New River Health

Updated 18 August 2016

Church Street surgery provides a range of primary medical services to the residents of Ware and the surrounding area. The practice operates from its current location of St Mary’s Courtyard, Church Street, Ware, Hertfordshire, SG12 9EF. The practice premises is a two storey building with all consultation and treatment rooms on the ground floor.

The practice population is pre-dominantly White British with a lower than average 10-24 year age range. National data indicates the area is one of low deprivation. The practice has approximately 9,300 patients and services are provided under a General Medical Services (GMS) contract. A GMS contract is a nationally agreed contract used for providing medical services.

The practice is led by three GP partners, two of whom are female and one male, and they employ four salaried GPs, all female. The nursing team consists of two nurse prescribers, a practice nurse, a family planning nurse and two health care assistants, all female. There is a practice manager and a business manager who lead a team of reception and administrative staff.

The practice is a registered teaching practice and they currently have four medical students from Cambridge University attending. They also provide placements for student nurses and at the time of the inspection had one nurse on a five week placement. The practice works with the local college to provide apprenticeships for administration staff in customer care.

The practice is open between the hours of 8am and 6.30pm Monday to Friday with extended opening hours offered one Saturday a month from 9am to 12pm.

When the practice is closed the out-of-hours services are provided by Herts Urgent Care and can be accessed via the NHS 111 service.

Updated 18 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Church Street Surgery over two days on 21 April 2016 and 9 May 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 felt the practice offered a good service and staff were supportive and helpful. They commented that they were treated with dignity and respect and staff were caring.
• 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.
• The practice sought the views of the patient participation group (PPG) to help them with the management of complaints.
• 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.
• The practice was pro-active in identifying carers and had a carers lead.
• They were working towards accreditation as a Purple Star practice. Purple Star was a local initiative hosted by Hertfordshire county council that promoted health equality for people with learning disabilities.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 August 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The respiratory nurse reviewed all patients who had a hospital admission following an acute exacerbation of their condition.

• Performance for diabetes related indicators was comparable to the national average. The practice achieved 99% of available points compared to the national average of 89%.

• Longer appointments and home visits were available when needed.

• 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, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 18 August 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 relatively high for all standard childhood immunisations.

• There were comments made on the CQC comments cards that children were treated well by the practice and they were happy to attend.

• The practice’s uptake for the cervical screening programme was 80%, 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.

• They employed a family planning nurse who was available during the extended opening hours one Saturday a month.

Updated 18 August 2016

The 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.

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

• They looked after patients in two local care homes providing weekly ward rounds and home visits on request.

• All of these patients are offered an annual review of their care needs.

Updated 18 August 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.

• Extended hours appointments were available one Saturday per month from 9am to 12pm with GPs and nursing staff.

• 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.

• Telephone consultations were available for patients who could not attend the practice.

Updated 18 August 2016

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 had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average.

• Performance for mental health related indicators was comparable to the national average. The practice achieved 98% of available points compared to the national average of 93%.

• 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.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended A&E 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 18 August 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.

• They gave patients information of a local organisation called Herts Help who offered advice, information and support in different areas including maintenance of a healthy lifestyle and activities to join if patients were isolated.

• 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 was working towards accreditation as a Purple Star practice. Purple Star was a local initiative hosted by Hertfordshire county council that promoted health equality for people with learning disabilities.

• The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 250 patients as carers this equated to 3% of the practice list.