Archived: Walton Surgery

Updated 17 September 2019

• The name of the registered provider is Suffolk GP Federation C.I.C. (Suffolk Fed). The provider is a community interest company, limited by shares. There is a Suffolk GP Federation C.I.C board which is made up of the registered manager, a Caldicott guardian, a GP, an accountable officer for controlled drugs, safeguarding and information governance leads. The provider is also registered to provide regulated activities at three other locations.
• The address of the location is 301 High Street, Felixstowe, Suffolk, IP11 9QL.
• The provider is registered to provide diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury.
• Walton Surgery provides services to approximately 4,500 patients in a semi-rural area in Suffolk.
• In addition to the staff from Suffolk GP Federation C.I.C., the practice has one salaried GP (female) and two regular locum GPs (one male and one female). There is a management team including an operational manager, supported by a team of administration staff. The practice employs one advanced nurse practitioner, two practice nurses, and one health care assistant.
• The practice holds a General Medical Services contract with NHS England.
• Walton Surgery is open Monday and Wednesday from 8am to 6.30pm, Tuesday from 7.45am to 7pm and Thursday and Friday from 7.45am to 6.30pm. Appointments can be booked twelve weeks in advance with urgent appointments available on the same day. The practice, in collaboration with two local practices, offered same day appointments at the practice and differing locations. The practice was also part of a GP+ service; patients were able to be seen for evening or weekend appointments at Felixstowe community hospital and a location in nearby Ipswich.
• Out of hours care is provided by Suffolk GP Federation C.I.C. via the NHS 111 service.
• We reviewed the most recent data available to us from Public Health England which showed that the practice population has a higher than average number of patients aged 45 and over and lower than average number of patients aged under 40 years, compared to the national average. 23% of the practice population is aged 65 years and over. The practice has a low level of deprivation. Income deprivation affecting children and adults is in line with the local and national averages.

Updated 17 September 2019

The practice is rated as Good overall.

Suffolk GP Federation C.I.C., the registered provider of this service. Suffolk GP Federation C.I.C is a community interest company and is the registered provider of three other locations and services are provided from various sites across Suffolk.

Walton Surgery (referred to in this report as ‘the practice’) was previously inspected in January 2019. It was rated as inadequate overall, and for providing safe, effective and well led services and good for providing caring and responsive services. It was placed in special measures. The practice was issued with a warning notice for Regulation 12, safe care and treatment. We carried out an announced focused inspection at Walton Surgery on 8 May 2019 and found the practice had met the requirements of the warning notice.

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection at Walton Surgery on 13 August 2019 following the six month period of the special measures. Our judgement of the quality of care at this service is based on a combination of

• what we found when we inspected

• information from our ongoing monitoring of data about services and

• information from the provider, patients, the public and other organisations.

At this inspection we found:

• At the previous inspection in January 2019, the practice was rated as inadequate for providing safe services. Improvements had been made in relation to safeguarding, infection control and equipment calibration. Systems to ensure the appropriate monitoring of medicines and monitoring the work of the nurses and advanced nurse practitioner were embedded. Improvements had been made, which ensured patient correspondence was followed up in a timely way, major and significant health needs were coded, and diagnostic reports were reviewed appropriately. A failsafe system to monitor cervical cytology had been established and embedded.
• Improvements had been made to ensure appropriate prescribing and monitoring of medicines and that patients were followed up in a timely way, major and significant health needs were coded, and diagnostic reports were reviewed appropriately. A system was in place to monitor the work of the nurses and advanced nurse practitioner and to check they were not working outside of their competency.
• The practice had started to use an appropriate tool to identify older people who were living with moderate or severe frailty. The uptake of health reviews for people with a learning disability had improved, with ten out of 15 completed from April 2018 to March 2019. They had undertaken work with the learning disability nurse to review the coding of patients with a learning disability. Seven out of 14 patients with a learning disability had received a health review since April 2019.
• Improvements had been made to the clinical oversight of the Quality and Outcomes Framework (QOF) at a practice level. The practice’s QOF achievement was in line with local and national averages. The exception reporting for one of the chronic obstructive pulmonary disease and two of the mental health indicators was above the local and national averages. We reviewed patient records from 2018/19 exception reporting and found examples where patients were not appropriately exception reported for COPD, although they were appropriate for mental health. We were told the process for 2019/20 had been amended so that exception reporting could only be completed by the primary care lead.
• Patients were supported, treated with dignity and respect and were involved in decisions about their care and treatment.
• Results from the national GP patient survey published in July 2018 were in line with local and national averages.
• Patients’ needs were met by the way in which services were organised and delivered. For example, Suffolk GP Federation C.I.C. had worked with two other local practices and had access to two full time mental health nurses and two paramedics. The three practices worked together to deliver an ‘on the day’ service from 3pm to 6.30pm to offer urgent appointments for patients.
• Improvements had been made and systems and processes to ensure clinical leadership and governance at the practice were embedded. There was clinical oversight of patient correspondence. The backlog of patient correspondence had been completed and systems embedded to monitor completion of this work. Governance systems and processes established by Suffolk GP Federation C.I.C., were followed by practice staff.

The areas where the provider should make improvements are:

• Continue work to review prescribing to ensure it is appropriate, especially in relation to areas of higher prescribing.
• Continue with the monitoring of achievement for the Quality and Outcomes Framework and embed the amended process for exception reporting.
• Continue work to identify and support patients living with moderate to severe frailty.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Updated 17 September 2019

Updated 17 September 2019

Updated 17 September 2019

Updated 17 September 2019

Updated 17 September 2019

Updated 17 September 2019