Archived: Dr William Littler Also known as Castle Surgery

Updated 29 October 2015

Dr William Littler’s practice provides general medical services to approximately 2881 patients living in Castle Hedingham and the surrounding rural area over two sites. The main site in Castle Hedingham and there is a branch site at Great Yeldham. We did not travel to the branch surgery as part of this inspection. Treatment and consultation rooms are situated on ground level of the premises to provide accessibility for patients. The practice holds a General Medical Services Contract (GMS) with the addition of enhanced services for example; ‘facilitating timely diagnosis and support for people with dementia’, minor surgery, reducing unplanned admissions, and the public health immunisation programmes. The practice provides a dispensing service to 80% of the practice population.

The practice has a team of two GPs meeting patients’ needs. There are two nurses who run a variety of appointments for long term conditions, minor illness and family health. There are three dispensers in the dispensary, a practice manager, and a team of five non-clinical, administrative, secretarial and reception staff who share a range of roles. There was access to midwives, health visitors and a smoking cessation counsellor for patients registered at the practice.

The main and branch practices provides between them access to the practice from 8.30am to 1pm and from 2pm to 6pm Monday to Friday. GP surgery hours are shared across the two sites providing access to GP appointments from 8.30am to 12 each morning and from 4pm to 6pm on Monday, Tuesday, Wednesday, Thursday, and Friday.

Outside of these hours, primary medical services are provided by ‘Primecare’.

Updated 29 October 2015

We carried out an announced comprehensive inspection at Dr William Littler on 05 August 2015. Overall the practice is rated as good.

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

• Staff knew and carried out their obligation to raise concerns, and to report safety incidents. Information about safety was recorded, and monitored appropriately although not reviewed regularly to identify any trends or recurring themes.

• Risks to patients were assessed and well managed but not reviewed regularly to undertaken or identify any trends or recurring themes.

• Patients’ requirements were considered and care was planned and provided in a way that followed best practice and current clinical guidance.

• Staff had received training applicable to their roles and further training needs had been recognised and planned.

• Patients told us they were treated with consideration, dignity and respect and they were involved in their care and decisions about their treatment.

• Information regarding how to complain about practice services was available and easy to understand.

• Patients indicated in the national patient survey that they found it easy to make an appointment with a named GP and they had continuity of care, with urgent appointments accessible on the day requested.

• The practice was suitably equipped to treat patients and meet their needs.

• There was a clear leadership structure and staff felt supported by management.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should

• Review of all safety incidents and complaints should be undertaken to identify any trends or recurring themes.

• Seek feedback from patients, to obtain their views with regard to where services might be improved.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 29 October 2015

The practice is rated as good for the care of people with long-term conditions. Patients in need of chronic disease management and those at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Those patients on the palliative care register in need of care were discussed at the regular multidisciplinary team meetings.

Updated 29 October 2015

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. Appointments were available outside of school hours and the premises were suitable for children and babies.

We saw good examples of joint working with midwives, and health visitors evidenced in patient records. The clinical staff had received recent child protection training and performed six week checks on new babies and their mothers. The practice also provided a full range of family planning services, both with the GPs and the nurses, including medicine checks, chlamydia screening, and long acting contraception advice.

Updated 29 October 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were similar to expected nationally for conditions commonly found in older people. For example; the percentage of patients aged 75 or over with a fragility fracture on or after 1 April 2012, who are currently treated with an appropriate bone-sparing agent during the period

01/04/2013 to 31/03/2014 was 100% compared with the national figure of 81.27%. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of services, for example; identifying patients aged 75 or over with a fragility fracture and treating them with an appropriate bone-sparing agent, developing care plans as part of the admission avoidance enhanced service for people who are at risk of unplanned hospital admissions, and referrals to the memory clinic if and when needed.

The practice was responsive to the needs of older people, and offered them home visits and urgent appointments when requested.

Updated 29 October 2015

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.

The practice offered a full travel advice and vaccination service. Appointments were available each morning and evening at times that were flexible for chronic disease monitoring within the clinics.

Updated 29 October 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). 90% of people experiencing poor mental health had received an annual physical health check which was higher than the clinical commissioning group (CCG) and national average. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice provided dementia screening for high risk patients using a scoring assessment and referred onwards to the memory clinic if needed.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training in caring for people with suffering with poor mental health and dementia. Patients receiving certain medicines for their mental health had their levels monitored at the practice and adjusted if needed.

Updated 29 October 2015

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 in a care organisation or with a learning disability. It had carried out checks for people with a learning disability and 100% of these patients had monitoring health review. Longer appointments were offered to people with a learning 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. Staff had received training and knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing and documentation of safeguarding concerns. Staff knew who the safeguarding lead at the practice was and who to contact with any concerns.

Alerts were put onto patient’s medical records to identify those people that may have needed urgent appointments on the day or had specific circumstances or health conditions that staff should be made aware of.