The Loughton Surgery

Updated 23 December 2016

The practice is situated near to a local shopping centre and has limited parking on site. There is public pay and display parking at the council leisure centre adjacent to the practice.

This practice currently has a branch surgery on the High Road in Loughton, that all patients can assess if they wish. We did not visit the branch surgery as part of this inspection. This is due to close in October 2016 and all patients will be seen from The Loughton Surgery premises on Traps Hill. In anticipation of this major building works were taking place at the time of our inspection with a completion date of October 2016. The newly refurbished premises will have consulting rooms for GPs from both practices and well as rooms for other clinical staff.

The current list size of the practice is 10500. There are three male GPs and two female GPs based at The Loughton Surgery. When the branch closes they will be joined by two male GPs and one female GP. There is one female nurse practitioner, a female practice nurse and a female health care assistant (HCA). There are a number of other staff carrying out administrative duties. The practice and branch surgery operate as three teams of doctors and all patients are allocated to one of the three teams to provide continuity of care.

This practice is a teaching and training practice. It has GP registrars in their final stage of training and from time to time medical students working under supervision. GP registrars are fully qualified GPs and will have had at least three years of hospital experience.

The practice opening hours vary from day to day. Monday is 7.30am to 6.30pm, Tuesday is 7.30am to 7.30pm, Wednesday is 8am to 6.30pm, Thursday is 7.30am to 7.30pm and Friday is 8am to 6.30pm. Appointments run throughout the day.

The branch surgery on the High Road is open Monday, Tuesday and Fridays 9am to 2pm, and 4pm to 7pm. On Wednesdays the practice is open between 9am to 7pm, and on Thursdays it’s open from 9am to 2pm and 4.30pm to 6.30pm.

When the practice is closed patients are advised to call 111 if they require medical assistance and it cannot wait until the surgery reopens. The out of hours service is provided by PELC.

There are fairly low levels of income deprivation affecting children and affecting older people.

Updated 23 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Loughton Surgery on 8 September 2016. Overall the practice is rated as good.

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

• Staff were aware of their responsibilities regarding safety, and reporting and recording of significant events. There were policies and procedures in place to support this.
• The practice assessed most risks to patients and staff. There were systems in place to manage most of these. However improvements as a result of an infection control audit had not been acted on.
• Patient and medicines safety alerts were received at the practice reviewed and appropriate action taken as required.
• The practice had identified a low number of carers.
• Patients’ care and treatment was assessed and delivered based on the current evidence based guidance.
• Staff received appropriate training to provide them with the necessary skills, knowledge and experience to fulfil their role. They had access to further role specific training if appropriate.
• Patients said they felt the practice offered an excellent service and staff were helpful, caring and treated them with dignity and respect.
• Performance data from 2015 to 2016 show that the practice were in line with the CCG and national averages for most indicators, this demonstrated an improvement from the previous year. However exception reporting in some areas was much higher than the local and national averages.
• Information about how to complain was available for patients both online and in the practice building itself. Complaints investigations and documentation showed that improvements were made to the quality of service provision.
• The practice undertook quality improvement activities to identify where services might be developed.
• The GP survey, published in July 2016, showed the practice performance for access to services was higher than the CCG and national averages.
• The practice facilities met the needs of its patient population.
• There was a clear management structure and staff told us they felt supported and involved in the development of the practice.
• The culture of the practice was open and honest, and the practice complied with the requirements of the duty of candour.
• Consideration had been given to the needs of the patient population needs when planning the redevelopment of the practice site.

The areas where the provider should make improvement are:

• Ensure that areas for improvement as a result of infection control audits are acted on in a timely manner.
• Improve the identification of carers and the support offered to this group.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 December 2016

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

• The practice nurse was responsible for the reviews of patients with long-term conditions and had received training in diabetes, COPD and asthma. To ensure that the nurse maintained their expertise, the community specialist nurses attended the practice to monitor their competency during consultations.
• The practice performance for diabetes indicators was in line with CCG and national average for four out of five indicators, but much lower for one indicator. For example, the percentage of patients with diabetes who had a flu immunisation in the preceding August to March was lower than the CCG or national average.
• Longer appointments and home visits were available when needed.
• The nurse practitioner visited the local care homes on a fortnightly basis to monitor those with long term conditions.
• The practice encouraged shared care prescribing so that the patient was able to be monitored locally.
• Patients were encouraged to be involved in decisions about management of their condition.
• Rescue packs were prescribed for patients with COPD to self-manage when their condition started to deteriorate.

Updated 23 December 2016

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

• There were systems and processes in place to enable staff to identify and take appropriate action to monitor and safeguard children and young people living in disadvantaged situations. For example, children with a large number of A&E attendances.
• Immunisation rates were in line with CCG and national averages for all standard childhood immunisations.
• Patients told us that children and young people were treated in an age-appropriate way.
• Due to extended hours appointments were available outside of school hours.
• The practice had attended an educational event that had been opened up for teenagers leaving care, so that they could provide a better service for this group of patients.
• The practice promoted breast feeding and offered mothers a private area to breast feed if required. A dedicated private area was being built for this purpose.
• The practice combined post-natal checks with the baby checks and first immunisations to minimise the number of appointments a mother had to attend.

Updated 23 December 2016

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

• The practice provided an avoiding unplanned admission enhanced service. They held a case load of ‘at risk’ patients. Some of these were identified through reviewing discharge summaries and GP held care plans after hospital admission to avoid further admissions.
• The nurse practitioner visited the local care homes on a fortnightly basis to monitor those with long term conditions.
• Home visits were available for house-bound patients and flu vaccinations are provided at home for them and their carers.
• Exception reporting for patients with osteoporosis taking a particular medicine was considerably higher than the local and national average. However for a different medicine the exception reporting was at 0%.
• The practice were aware that a large number of older people at the practice preferred earlier appointments so the practice tried to allocate these to them.
• The new reception area had been designed to improve the facilities for their patients, including a hearing loop and access for those with limited mobility.

Updated 23 December 2016

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

• The practice offered extended hours as well as lunchtime telephone appointments.
• Prescriptions were sent electronically to the patients preferred chemist.
• Text messages were sent for health promotion reminders or checks.
• The practice offered online appointment booking and prescription requests.
• The practice saw students on a temporary basis that were staying at home for the holidays but registered with their university GP practice.
• The percentage of women aged 25-64 who have had a cervical screening test in the past 5 years was in line with the CCG and national average.

Updated 23 December 2016

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

• The percentage of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, was comparable to the CCG and national average.
• The practice offered same day telephone advice for those patients experiencing a mental health crisis.
• Exception reporting for conducting reviews on patients with depression was higher than the local and national average.
• The practice worked closely with mental health professionals to deliver coordinated care in the community.
• Patients were offered an annual review of both physical and mental health.
• Longer appointments were available for patients experiencing poor mental health.
• Patients who failed to attend for appointments were followed up to establish the reasons for non-attendance.
• The practice developed their own template for referring patients to community mental health services, as the referral forms were continually changing.
• The practice signposted patients to local voluntary support services.

Updated 23 December 2016

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

• The practice attended an educational event by a new facility that had been opened up for teenagers leaving care, so that they could provide a better service for this group of patients.
• The practice followed up vulnerable patients who continued not to attend booked appointments, and worked with the patient to find a way to prevent non-attendance in the future.
• Staff have received training in identifying and reporting possible signs of abuse and the practice keep registers of different groups of people whose circumstances make them vulnerable.
• The practice offered shared care services for those with substance abuse issues and this group of patients were offered same day telephone appointments. The practice wrote letters to organisations, if required, on behalf of these patients who may require extra support in accessing services.
• The practice had identified 44 carers which was 0.5% of the patient list.