Archived: High Street Surgery - Epping

Updated 19 February 2015

High Street Surgery - Epping is located in the heart of Epping Town. The practice services a geographical area that covers Epping, North Weald and Theydon Bois. High Street Surgery - Epping provides services for approximately 6,600 patients living in the area.

The practice is a partnership between two GPs. The practice employs one salaried GP, one advanced nurse practitioner, three practice nurses and one health care assistant. In addition there is a team of administrative and reception staff who support the practice.

The practice is open between 8.30am and 6.30pm on weekdays with extended hours up to 8pm on Thursday evenings. The practice operates a telephone triage service during the morning. Patients may speak with the a GP and on two mornings a week with the advanced nurse practitioner. Patients are offered a telephone consultation or a face to face appointment as needed. All afternoon and evening appointments must be pre-booked in advance and patients may pre-book appointments up to three months in advance.

High Street Surgery – Epping does not provide an out-of-hours service to patients. Details of how to access out-of-hours emergency and non-emergency treatment and advice is available within the practice and on its website.

Updated 19 February 2015

Letter from the Chief Inspector of General Practice

We conducted a comprehensive announced inspection on 8 October 2014 under our new approach.

Our key findings were as follows:

• Staff recognised and understood the needs of patients and tailored access to care and treatments to meet these needs.
• The practice was working in partnership with other health and social care services to deliver individualised care.
• Staff were trained and supported to deliver high quality patient care and treatment and to improve outcomes and experiences for patients.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Implement systems for sharing learning from complaints, incidents and significant events with staff so as demonstrate and embed improvements where necessary.

• Ensure that records are maintained to evidence checks carried out, to ensure that medicines are available as required and are in date and fire safety check including fire alarm and emergency lighting are carried out.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 February 2015

The practice is rated as good for the population group of people with long term conditions. Emergency processes were in place and referrals made for patients in this group that had a sudden deterioration in health. Appointments were available with the nurse practitioner for annual health checks and reviews for long term conditions such as diabetes and respiratory conditions including asthma and chronic obstructive pulmonary disease (COPD). When needed longer appointments and home visits were available. For those people with the most complex needs the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 19 February 2015

The practice is rated as good for the population group of families, children and young people. Appointments could be booked in person, by telephone or via the practice website. Appointments could be booked up to six weeks in advance.

Information and advice was available to promote health to women before, during and after pregnancy. Expectant mothers had access to midwife clinics every week. The practice monitored the physical and developmental progress of babies and young children. There were arrangements for identifying and monitoring children who were at risk of abuse or neglect. Records showed that looked after children, those subject to child protection orders and children living in disadvantaged circumstances were discussed and any issues shared and followed up at monthly multi-disciplinary meetings. GPs and nurses monitored children and young people who had a high number of A&E attendances or those who failed to attend appointments for immunisations and shared information appropriately. Staff were trained to recognise and deal with acutely ill babies and children and to take appropriate action.

There was information available to inform mothers about all childhood immunisations, what they are, and at what age the child should have them as well as other checks for new-born babies. Appointments for childhood immunisations were available at times to suit patients.

Information and advice on sexual health and contraception was provided during GP and nurse appointments.

Updated 19 February 2015

The practice is rated as good for older people. We found that the practice provided good, individualised care to meet the needs of patients who were 75 years of age and older. This was achieved by speaking with people, understanding their individual circumstances and taking into account their needs when planning and delivering services. Patients needs were considered when discussing care and arranging appointments. For example home visits and telephone consultations were available where patients were unable to attend the practice.

The practice identified people with caring responsibilities and those who required additional support which was recorded on their patient record. Patients with caring responsibilities were invited to register as carers so that they could be offered support and advice about the range of agencies and benefits available to them

The practice had identified all their patients over 75 years of age. Each patient who was 75 years or older had a named accountable GP who was responsible for their care and treatment, in line with recent GP contract changes for 2014 to 2015.

The practice monitored the uptake rate of flu vaccinations for patients 75 years and over. We found regular patient care reviews were conducted in consultation with patients and carers where appropriate, which ensured the information was accurate and they were involved in the coordination of the care. The practice worked with other health care professionals such as district nursing teams and social services, and care plans were in place to support patients living at home to reduce unplanned hospital admissions.

Updated 19 February 2015

The practice is rated as good for the population group of the 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 offer continuity of care. Appointments could be booked in person, by telephone system or via the practice website. Appointments could be booked up to six weeks in advance. Pre-booked late evening appointments up to 8pm on Tuesdays were available.

Information about annual health checks for patients aged between 40 and 74 years was available within the practice and on their website. Health checks including well man and well woman checks were available through pre-booked appointments with the nurse practitioner. The practice provided travel advice and vaccination through appointments with the practice nurse team. Information on the various vaccinations available including diphtheria, tetanus, polio, and hepatitis A was available on the practice website.

When patients required referral to specialist services they were offered a choice of services, locations and dates.

Updated 19 February 2015

The practice is rated as good for the population group of people experiencing poor mental health (including people with dementia). The practice had a lead GP for overseeing the treatment of patients who experienced poor mental health. People experiencing poor mental health had received an annual physical health check.

The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. The practice provided dementia screening services and referrals were made to specialist services as required.

The practice had sign-posted patients experiencing poor mental health to various support groups and third sector organisations including MIND. Patients were referred to local counselling sessions where appropriate and patients were provided with information about how to self-refer should they wish to receive counselling.

Updated 19 February 2015

The practice is rated as good for the population group 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 learning disabilities. The practice was well established within the community and knew their patient group well. The practice kept a register of patients with learning disabilities. From records we saw that of the practice was proactive in encouraging patients with learning disabilities to attend their appointments for their annual health checks.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. The practice had sign-posted vulnerable patients to various support groups and third sector 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 and out of hours.