Guildhall Surgery Clare

Updated 28 October 2016

Guildhall Surgery Clare provides a range of medical services to approximately 5,000 patients. The practice is in a Grade II listed building and the practice boundary includes a number of villages and hamlets. Approximately two thirds of the practice population come from within the county of Suffolk and one third from within the county of North Essex. Clare is set in a rural area with a high number of retired homeowners, older population, and members of the farming community.

The practice is in the NHS West Suffolk CCG (Clinical Commissioning Group).

The practice holds a General Medical Services (GMS) contract to provide GP services.

Data from Public Health England shows the practice serves an area where income deprivation affecting children and older patient’s people is lower than the England average.

The practice has a team of three GPs meeting patients’ needs. These GPs (two male and one female) are partners and they hold managerial and financial responsibility for the practice. There are three female practice nurses, a female health care assistant, and a cleaner. A team of thirteen reception/administration staff support the practice manager.

Patients using the practice have access to a range of services and visiting healthcare professionals. These included midwives, a diabetic specialist nurse, and a community mental health nurse.

Appointments are available Monday to Friday from 8.30am to 7pm.

Outside of practice opening hours Care UK provides an emergency service. Details of how to access emergency and non-emergency treatment and advice is available within the practice and on its website.

Updated 28 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Guildhall Surgery Clare on 17 March 2016. Overall the practice is rated as good.

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

• The appointment system was flexible and ensured that patients who requested to be seen on the same day were.

• The practice had good facilities including disabled access. There was a lift for those patients who could not manage the stairs.

• Information about services and how to complain was available. The practice sought patient views about improvements that could be made to the service, including having a patient participation group (PPG).

• The practice proactively managed care plans for vulnerable patients and had effective management strategies for patients at the end of their life.

• The practice had a number of policies and procedures to govern activity; however, some were introduced within the last six months and had not been embedded into the practice culture.

• Systems to reduce risks to patient safety for example, infection control procedures, needed to be improved.

• There was a leadership structure; however, at times it was not always clear there was a cohesive approach that gave clarity to staff and would lead to improvements. Staff generally felt supported by the management.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

The areas where the provider must make improvements are:

• Ensure that a risk assessment for the testing of legionella is completed and any identified actions are taken.

• Ensure that all medical devices available for use are within the expiry dates.

In addition the provider should;

• Continue to embed processes for reporting, recording, acting on and monitoring incidents and complaints to ensure reflective and shared learning.
• Continue to embed formal governance arrangements including systems for assessing and monitoring risks to patients and staff health and wellbeing.
• Continue to embed policies and guidance to enable staff to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.
• Carry out clinical audits including re-audits to ensure improvements have been achieved.

• Continue to strengthen the leadership structure to give clarity to staff and to deliver all improvements.

• Monitor systems in place to ensure that the monitoring of fridge temperatures is robust.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 April 2016

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

Nursing staff had roles in chronic disease management; data showed patient outcomes were mixed when compared with other practices in the locality. All these patients had a structured annual review to check that their health and medication needs were being met. Home visits were available to those patients who could not attend the surgery.

Longer appointments were available if required. Practice staff followed up patients who did not attend their appointments by telephone.

Updated 29 April 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 patients who had a high number of A&E attendances. Immunisation rates were in line with local averages for all standard childhood immunisations. Young children were given priority appointments for urgent needs.

Appointments were available outside of school hours and the premises were suitable for children and babies. We saw examples of joint working with midwives, health visitors, and school nurses.

Updated 29 April 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. Home visits were available for those unable to attend the practice. Continuity of care was maintained for older people through a stable GP workforce and personalised patient centred care. The practice provided visits to a local care home.

We saw evidence that the practice was working to the Gold Standards Framework for those patients with end of life care needs.

Updated 29 April 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, including 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 did not restrict patients to certain appointment times to attend for their annual reviews; patients who worked were able to book at times that were convenient to them. Telephone consultations were available for those patients who wished to seek advice from a GP. NHS health checks were available.

Updated 29 April 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.

Staff told us that 91% of patients with dementia had received advance care planning and had received an annual review. These patients had a named GP and continuity of care was prioritised for them.

Same day appointments and telephone triage with a GP was offered to ensure that any health needs were quickly assessed for this group of patients.

The practice told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Staff had knowledge on how to care for patients with mental health needs and dementia.

Updated 29 April 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. It offered longer appointments and carried out annual health checks.

The practice told us that 77% of patients with learning disabilities had received an annual review.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. We saw the practice provided vulnerable patients with information about how to access various support groups and voluntary organisations.

Staff knew how to recognise signs of abuse or neglect 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.

Practice staff were intuitive to the needs of this group of patients and demonstrated that they had a personalised approach to helping them. Phlebotomy appointments were available at the practice for this group of patients.