Dr Sulakshana and Partners Also known as The Surgery

Updated 2 December 2016

Dr Hughes and Partners provide primary medical service to the village of Barton Le Clay in Bedfordshire. The practice operates from The Surgery, Hexton Road, Barton-le-Clay, Bedfordshire, MK45 4TA and has a branch surgery at The Health Centre, Gooseberry Hill, Luton, Bedfordshire, LU3 2LB. Regulated activities are carried out at both sites with one patient list, the branch surgery was not inspected on the day of inspection.

The practice holds a General Medical Services (GMS) contract for providing services, which is a nationally agreed contract between general practices and NHS England for delivering general medical services to local communities.

The practice serves a population of approximately 11,300 patients with slightly higher than average population of males and females aged 45 to 79 and marginally lower than average population of male and female patients aged 0 to 9 years and 15 to 39 years. The practice population is largely White British. National data indicates the area served is one of low deprivation in comparison to England as a whole.

The practice is based in a purpose-built building, constructed in 1985. Situated in a medium size village with a semi-rural surrounding area. All patient contact is on the ground floor which is accessible for patients in wheelchairs and pushchairs. Patient parking is available on site as the surgery is built behind the Village Hall and the practice pay for the use of their car park. There are designated disabled parking spaces available.

The practice includes a dispensary, which dispenses medicines to approximately 25% of the registered population. A delivery service is also provided for patients over the age of 60 and vulnerable patients who are unable to access the dispensary or local pharmacies.

The staff team consists of two male and four female GP partners. The GP’s are clinically supported by four practice nurses and a health care assistant. There is a practice manager, a reception manager and a number of team leaders who manage the administrative staff. There is a dispensary which is managed by a dispensing manager and four dispensers; the practice also employs a dispensary driver who delivers medicines to patients unable to get to the surgery.

This is a teaching practice which takes up to four GP registrars at any one time. The practice has three GP trainers and one associate trainer including one of the GP partners being a training programme director.

The practice is open between 8.30am to 6.30pm Monday to Friday. The dispensary is open during surgery hours but is closed each day between 12.30pm and 2.30pm. Appointments are available from 8am and the practice offers extended hours appointments until 7pm, twice each month.

For patients requiring the services of a GP outside of normal surgery hours the practice use an out of hours service which is provided by Care UK. Information about this is available in the practice and on the practice website and telephone line.

The services provided at this location include midwifery, childhood immunisations, childhood surveillance, minor surgery, travel clinics, joint injections, cryotherapy, family planning, antenatal/postnatal care, sexual health, diagnostic and screening procedures, cervical screening, immunisations and minor illness.

Updated 2 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr SP Hughes and Partners on 17 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.
• Practice staff had developed good working relationships with community teams to ensure continuity of care.
• The practice monitored performance using the information collected for the Quality and Outcomes Framework (QOF) and performance against national screening programmes to monitor outcomes for patients. (QOF is a system intended to improve the quality of general practice and reward good practice). We saw evidence of progress in performance as a result of regular monitoring and improvement work.
• 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 were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Patients 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 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
• Partners were visible and supported all areas of the practice.
• The practice had an effective in-house training programme and encouraged staff development.
• The practice proactively sought feedback from staff and patients, which it acted on.
• The practice worked closely with the patient participation group.
• The practice had been awarded the Practice Team of the Year Bedfordshire and Hertfordshire for 2016.
• The provider was aware of and complied with the requirements of the duty of candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 December 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.
• Performance for diabetes related indicators was higher than the Bedfordshire Clinical Commissioning Group (CCG) and national averages. For example, the percentage of patients with diabetes, on the register, in whom the last blood glucose reading showed good control in the preceding 12 months, was 86%, where the CCG average was 76% and the national average was 78%.
• The percentage of patients with hypertension having regular blood pressure tests was 84%, the same as the CCG and national averages of 84%. Exception reporting for this indicator was 2% compared to the CCG and national averages of 4%.
• 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 multi-disciplinary package of care.
• Patients with long term conditions were included on the avoidance of unplanned admissions scheme.
• Some patients had advanced care plans including end of life planning.  

Updated 2 December 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.
• 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 88%, 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.
• Family planning and contraceptive advice was available.
• Early morning and late afternoon appointments as well as a number of ‘book on the day’ appointments were available and reception staff were trained to understand the needs of this group.
• The practice participated in health promotion programmes aimed at reducing sexual health risks including contraception and safe sex advice and screening for sexually transmitted diseases including Chlamydia. The practice provided a wide range of contraception services.
• The practice held fortnightly childhood immunisation clinics and an eight week baby check, GP clinics for babies were available at the same time. These clinics enabled the teams to offer a multi-disciplinary approach to safeguarding and child health.

Updated 2 December 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.
• The practice provided influenza, pneumonia and shingles vaccinations.
• All patients in this group had a named GP and the practice recorded information in the patient record regarding next of kin and carers.
• The practice worked closely with community staff including district nurses and community matrons to support these patients. Monthly multi-disciplinary team (MDT) meetings were held with these staff to discuss frail, housebound and/or elderly patients with complex needs.
• A medicine delivery service was provided for patients unable to go to the practice dispensary.
• The surgery adopted a number of measures aimed at helping elderly patients and those with sensory problems. There was an induction hearing loop system in the waiting room and signage was regularly reviewed to ensure that it was clear.
• There was a drop off point for disabled patients outside the front door at the main surgery and wheelchair access was available. There was also designated disabled parking at the branch surgery.

Updated 2 December 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 reflects the needs for this age group.
• 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.
• GP appointments were available from 8.00am to 6.00pm and an extended hours service was available until 7pm, twice monthly.
• The practice provided an online access service for patients which included booking and cancelling appointments, requesting repeat prescriptions, viewing test results and sending messages to the surgery regarding prescriptions. The practice also had a website with links to online services.
• Smoking cessation clinics were available at the practice and advice or referrals could be carried out to specialist services for weight management.

Updated 2 December 2016

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

• 91% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is higher than the CCG and national averages of 84%.
• Performance for mental health related indicators were otherwise comparable to local and national averages. For example, the percentage of patients with diagnosed psychoses who had a comprehensive agreed care plan was 95% where the CCG average was 87% and the national average was 88%.
• 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 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.
• The practice held clinics throughout the year to carry out health checks for this group.
• There was a lead GP for patients experiencing mental health issues.
• The practice worked closely with the local Alzheimer’s Society, they also attended the practice annual health evening for patients and the practice flu clinics to offer support.

Updated 2 December 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 support groups and voluntary organisations some of which had rooms within the practice
• 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.
• Vulnerable adults were identified and discussed at multi-disciplinary team (MDT) meetings and regular meetings were held with health visitors when vulnerable children were discussed.
• The practice had a system for recording vulnerable patients on the clinical system
• The practice held palliative care meetings involving district nurses, community matrons Macmillan nurses, GPs and other local support organisations.
• The practice had identified 146 patients (approximately 1% of the practice list) as carers. The practice was making continued efforts to identify and support carers in their population.
• The reception manager was the carers lead.
• The practice hosted a drug and alcohol worker as well as counsellors and wellbeing workers.