Holbrook Surgery

Updated 17 May 2016

Holbrook Surgery is a dispensing practice situated in the village of Holbrook, Ipswich, Suffolk. They have a branch surgery in Shotley. The practice provides services for approximately 7,800 patients. They hold a General Medical Services contract. The practice has five GP partners, four male, one female and one female salaried GP. Three GPs work full time, two ¾ time and one is part time. The team also includes four female practice nurses, two female phlebotomist / health care assistants and ten dispensary staff members. They also employ a practice manager, a dispensary manager and a team of reception/administration/secretarial staff. The practice employs two cleaners.

The practice’s opening times are from 8am until 6.30pm Tuesday and Friday, 7.30am until 7pm on Mondays, 8am until 7pm on a Wednesday and Thursday and 8.30am until 10.30am on Saturdays.  The practice has opted out of providing GP services to patients outside of normal working hours such as nights and weekends. During these times GP services are provided by GP plus and the 111 out-of-hours service delivered by CareUK.

We reviewed the most recent data available to us from Public Health England which showed that the practice had a significantly higher than average practice population aged 10 to 19 compared to national England average and a higher than average population aged 45 to 85. The practice had a significantly lower than average population aged between 20 and 45. The deprivation score was lower than the average across England.

Updated 17 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Holbrook Surgery on 15 March 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 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.
• Urgent appointments with a GP were available on the same day.
• Information about services and how to complain was available and easy to understand.
• 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 practice was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider should make improvements are;

• Ensure phlebotomy is only undertaken in rooms with flooring and surfaces that meet the requirements of the Code of Practice for health and adult social care on the prevention and control of infections and related guidance.

There were some areas of outstanding practice;

• The practice and patients made fidget quilts for dementia patients to help reduce anxiety and stress during hospital stays. The practice had sent 1451 baby jumpers, hats and blankets knitted by the staff and patients for Rwandan babies.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 May 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.

• The practice used 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. Data from 2014/2015 showed performance for diabetes related indicators was 96%, which was better than the CCG average by 5% and the England average by 6%. Performance for asthma related indicators was 100%, which was better than the CCG average by 6% and the England average by 3%.

• Longer appointments and home visits were available to patients when needed.

• The practice offered health checks for patients who needed long term condition management.

• 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.

• The practice supported the district nurses by offering a community phlebotomy clinic on Mondays to assist in taking necessary bloods.

Updated 17 May 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. Children and young people’s safeguarding meetings were every eight weeks with health visitors and safeguarding was a standing agenda for the weekly GPs meetings. GPs were safeguarding level three trained (safeguarding children and young people).

• Immunisation rates were above average for the 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 86%, which was 4% above the CCG and England average

• 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.

• The practice had a private room available for breast feeding.

• The practice supported a large boarding school with 361 boarders with regular clinics held at the school (during the summer, the school became a language school therefore presented a more transient population). The practice worked closely with the counsellor at the school to support the students’ needs.

Updated 17 May 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 offered annual health checks for patients aged over 75 who were on regular medications and who lived in a care home.

• GPs regularly visited patients in local residential and nursing homes and liaised with the home managers and supported an independent living home.

• They offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. The practice ensured palliative care end of life patients and family/carers had access to their GP’s personal telephone numbers if needed.

Updated 17 May 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. They operated extended hours on a Monday from 7.30am to 7pm, Wednesday and thursday from 8pmto 7pm and Saturday mornings from 8.30am to 10.30am. They offered telephone consultations during the day to patients that might not be able to access the surgery during normal hours. Non urgent appointments could be booked in advance.

• The practice was part of the pilot for the GP plus system which enabled them to book GP and nurse practitioner appointments at a specified location. 

• The practice offered online appointments as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 17 May 2016

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

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

• 88% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in their record in the preceding 12 months which was above the CCG average by 4% and the same as the England average.

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

• 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 accident and emergency where they might have been experiencing poor mental health including patients seen during out of hours.

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

• The practice and patients made fidget quilts for dementia patients to help reduce anxiety and stress during hospital stays.

Updated 17 May 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 homeless people, travellers and those with a learning disability. They had identified 22 learning disability patients and supplied health checks for these patients on the register.

• The practice referred patients to various support services and regularly supported a learning disabilities supported living complex.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• 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 provided weekly home deliveries of medications for patients who were housebound or vulnerable.