Archived: The Amwell Street Surgery

Updated 20 September 2016

Amwell Street Surgery situated in Hoddesdon Hertfordshire, is a GP practice which provides primary medical care for approximately 12,100 patients living in Hoddeston and surrounding areas. The practice population spans the counties of Hertfordshire and some parts of Essex.

The Amwell Street Surgery provide primary care services to local communities under a General Medical Services (GMS) contract, which is a nationally agreed contract between general practices and NHS England. The practice provides training to doctors studying to become GPs. The practice population is predominantly white British along with a small ethnic population of Eastern European Asian and Italian origin.

The practice has five GPs partners and two salaried GP (four female and three male). There are two practice nurses and two health care assistant who are supported by a nurse manager. There is a practice manager who is supported by a team of administrative and reception staff. The local NHS trust provides health visiting and community nursing services to patients at this practice.

The Amwell Street Surgery operates from single storey premises. Patient consultations and treatments take place on the ground floor. There is free car parking outside the surgery with adequate disabled parking available. We were advised that the practice intended to move to a larger purpose built premises in the near future.

The practice is open Monday to Friday from 8am to 6.30pm. Appointments are available from 8.30am till 6pm Monday to Friday. The practice offers a variety of access routes including telephone appointments, on the day appointments and advance pre bookable appointments.

Updated 20 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Amwell Street Surgery on 28 June 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 been trained to provide them with 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.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and 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.

We saw one area of outstanding practice:

The practice provided ‘Just in Case’ boxes in the homes of patients receiving palliative care to avoid distress caused by poor access to medications in the period the practice was closed, by anticipating the patient’s symptom control needs and enabling the availability of key medications.

The areas where the provider should make improvement are:

• Continue to ensure appropriate precautions are in place to minimise conversations being overheard when the treatment room is temporarily divided into a nurse consultation area and a treatment area.

• Ensure actions are taken to mitigate risks identified following risk assessments, for example fire risk assessments.

• Continue to develop the Patient Participation Group.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 September 2016

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

• Clinical staff trained in chronic disease management had lead roles in supporting patients with long term conditions such as diabetes, asthma and chronic obstructive pulmonary disease (COPD).

• Performance for diabetes related indicators were above the national average. For example, the percentage of patients with diabetes, on the register, in whom the last blood glucose reading showed good control in the in the preceding 12 months (01/04/2014 to 31/03/2015), was 81%, compared to the CCG average of 76% and the national average of 78%.

• 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 or at high risk of hospital admission, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• Longer appointments and home visits were available when needed.

Updated 20 September 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 comparable to CCG and national averages for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• 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.

• The practice worked collaboratively with various support agencies such as Habs Family Support team, children’s centres and school nurses to help improve the lives of families living within Hoddesdon.

• The practice worked with the local healthy lifestyle liaison workers to support those children and families identified as obese to maintain a healthy weight and adopt healthier lifestyles.

• The practice provided contraceptive advice, including fitting of intra-uterine devices and implants.

• The practice provided a variety of health promotion information leaflets and resources for this population group for example the discreet provision of chlamydia testing kits.

Updated 20 September 2016

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.

• Patients aged 75 years and older had a named GP.

• All these patients were offered the over 75 health check and there was a dedicated member of staff who visited housebound patients to offer these checks.

• The practice had identified older patients at high risk of admissions to hospital (patients with multiple complex needs, and involving multiple agencies) and worked with local partners such as the community matron and the rapid response & intermediate care services to coordinate their care (The rapid response & intermediate care services are community based services which combined health, social and mental health services and aimed to reduce hospital admissions by providing appropriate timely care in patient’s own home).

• The practice operated an acute home visiting service that provided urgent medical response during the time the practice was open for urgent new conditions which ensured continuity of care as well as avoiding hospital admissions.

• The GPs routinely visited the local care home once each week to ensure continuity of care for patients.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Updated 20 September 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 reflected the needs for this age group.

• The practice offered health checks, travel advice, cervical screening, and contraceptive services for this population group.
• The practice provided telephone consultations when appropriate.

• The practice had enrolled in the Electronic Prescribing Service (EPS). This service enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.

Updated 20 September 2016

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

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• 80% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was similar to the national average.
• Patients attending the hospital memory clinic with a diagnosis of dementia and who were stabilised on their medication were managed by the practice avoiding frequent visits to the hospital clinic.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations including to direct access counselling and cognitive behavioural therapy through the wellbeing service provided by the local mental health trust.

• 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 20 September 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 other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• The practice held regular review meetings involving district nurses, GP’s and the local palliative care nurses for people that require end of life care and those on the palliative care register.

• There was a diabetic review service for the housebound patient.

• There was a domiciliary service for the housebound patient.

• 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.

• The practice identified patients who were also carers and signposted them to appropriate support. The practice had identified 252 patients as carers (2% of the total practice list).

• The practice provided ‘Just in Case’ boxes in the homes of patients receiving palliative care to ensure support and access to medications in the period the practice was closed.