Acorn Surgery

Updated 21 March 2017

Acorn Surgery is a member of the NHS Cambridgeshire and Peterborough Clinical Commissioning Group (CCG). General Medical Services (GMS) are provided under a contract with NHS England.

The surgery is in a purpose built building with consulting and treatment rooms on the ground floor. There is a substantial car park with disabled parking bays and disabled access into and throughout the building.

The practice is located in an area of deprivation in Huntingdon in Cambridgeshire. Information published by Public Health England rates the level of deprivation within the practice population group as six on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest.

The practice currently has a patient list size of 9,765. The average life expectancy of the practice population comparable with both CCG and national averages for males at 78 years (compared to national average 80 years). Life expectancy for females is also comparable with CCG and national averages at 83 years (national average 83 years).

The practice has 25% of their patients aged less than 15 years of age and the highest birth rate in the county.

There are seven GPs at the practice (five female and two male). Nursing staff consist of a female nurse specialist practioner (prescriber), five female practice nurses,  one assistant practioner and two health care assistants. There is a practice manager and a team of reception and administrative staff who oversee the day to day running of the practice.

Acorn Surgery has been a GP training practice since 2002. They are accredited to train doctors to become GPs (registrars) and to support undergraduate medical and nursing students with clinical practice and theory teaching sessions. Some of these students have qualified and returned to work at the practice.

The practice has good working relationships with health and social services to support provision of care for its patients. Locally, they have close working links with four nursing homes. Each nursing home has a lead GP. Regular visits are made by the clinicians to these sites.

The practice (reception) is open Monday to Friday 8am to 6pm with appointments available from 7:30am until 8pm on some days.

Updated 21 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Acorn Surgery on 9 January 2017. Overall the practice is rated as outstanding.

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

• There was a clear leadership structure, staff were aware of their roles and responsibilities and told us the GPs were accessible and supportive.
• There was evidence of an all-inclusive team approach to providing services and care for patients.
• Feedback from patients about their care was consistently positive.
• Staff said they were proud to work at the practice and felt they delivered good quality service and care to patients.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure they meet patients’ needs. For example the introduction of a dedicated mental health service at the practice.
• Staff had the skills, knowledge and experience to deliver effective care and treatment.
• The practice staff had a very good understanding of the needs of their practice population and were flexible in their service delivery to meet patient demands; such as providing flexible GP appointments when required.
• There was good access to clinicians and patients said they found it easy to make an appointment. There was continuity of care and if urgent care was needed patients were seen on the same day as requested. Consultations were available through Skype.
• Patients’ needs were assessed and care was planned and delivered following local and national care pathways and National Institute for Health and Care Excellence (NICE) guidance.
• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• The practice promoted a culture of openness and honesty. There was a nominated lead for dealing with complaints and significant events. All staff were encouraged and supported to record any incidents. There was evidence of good investigation, learning and sharing mechanisms in place.
• The practice complied with the requirements of the duty of candour. (The duty of candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment.)
• There were safeguarding leads in place and systems to protect patients and staff from abuse.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example the practice had reviewed the appointment system and significantly improved access to appointments for patients.

We saw some outstanding practice:

• There was a proactive approach to understanding the needs of different groups of people, with a focus on people living in vulnerable circumstances. These included support for patients who were homeless, seeking refuge and those with alcohol dependency and substance misuse.
• The practice aimed to reduce unecessary hospital attendance, with a range of practice based clinics and services. For instance ‘no scalpel vasectomy’, acupuncture, anticoagulation monitoring services and working closely and collaboratively with the on site pharmacy which delivers direct HIV services, and with the GUM clinic which operates from the same building.
• There was a proactive approach to safeguarding, with GP leads in place to support a high number of children who were at risk.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure they met patients’ needs promptly. For example: a pilot project for enhanced mental health needs and an alcohol support service to facilitate ‘home detox’ for patients.
• The practice team proactively promoted health awareness and self-care in the community by the GP lead and practice team attending local nursery, primary schools and local community events. They have also been selected by the NHS England to deliver a supported self-care pilot programme.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 March 2017

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

• The practice nurses had lead roles in the management of long term conditions, supported by the GPs.
• A nurse led diabetes service with GP support was in place working with a  specialist community diabetes nurse to help ensure coordinated delivery of care.
• The practice had identified patients at high risk of developing diabetes. This enabled the clinicians to support and advise patients on changes required to prevent diabetes developing.
• 91% of patients with diabetes had an HbA1C result higher than both local and national figures at 89% and 88%. (HbA1c is a blood test which can help to measure diabetes management.)
• Annual reviews were undertaken to check patients’ health care and treatment needs were being met.
• 79% of patients diagnosed with asthma had received an asthma review in the last 12 months, compared to 76% locally and 76% nationally.
• 97% of patients diagnosed with chronic obstructive pulmonary disease (COPD) had received a review in the last 12 months, compared to 88% locally and 90% nationally.

Updated 21 March 2017

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

• The practice worked with midwives and health visitors to support the needs of this population group. For example, the provision of ante-natal, post-natal and child health surveillance clinics.
• 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.
• There was a high rate of child related safeguarding alerts and concerns. This included children who may be at risk of female genital mutilation. A GP lead was in place and dedicated staff were in place to ensure children were protected. Regular safeguarding meetings were in place in at the practice to review concerns. The practice identified and provided additional support for children at risk  trafficking and radicalisation.
• The practice also worked with a local women’s refuge providing primary care and counselling support to women and their children. Children at risk of abuse, hospital admission, living in disadvantaged circumstances or deteriorating health needs had their health and social care needs discussed at regular multi-disciplinary meetings attended by the health visitor.
• Immunisation rates were high for all standard childhood immunisations.
• Patients and staff told us children and 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. Same day access was available for all children under the age of five.
• GP led baby clinics were held weekly at the practice. The practice had access to on site midwives and health visitors in the building.
• The practice team reviewed all new births on a regular basis to ensure post-natal care was in place for the mothers. Dedicated members of the admin team regularly contacted  mothers to discuss registration of their new baby and encourage attendance.
• We saw positive examples of joint working with the midwives. For example, the midwife and GP reviewed the care of expectant mothers with gestational diabetes.
• The practice ensured rapid registration and vaccinations and health checks of university students, signposting them to further support services.
• Sexual health, contraceptive and cervical screening services were provided at the practice.
• 83% of eligible patients had received cervical screening, compared to 82% locally and 81% nationally.
• The practice worked with local nurseries and preschool services in promoting early health promotion.

Updated 21 March 2017

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

• Proactive, responsive care was provided to meet the needs of the older people in its population.
• Registers of patients who were aged 75 years and above and also the frail elderly were in place to ensure timely care and support were provided. Health checks were offered for all these patients.
• The practice worked closely with other health and social care professionals, via multi-disciplinary care teams. This helped housebound patients receive co-ordinated care and support and reduced hospital admissions.
• The practice worked with local nursing homes and sheltered living establishments to providing regular support and guidance. A GP lead was in place for each service.

Updated 21 March 2017

The practice is rated as outstanding for the care of working age people (including those recently retired and students).

• The needs of these patients 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 provided video and telephone consultations, online booking of appointments and ordering of prescriptions. The practice also sent patient appointment reminders and information such as help line contacts and appointment updates by text (SMS) messaging.
• Appointments were available earlier and later in the day to accommodate patients who worked.
• The practice offered a range of health promotion and screening that reflected the needs for this age group.
• Practice staff carried out NHS health checks for patients between the ages of 40 and 74 years. We saw evidence where an early diagnosis of diabetes and another of hypertension had been made for patients giving them the opportunity to improve their long term outcomes.

• Travel health advice and vaccinations were available.

• 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.
• Fast track registration was made available to University students.
• The practice offered a full range of contraceptive services including long acting reversible contraceptive services (LARC).The practice arranged appointments convenient to the patient.

Updated 21 March 2017

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

• 100% (45 patients) diagnosed with dementia had received a face to face review of their care in the last 12 months, which is higher than the local and national averages 87% and 83%.
• The practice had developed comprehensive care plans for patients with patients diagnosed with dementia.
• The practice had responded to the needs of its patients experiencing poor mental health and there were effective arrangements to provide care and support for those patients. The practice is a pilot project for enhanced mental health services. They worked closely with a dedicated Community Psychiatric Nurse (CPN) based at the practice, and had local access to a psychiatric consultant to support patients promptly and effectively.in primary care.
• 95% (63 patients) who had a severe mental health problem had received an annual review in the past 12 months and had a comprehensive, agreed care plan documented in their record. This was higher than the local average of 90% and the national average of 89%.
• Same day appointments and phone consultations were made for patients experiencing poor mental health.
• Patients and their carer, where appropriate, were given information on how to access various support groups and voluntary organisations.

Updated 21 March 2017

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

• Staff 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.
• We saw there was information available on how patients could access various local support groups and voluntary organisations.
• There was a GP led service for patients with a learning disability. There were longer appointments available for patients with a learning disability either in their own home or at the practice to reduce the stress a visit to the practice may cause. Annual health checks and flu jabs with dedicated leads for learning disabilities in place.
• There was a proactive approach to understanding the needs of different groups of people, including people living in vulnerable circumstances. The practice was the primary care provider for a local service for the homeless. They had developed a trusting rapport with a homeless hostel through a flexible, close working and a non-judgemental approach, and developing a better understanding of their needs.
• GPs worked with a local alcohol and substance misuse charity and helped provided a ‘home detox’ service. This gave patients 24/7 support GP led substance misuse clinic held at the practice to provide accessible support and advice and offer a range of vaccinations and health screening.