38 of these patients had received a health review in the last 12 months. 29 patients had refused a review. The practice had links with a learning disability nurse and was planning to jointly review those patients who had refused.
• 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.
• 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 computer system alerted GPs if a patient was also a carer. The practice had identified 368 patients as carers (3% of the practice list).