Deal Tree Health Centre

Updated 28 June 2016

Dr Butlers and Partners is also known as Deal Tree Health Centre (previously known as Doddinghurst Surgery). The practice is housed in new, modern, purpose-built GP surgery located in a semi-rural position with extensive onsite parking. Deal Tree Health Centre is a dispensing practice employing qualified dispensers as well as being a training practice employing GP Registrars.

The practice has four GP partners, one salaried and two Registrars (two female and five male doctors). GP registrars are fully qualified and registered doctors. They were supported by two nurse practitioners, three practice nurses, dispensary staff and an administrative team overseen by the practice manager. They are currently recruiting a GP partner and a healthcare assistant.

They have approximately 9248 registered patients. Their patient population is more highly represented amongst the over 65 year olds and over 75 year olds with lower than the local and national averages for patients four years and younger. Their patient population has low deprivation levels amongst both children and older people and low levels of unemployment. The patient life expectancy is above the CCG and national averages for both male and female.

The practice and the dispensary are open between 8.30am to 1pm and 2pm to 6.30 Monday to Thursday. On Friday the practice is open from 8.30am to 1pm and 2pm to 6pm. Appointments are from 9am to 12.30 and 2pm to 6.30pm (6pm on a Friday). Extended surgery hours are offered on a Saturday morning, when the surgery is open from 8.45am to 11am, appointments are available from 9am. The dispensary is also open on a Saturday morning at the same times. Saturday appointments are pre-bookable.

The practice does not provide out of hour’s services. Patients are advised to call the national 111 service who will advise patients of the service they require. Currently their out of hour’s service is provided by IC24 and commissioned by Basildon and Brentwood CCG.

The practice provides a range of services including, minor surgery, nurse run clinics (asthma, diabetes, heart disease and hypertension), contraception services, child health surveillance travel vaccinations, antenatal and postnatal care.

The practice has a comprehensive website detailing opening and appointment times. There is health information including signposting to support and specialist services.

Updated 28 June 2016

Letter from the Chief Inspector of General Practice

On 17 February 2016 we carried out a comprehensive inspection at Dr Butler and Partners. The practice was rated as requires improvement overall. The practice was rated as requires improvement for safe and effective and good for caring, responsive and well led.

The practice were issued with a requirement notice for improvement for medicine management. As the practice pharmacy team were unable to demonstrate they had the competence, skills and experience to undertake their roles. Patient alerts had not been appropriately actioned and patient records reviewed to ensure safe prescribing practices and medicines reviews were not conducted in accordance with national guidance.

We also recommended the practice;

• maintained cleaning records to demonstrate when, where and how rooms had last been cleaned. Where improvements have been identified provide an audit trail to reflect they have been actioned.
• Recorded written patient consent for surgical procedures.
• Ensured staff receive training on infection and prevention control.

As a result of this inspection the practice sent us an action plan outlining the steps they had taken to improve.

We then carried out an announced follow up inspection at Dr Butler and Partners also referred to as Deal Tree Health Centre, on 3 June 2016 to check that the improvements had been made. We found that the practice had made the necessary improvements. Overall the practice is rated as good.

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

• The practice had introduced a medicine management lead GP who oversaw the actioning and review of medicine alerts to ensure safe prescribing.
• The medicine management lead GP had protected time allocated to be accessible to the dispensing team and undertake training and supervision.
• The dispensary staff had undertaken update training in accurate dispensing or the management of control drugs.
• The practice were members of the Dispensary Doctors Association and were surveying their patients to obtain their views and experience of their dispensary.
• The practice maintained cleaning records to demonstrate when, where and how rooms had last been cleaned. Where improvements had been identified they provided an audit trail to reflect they have been actioned.

• Written patient consent was obtained for procedures such as surgical procedures and muscle injection.
• Staff were scheduled to attend infection prevention control training in June. This was promoting awareness for hand hygiene, how to manage body spillage, safe disposal of clinical items.
• Staff reported a more transparent and supportive culture following the last inspection. Where their expertise was acknowledged and being utilised such as delivering inhouse training in infection prevention control and medicine management updates in chronic diseases.

However there was an area of practice where the provider should make improvements:

• Ensure the quality of the dispensary service through audit of the dispensing process and review of near misses and significant incidents.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 June 2016

The practice is rated as good. We found;

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Nursing staff provided advice and guidance for patients with long term conditions promoting and support their management of conditions through regular reviews and telephone support.

• 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 multidisciplinary package of care.

Updated 28 June 2016

The practice is rated as good. We found;

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk. Children at risk and vulnerable patients were reviewed and discussed during practice and clinical meetings.

• Immunisation rates for the standard childhood immunisations were above the national average.

• Patients told us that children and young people were treated in an age-appropriate way and we saw evidence to confirm this.

• Appointments were available outside of school hours and the premises were suitable for families, children and young people.

• The practice conducted antenatal and postnatal checks. They provided patients with a range of contraceptive advice and services.

• Cervical and breast screening rates for patients were above the national average.

Updated 28 June 2016

The provider was rated as good. We found;

• Care and treatment of older people reflected current evidence-based practice. The GP Care Coordinator led on the care of over 75 year old patients. Home visits took place for at risk patients, conducting mental capacity assessments, deprivation of liberty concerns and end of life care plans.

• Longer appointments and home visits were available for older people when needed, and this was acknowledged positively in feedback from patients.

Updated 28 June 2016

The practice is rated as good. We found;

• The age profile of patients at the practice is mainly those of working age, students and the recently retired but the services available reflected the needs of this group. They offered telephone consultations, WebGP and Saturday morning surgery with GP and practice nurse appointments.

• Appointment could be booked online and patients had access to online repeat prescriptions dispensed from a pharmacy of their choice and access to their summary care records.

• Health promotion advice was offered and health checks for 40-75year olds.

Updated 28 June 2016

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

• Performance for mental health and dementia related indicators was better than the national average.

• The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health including carrying out advance care planning for patients with dementia.

• The GP Care Coordinator led on services provided to patients with dementia, conducting mental capacity assessments, deprivation of liberty concerns and end of life care plans.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations and onsite counselling was available weekly.

Updated 28 June 2016

The practice is rated good for the care of people whose circumstances may make them vulnerable. We found;

• There were arrangements to allow people to register temporarily/immediately to be seen at the practice and guidance provided to staff.

• The practice held a register of patients living in vulnerable circumstances including travellers and those with a learning disability. It had carried out annual health checks for people with a learning disability

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

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

• Staff knew how to recognise signs of abuse in vulnerable adults and children. They 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.