The Pump House Surgery

Updated 11 April 2017

Pump House Surgery is a dispensing practice located in the village of Earls Clone in Essex. The practice has a list size of 8,000 patients from Earls Clone and the surrounding area. The practice has parking available for staff and patients and provides access for disabled patients. The practice serves a larger than average population of females aged 45 to over 80 years and males 50 to over 80 years. There is a predominately smaller than average population aged 34 years and under.

There are three GP partners; two male and one female, they also have a minor illness nurse that is able to prescribe medications and assist with home visits. There are three practice nurses and two health care assistants. There is a practice manager and a team of administrative staff including medical secretaries and receptionists. There is a dispensary manager with a team of dispensing assistances. The practice dispenses medicines to 3,300 of their patients, which represents 43% of their list.

The practice is open between 8.30am and 6.30pm, the phone lines open at 8am; the surgery is closed for lunch from 1pm-2pm but the phone lines remain open Monday to Friday. Appointments are available from 8.20am to 6.20pm daily.

When the practice is closed patients are signposted to call 111 for out of hours care. This service is provided by the walk in centre in Colchester. The out of hour’s service operates from 6.30pm to 8 am Monday to Thursday and from 6.30pm Friday to 8am on Monday and all bank holidays and is provided by care UK.

Updated 11 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Pump House Surgery. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Incidents were investigated and learning had been identified but there was a lack of evidence to demonstrate that this learning had been cascaded to relevant staff.

• There were no practice specific standard operating procedures in place for the dispensary service offered by the practice; however medicine errors and near misses were being reported, analysed and lessons learnt embedded into practice.

• We saw that national patient safety and medicine alerts were received, reviewed and actioned appropriately. However some staff were not aware of a recent alert and the documentation of initialling the alert once read; several alerts had one signature.

• There was a bespoke standard operating procedure in place for the dispensary.

• Infection control audits were undertaken and actions identified dealt with in a timely way.

• Families who suffered bereavement received personalised follow up care from the GP that had most contact with the family in the last weeks of care.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

• There was some evidence of quality improvement activity including clinical audit. However the conclusions of the audits did not identify where improvements could be made.

• Patients were supported, treated with dignity and respect. Patients were encouraged and supported to be involved as partners in their care.

• 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; however the lessons identified and actions to be taken were not sufficiently documented to ensure the improvements had ben actioned.

• Patients said they were able to access the right care at the right time; appointments were managed to take account of patient’s needs, including those with urgent needs.

• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had identified a low number of patients who were carers.
• There was a system in place for infection control but issues identified as areas for improvement had not been actioned. There had been no infection control audit as required by guidance.
• 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 had good facilities and was well equipped to treat patients and meet their needs.

The areas where the provider should make improvement are:

• Ensure that the learning from the investigation of safety incidents and complaints is shared with relevant staff and documented.

• Identify a lead staff member to oversee infection control.

• Improve the identification of patients who are carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 April 2017

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. Annual reviews of these patients were carried out by the practice nurses.
• Phlebotomy services were provided within the practice five days a week.
• Dispensing services were provided for patients living more than one mile away from the practice.
• The practice had processes in place for monitoring prescriptions that were not collected from the dispensary.
• Longer appointments and home visits were available when needed.
• Patents received 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 11 April 2017

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.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

• Child immunisation performance data was comparable to the CCG.

• 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, health visitors and school nurses. Weekly clinics were held at Halsted hospital for the health visitors and midwives.

• The practice offered postnatal checks and eight- week baby checks. We saw a copy of the letter sent to new mothers that included a new birth registration form and an invitation to visit the practice for the child health clinic.

• Same day appointments were available for children and those with serious medical conditions.

• The practices uptake for the cervical screening programme was 90%, which was above the national average of 82%.

Updated 11 April 2017

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 patient list included residents living in eight care homes locally.

• Phlebotomy services were provided within the practice five days a week.

• Dispensing services were provided for patients living more than one mile away from the practice.

• The practice had processes in place for monitoring prescriptions that were not collected from the dispensary.

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

• The practice participated in the Avoiding Unplanned Admissions Enhanced Service. The practice contacted patients shortly after discharge and after attendance at an emergency department. We reviewed the care plan of a patient in this category and found it was well written.

• All eligible patients were offered the shingles vaccination.

• Regular meetings were held with the palliative care nurses, district nurses and community matron.

Updated 11 April 2017

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 including appointments, prescriptions and summary care records.

• Telephone consultations were available each day for those patients who had difficulty attending the practice due, for example, to work commitments.

• The practice offered a full range of health promotion and screening that reflects the needs for this age group.

• Patients were able to receive travel vaccinations available on the NHS.

• The practice registered students as temporary patients.

• 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.

Updated 11 April 2017

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 had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Information leaflets were available in the waiting area.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

• 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.

Updated 11 April 2017

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 homeless people, travellers and 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.

• 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 had processes in place for monitoring prescriptions that were not collected from the dispensary.

• The practice gained written consent for relatives to share their medical information and treatment planning for patients diagnosed with memory loss or dementia.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities and how to contact relevant agencies in normal working hours and out of hours.