William Fisher Medical Centre

Updated 16 September 2016

William Fisher Medical Centre is located in the town of Southminster, situated in the centre of a peninsula in eastern Essex. The practice is a dispensing practice providing medical services to about 6,000 patients living in and around the town of Southminster.

The medical centre is based in a purpose built two story building. The ground floor accommodates the reception and most of the clinical rooms with two nurse rooms on the first floor and the administration team. There is some free parking to the side of the building and there is a public car park nearby.

The practice has three GPs (two male and one female), a female advanced nurse practitioner and a female practice matron. They are supported by two part time practice nurses and two HCAs. The clinical team are supported by a practice manager, a dispensary team, administration and office team.

The practice is open between 8am and 6:30pm Monday to Friday. Appointment times varied between the clinical staff but usually ranged from 8.30am to 12.30pm and 2.30pm to 6pm. Extended hours appointments were offered on Wednesdays from 6.30pm to 8pm. This was for routine appointments with a doctor or a nurse and had to be booked in advance. In addition to pre-bookable appointments that could be booked approximately four weeks in advance, additional appointments were released for face to face consultations and telephone triage each day for those with more urgent needs.

The practice 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. This information is also available on their website and the NHS choices website.

The practice provides the following directed enhanced services:

• Dispensing medicines.
• Childhood immunisations and vaccinations.
• Dementia screening.
• Flu vaccinations.
• Unplanned hospital admissions avoidance.
• Improving on-line access.

Minor surgery

Updated 16 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at William Fisher Medical Centre on 2 August 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• The practice demonstrated to us a safely run service over time.

• We found there was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

• There were robust processes in place for managing medicines.

• Effective standards of cleanliness and hygiene were maintained throughout the practice.

• The practice had a system in place to ensure enough staff with the right skill mix were on duty to ensure safe care delivery.

• Staff had received appropriate training to undertake their roles and responsibilities.

• The practice recognised the importance of the continuing development of staff skills, competence and knowledge to ensure high-quality care.

• The practice held several different meetings with health care professionals to share and coordinate services for patients.

• Staff understood the relevant consent and decision making requirements of legislation and guidance.

• Staff used every contact as an opportunity to identify potential risks to patients health and signposted them to support to live healthier lives.

• There was a strong, visible, person-centred culture within the practice. Staff were highly motivated to offer care that was kind and promoted patient’s dignity.

• Information about services and how to complain was available and easy to understand. We found improvements had been 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 named GP and there was continuity of care, with urgent appointments available the same day.

• The practice had a clear vision and a set of values, with patient’s wellbeing as a priority.

• There was a clear leadership structure and staff felt supported by management.

• The practice actively sought the views from a wide range of stakeholder, including patients, staff, visiting professionals and commissioners about their experience of and quality of care and treatment delivered.

We saw an area of outstanding practice that ensured that patients with long term conditions;

• The practice adopted a proactive approach to understanding the needs of different groups of patients and to deliver care in a way that met these needs. The practice had employed a practice matron to provide a bespoke service for these patients at the practice. This ensured joined up care delivery to patients.

• The matron visited care homes weekly to review patients and to support staff in understanding and managing patient’s medical conditions. Home visits were arranged in conjunction with a GP, for the review of patients with long term conditions that were unable to attend the surgery.

• The matron conducted reviews of all A&E attendances, hospital admissions and discharges. Where relevant the practice arranged a telephone call or home visit to identify if any support was required.

• The practice had identified a delay in receiving discharge information. The practice matron liaises with the hospitals and follows up the patient on discharge to ensure the patient’s health and wellbeing needs had been meet

• The practice matron reviewed and promoted the carers register ensuring this group of patients received support, advice and checks for their wellbeing so that they were able to provide the care required.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 September 2016

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

• There was proactive approach to understanding the needs of different groups of patients and to deliver care in a way that met these needs and promoted equality. This included patients who were in vulnerable circumstances or who had complex needs. The practice employed a practice matron to provide a bespoke service. This ensured joined up care delivery to patients.

• The matron visited care homes weekly to review patients and to support staff in understanding and managing patient’s medical conditions. Home visits were arranged in conjunction with a GP, for the review of patients with long term conditions that were unable to attend the surgery.

• Reviews of all A&E attendances, hospital admissions and discharges. Where relevant the practice arranged a telephone call or home visit to identify if any support was required.

• The practice matron liaised with the hospitals and follows up the patient on discharge to ensure the patient’s health and wellbeing needs had been meet. Reviewed and promoted the carers register ensuring this group of patients received support, advice and checks for their wellbeing.

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

• The practice achieved above the local and national averages for their performance with a 98% achievement for clinical indicators.

• Longer appointments and home visits were available when needed.

• Patients told us they felt that their long term condition care provided was of a high standard. This was supported by the high QOF performance. For example the percentage of patients with COPD who had a review, undertaken in the preceding 12 months was 94% compared to a CCG average of 88% and a national average of 89%.

• The practice had identified GP leads in specialist clinical areas such as, diabetes, heart disease, asthma and gynaecology; the practice nurses supported this work.

• All patients with a long-term condition received a structured annual review to check their health and medicines needs were being appropriately met.

• For those patients with the most complex needs and associated risk of hospital admission, the practice team worked closely with the local community health providers including the community matron and respiratory team to deliver a multidisciplinary package of care.

Updated 16 September 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 high for all standard childhood immunisations. Childhood immunisation rates for the vaccinations given to under two year olds ranged from 96% to 100% and five year olds from 91% to 98%.

• The practice provided an online appointment booking facility and online ordering of repeat prescriptions.

• Patients we spoke with on the day, and feedback received from our comment cards, showed 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. Baby changing facilities were available and the practice accommodated mothers who wished to breastfeed.

• Personal GP patient lists enabled the doctor to build family relationships, and promote continuity for patients.

• The practice reviewed any children on a child protection plan at their own monthly clinical meeting.

• The practice provided neonatal checks, six week post-natal checks for new mothers and eight week baby checks.

Updated 16 September 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.

• Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs in order to deliver care more effectively. Monthly meetings with wider members of the healthcare team were held to review more complex and vulnerable patients.

• Each GP maintained their own personal list to promote continuity of care and to establish strong relationships with individuals and their families. However patients could see any GP of their choice.

• Longer appointments were available for patients. Double or triple appointment slots could be booked for patients with complex needs.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. These were triaged by the practice matron or duty GP.

• The practice visited two care homes on a weekly basis to undertake ward rounds, as well as requested visits.

Updated 16 September 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.

• Telephone consultations were available each day for those patients who had difficulty attending the practice due, for example, to work commitments.

• The practice provided an online appointment booking facility and online ordering of repeat prescriptions.

• Feedback from patients was consistently positive. They told us they could get an appointment quickly and at a time that was convenient to them. For example, the January 2016 national GP patient survey indicated that 93% of patients were able to get an appointment to see or speak to someone the last time they tried compared to a CCG average of 92% and a national average of 91%.

• 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 September 2016

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

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia whom they carried out advance care planning for.

• Patients with a learning disability and those with dementia were supported to make decisions through the use of care plans, which they were involved in and agreed with.

• QOF data from January 2016 showed 90% of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was higher than CCG and national averages.

• 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.

• The practice had processes in place for monitoring prescriptions that were not collected from the dispensary, particularly where patients had been identified as experiencing poor mental health.

• Each GP maintained their own personal list to promote continuity of care and to establish strong relationships with patients and their families. However patients could see any GP of their choice.

• For patients with dementia, written consent for relatives to share in medical information and treatment planning was encouraged.

• The practice told patients experiencing poor mental health and patients with dementia and their carers about how to access services including talking therapies and various support groups and voluntary organisations. Information was available for patients in the waiting area.

Updated 16 September 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 worked with multi-disciplinary teams in the case management of vulnerable people and informed patients how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adults. 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 provided good care and support for end of life patients. Patients were kept under constant review by the practice in conjunction with the wider multi-disciplinary team.