Dolphin House Surgery

Updated 16 March 2016

Dolphin House Surgery provides a range of primary medical services to the residents of Ware and the surrounding villages Wareside, Thundridge, Wadesmill and Stanstead Abbotts. The practice has been at its current location of 6-7 East Street, Ware, Hertfordshire SG12 9HJ since 1982. There is a part-time branch practice at Sheffield House Surgery, 21 High Street, Stanstead Abbotts, Hertfordshire, SG12 8AA. The branch practice was not inspected as part of this inspection.

The practice population is pre-dominantly White British. National data indicates the area is one of low deprivation and covers an average age range. The practice has approximately 11,200 patients with services provided under a general medical services (GMS) contract.

There are six GP partners, four male and two female and a non-clinical managing partner who run the practice. They employ one female salaried GP. The nursing team consists of one nurse practitioner, three practice nurses and two health care assistants all female. There are also a number of reception and administration staff.

The practice is a training practice and currently has one trainee GP and one post graduate trainee gaining experience in general practice.

The practice is open from 8am to 6.30pm Monday to Friday and offers extended opening hours from 7.30am on Monday, Thursday and Friday and until 8.15pm on Wednesday. The branch surgery is open from 8am to 11.30am Monday to Friday.

When the practice is closed out of hours services are provided by Herts Urgent Care and can be accessed via the NHS 111 service.

Updated 16 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dolphin House Surgery on 21 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.
• The practice engaged with the patient participation group (PPG) and responded to suggestions for improvements.
• Information about services and how to complain was available and easy to understand.
• There were a variety of appointments available including urgent and pre-bookable. The practice responded to patient feedback and introduced telephone consultations and a ‘Just 5’ clinic on Mondays for patients to have a five minute appointment for simple problems.
• The practice 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 16 March 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.
• Performance for diabetes related indicators was better than the CCG and national average. The practice achieved 94% of available points compared to the CCG average of 89% and the national average of 89%.
• 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 16 March 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.
• The practice’s uptake for the cervical screening programme was 82%, which was comparable to the CCG average of 83% and the national average of 82%.
• 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 and health visitors.

Updated 16 March 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.
• They were aligned to two local care homes and carried out regular visits to these.

Updated 16 March 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.
• Telephone consultations and extended hours appointments were available.

Updated 16 March 2016

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

• 92% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was better than the national average of 84%.
• Performance for mental health related indicators was better than the CCG and national average. The practice achieved 100% of available points, compared to the CCG average of 96% and the national average of 93%.
• The practice regularly worked with multi-disciplinary teams in the case management of people 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 16 March 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 offered longer appointments for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• 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.