Maynard Court Surgery

Updated 2 October 2017

Maynard Court Surgery is located in a residential area in Waltham Abbey, Essex. The practice is based on the ground floor although there is ramped access to the front and back doors. There is very little allocated parking although there is street parking available in the surrounding roads. At the time of our inspection the list size was approximately 3840. The practice has a General Medical Services contract. A GMS contract is one between NHS England and the practice for delivering primary care services to local communities.

The practice has two male partner GPs, one male and two female salaried GPs. There are two long-term locums, a nurse practitioner, a practice nurse, a practice manager and a team of reception and administration staff.

The practice is open between 8.30am to 6.30pm Tuesday, Thursday, Friday, 7.30am to 6.30pm Monday and 8.30am to 8pm Wednesday. The practice is shut between 1pm and 2pm.

GP appointments are available: Monday 7.30am to 11am and 3.30pm to 6pm; Tuesday 9am to 11am and 3.30pm to 6pm; Wednesday 9am to 11am, 4pm to 6pm and 6.30pm to 7.50pm; Thursday 8.30am to 11.00am and 4pm to 5.30pm; Friday 9am to 11.00am and 3pm to 6pm. When the practice is closed patients are signposted to NHS 111 for out of hours care which is provided by PELC.

Updated 2 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Maynard Court Surgery on 5 September 2017. Overall the practice is rated as good.

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

• Significant events were fully investigated; if patients were involved they would receive support, honest explanations and apologies in line with the duty of candour. Learning was shared in clinical meetings, however there was no formal way of informing staff that were not at the meeting. Following inspection the practice implemented a system to ensure this was done.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Some of the clinical and non-clinical staff had not received updated infection control training. However, following inspection this training was arranged to occur within the week.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect.
• Information about services and how to complain was available. Complaints were fully investigated.
• Patients we spoke with 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 was restricted by the building they were based in however worked around this to provide appropriate facilities and services 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 the requirements of the duty of candour. It was evident that the practice complied with these requirements.
• The practice had identified a low number of patients who were carers.

The areas where the provider should make improvement are:

• Improve the identification of carers.
• Improve the cascading of learning from significant events to relevant staff.
• Review systems for ensuring staff complete updates on infection control training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 October 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• Nationally reported data showed that outcomes for patients for long-term conditions were in line with other practices within the Clinical Commissioning Group (CCG) and nationally. For example, numbers of patients with diabetes receiving appropriate reviews were in line with the CCG and national average for the majority of indicators.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• All these patients had a named GP and there was a system to recall patients for 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 2 October 2017

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

• We found there were systems to identify, monitor and follow up children living in disadvantaged circumstances and/or who were at risk.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Children’s’ asthma reviews were scheduled either in school holidays or outside of school hours.
• A room was available which parents could use to change nappies or for mothers to breast-feed, should they prefer to do this in private.

• Clinical staff had an understanding of Gillick competence and Fraser guidelines.
• The practice worked with midwives, health visitors to support this population group. For example, in the provision of antenatal, post-natal and child health surveillance clinics. The practice had emergency processes for acutely ill children and young people.

Updated 2 October 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Where older patients had complex needs, the practice discussed how their needs could be met holistically with local health and social care services.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. For example, advice on healthy eating.

Updated 2 October 2017

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

• The needs of this population had been identified and the practice had adjusted the services it offered to ensure these were accessible and flexible, for example, extended opening hours on two days.
• The practice offered as a full range of health promotion and screening that reflected the needs for this age group. These included, well woman and well man checks.
• Nationally reported data showed that outcomes for patients for uptake of cervical smears were in line with other practices within the Clinical Commissioning Group (CCG) and nationally.
• The practice offered the electronic prescription service. This service allows patients to choose or ‘nominate’ a pharmacy to get their medicines from; the GP then sends the prescription electronically to the nominated place.
• The practice offered a range of online services such as online booking and repeat prescription ordering.

Updated 2 October 2017

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

• 79% of patients diagnosed with dementia who had their care reviewed in a face-to-face meeting in the last 12 months, which was in line with the CCG and national average.
• 93% of patients with schizophrenia, bipolar affective disorder and other psychoses had a care plan in their notes, which was higher than the CCG and national average.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to support patient that may be in crisis with their mental health.
• Staff interviewed had an understanding of how to support patients with mental health needs and dementia.

Updated 2 October 2017

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.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered urgent appointments for those patients who needed them.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients with a learning disability.