Regal Chambers Surgery

Updated 20 April 2016

Regal Chambers Surgery provides primary medical services, including minor surgery, to approximately 13045 patients from premises at 50 Bancroft, Hitchin, Hertfordshire, SG5 1LL.

The practice serves a lower than average population for those aged between 20 to 29 years, and higher than average population of those aged between 35 to 54 years. The population is 91% White British (2011 Census data). The area served is less deprived compared to England as a whole.

Regal Chambers Surgery is an approved teaching and training practice. They have been approved to train doctors who wish to undertake additional training (from four months up to one year depending on where they are in their educational process) to become general practitioners, and have been accredited by teaching hospitals so that medical students train at the practice for short periods as part of their general medical education. The team consists of eight GP partners and two salaried GPs. Six GPs are female and four are male. There are two GP trainees, one ST2 (second year of speciality training) and one ST3 (third year of speciality training). There are seven nursing team members including three practice nurses, two urgent care nurses, who are nurse prescribers, and two healthcare assistants. There is a business manager, six reception team members, six clinical administration team members and three general administration team members. There is a nominated team leader for the nursing, reception, clinical administration and general administration teams.

The practice is open to patients between 8am and 6.30pm Monday to Friday. Appointments with a GP are available from 8.45am to 11.45am and from 2.30pm to 6pm Monday to Friday. The practice offers extended opening hours between 7am and 8am on a Tuesday and Thursday during the first week of each month, between 6.30pm and 8pm on a Tuesday during the second week of each month and between 8.30am and 10.30am on the last Saturday of each month. Emergency appointments are available daily and are provided by two duty doctors and urgent care nurses. A telephone consultation service is also available for those who need urgent advice. Home visits are available to those patients who are unable to attend the surgery and the practice is also able to offer home visits via the Acute In Hours Visiting Service. This is a team of doctors who work across East and North Hertfordshire to visit patients at home to provide appropriate treatment and help reduce attendance at hospital. The out of hours service is provided by Hertfordshire Urgent Care via the NHS 111 service and information about this is available on the practice website and telephone line.

Updated 20 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Regal Chambers Surgery on 14 January 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.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• 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.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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.                      

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 April 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 practice held weekly nurse-led COPD (chronic obstructive pulmonary disease) and asthma clinics.
• The overall performance for diabetes related indicators was below the local Clinical Commissioning Group (CCG) and national averages.
• The practice held a multidisciplinary diabetic clinic for patients on a weekly basis, providing all aspects of diabetes management including insulin initiation. The practice worked closely with the secondary care diabetes consultant and completed an annual review of patients.
• Longer appointments and home visits were available when needed.
• The practice held a register of cancer patients and regularly reviewed new cancer diagnosis.
• All patients with a long-term condition 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 20 April 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.
• 69% of patients diagnosed with asthma, on the register, had an asthma review in the last 12 months which was comparable with the national average of 75%.
• 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’s uptake for the cervical screening programme was 83% which was comparable with the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice held nurse-led baby immunisation clinics twice a week.
• The practice provided GP services to a local independent school.
• We saw positive examples of joint working with midwives and health visitors.

Updated 20 April 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, this included enhanced services for dementia and end of life care.
• Weekly visits to three local care homes were carried out by named GPs for continuity of care and emergency visits were also provided when needed.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments when required.
• The practice worked closely with a rapid response and case management service in place to support older people and others with long term or complex conditions to remain at home rather than going into hospital or residential care.
• The practice had completed 366 over 75 health checks in the last 12 months, which was 32% for this population group.
• Flu vaccination rates for the over 65s were higher than the national average.

Updated 20 April 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.
• It provided a health check to all new patients and carried out routine NHS health checks for patients aged 40-74 years.
• The practice was proactive in offering online services such as appointment booking and repeat prescriptions services, as well as a full range of health promotion and screening that reflects the needs for this age group.
• It offered an appointment reminder text messaging service and appointment times were extended four times a month, including one Saturday morning each month.
• The practice provided an electronic prescribing service (EPS) which enables GPs to send prescriptions electronically to a pharmacy of the patient’s choice. 

Updated 20 April 2016

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

• 95% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was higher than the national average of 84%.
• Fortnightly visits to two local mental health/learning disability facilities were carried out by named GPs for continuity of care and emergency visits were also provided when needed.
• The practice held a register of patients experiencing poor mental health and offered regular reviews and same day contact.
• It had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Patients were referred to the Improving Access to Psychological Therapies (IAPT) service and these sessions were delivered at the practice by the local community wellbeing team.
• 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 20 April 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 those with a learning disability.
• The practice provided same day appointments for people from a nearby hostel.
• It offered longer appointments and annual health checks for people with a learning disability.
• The practice held a register of carers, there was a nominated carer’s champion who was proactive in offering health checks, flu vaccinations and information and advice about local support groups and services.
• There was a system in place to identify patients with a known disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• It had told vulnerable patients about how to access various support groups and voluntary organisations.
• There was a system in place to identify patients who required additional support and extra time during appointments.
• Staff had received safeguarding training and 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.