Peartree Surgery and West Horndon Surgery

Updated 15 September 2017

This practice is also known as Pear Tree Surgery. The practice is situated near to a busy road junction and has limited parking on site. There is public parking a short walk away. The practice was able to offer dispensing services from their branch surgery located at West Horndon to those patients on the practice list who lived more than one mile (1.6km) from their nearest pharmacy. We carried out a focused inspection at their main surgery based in South Ockendon therefore the branch surgery was not inspected at out July 2017 inspection. The list size of the practice is 7261.

• The practice operates from two locations: Pear Tree Surgery, South Ockendon, Thurrock, RM15 6PR and 129 Station Road, West Horndon , Essex, CM15 3NB.

• Services provided include: a range of clinics for long term conditions, health promotion and screening.
• At the time of inspection, the practice had three male GPs, one female GPs and one female practice nurse.
• The non-clinical team comprises of a practice manager, reception and administrative staff.
• The practice is open between 8am and 6.30pm Monday to Friday, excluding Wednesdays when it closes at 5pm. Appointments are available from 9am to 12pm every morning and from 3pm to 5pm every afternoon. Extended hours are offered Mondays and Tuesdays 6.30pm to 7.30pm. The dispensary is open during practice opening hours.
• The branch surgery at West Horndon is open Monday to Fridays 9am to 12pm. On Mondays, Tuesdays, Wednesdays and Fridays it is open from 3pm to 6pm in the afternoon. The dispensary is open during these times but shut on Thursday afternoon.

• On evening, weekends and bank holidays out of hours care is provided by IC24, another healthcare provider. This can be accessed by patients dialling either the surgery or 111.
• Thurrock Clinical Commissioning Group (CCG) has a weekend system called ‘Thurrock Health Hubs’. Patients are able to book through the practice to see either a doctor or a nurse between 9.15am and 12.30pm at the weekend, at one of four ‘hub’ locations. The Hub locations have Wednesday, Saturday and Sunday availability.
• The practice has a comprehensive website providing information on opening times, appointments, services, staff and patient group information.
• The practice demographic comprises of mainly white British patients, with other nationalities including African, European and Asian.
• There are fairly low levels of income deprivation affecting children and slightly higher than local and national average levels of income deprivation affecting older people.

Updated 15 September 2017

Letter from the Chief Inspector of General Practice

On 1 June 2016 we carried out a comprehensive inspection at Dr Amanda M Davies and Dr C S Jayakumar also known as Peartree Surgery. Overall the practice was rated as requires improvement. The practice was found to be good in providing safe, caring and responsive services. However, they required improvement in providing effective and well-led services. Issues highlighted at the June 2016 inspection were related to the monitoring of patients with long term conditions and the absence of quality improvement processes such as clinical audits to drive improvement. The full report for the June 2016 inspection can be found by selecting the ‘all reports’ link for Dr Amanda M Davies and Dr C S Jayakumar on our website at www.cqc.org.uk.

We carried out a focused inspection of the practice on 31 July 2017 to establish whether the improvements required had been met. We found the practice had made appropriate improvements; overall the practice is rated as good.

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

• The practice had improved their clinical performance in respect of QOF. Published figures from 2015/2016 showed the practice had achieved 85% of their total QOF points. Unverified figures showed the practice had improved to 94% in 2016/2017.
• The practice had improved exception reporting by monitoring their patient lists closely.
• The practice had monitored their patients with long term conditions and improved their outcomes.
• The practice had conducted audits to review patients care and drive improvement.
• Their patients experiencing mental health conditions were reviewed and treated in line with their needs and current guidelines.
• The practice had identified 71 patients as a carer which was 1% of their patient list. Carers were offered a range of services and information relating to addition support groups and they were given regular health checks.
• The practice had reviewed their data from the national GP patient survey and conducted internal patient surveys to monitor patient satisfaction.
• The practice had addressed their staffing issues experienced during the previous inspection in June 2016.
• Staff understood their roles and responsibilities and how these contributed directly to improving patient experiences of the service and the practices performance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 September 2017

Previously this population group was rated as requires improvement. The provider had resolved the concerns identified at our last inspection on 1 June 2016 which related to patients with long-term conditions and is now rated as good for the care of people with long term conditions.

• Doctors and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The practice had improved their QOF achievement in the assessment and delivery of interventions for the management of chronic diseases.
• Longer appointments and home visits were available when needed.
• All these patients had 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 the practice nurse and relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 11 October 2016

The practice is rated as good for the care of families, children and young people.

• The practice had policies and procedures in place for staff to identify and support children and young people who were vulnerable or at risk of abuse. For example, the practice held monthly MDT meetings which included school nurses and health visitors.
• Immunisation rates were comparable with CCG and national averages for all standard childhood immunisations.
• Patients told us that children and young people were treated in an age-appropriate way and where appropriate treatment was explained to them. We saw evidence to confirm this.
• Appointments were available for children outside of school hours.
• The premises were suitable for this population group. For example, there was access for pushchairs and prams.
• The practice made use of a rapid access paediatric clinic.

Updated 11 October 2016

The practice is rated as good for the care of older people.

• The practice was aware of the needs of older people. For example, they offered 24 hours blood pressure monitoring, so that patients did not have to visit the hospital for this.
• If patients required a longer appointment due to complex needs or multiple medical conditions this was available.
• Housebound patients could also request a home visit.
• The practice nurse provided a phlebotomy service for those patients unable to access this service through other local services.

Updated 11 October 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice offered extended hours on Monday and Tuesday evenings until 7.30pm for working patients who could not attend during normal opening hours.
• The percentage of women aged 25-64 who had attended for a cervical screen in the preceding five years was in line with local and national averages.
• The needs of the working age population, those recently retired and students had been identified and the practice offered later appointments on two days per week and appointments at the Thurrock Health Hub at weekends.
• The practice offered online services such as, repeat prescriptions, online booking for both face to face consultation and telephone appointments.
• There was a range of health promotion and screening available that reflected the needs of this age group.

Updated 15 September 2017

Previously this population group was rated as requires improvement. The provider had resolved the concerns identified at our last inspection on 1 June 2016 which related to patients experiencing poor mental health. The practice is now rated as good for the care of people experiencing poor mental health (including people with dementia).

• The practice met every six weeks with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia and mental health concerns.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations including counselling services.
• Staff had a good understanding of how to support patients with mental health needs and dementia and escalate concerns to specialist services.

Updated 11 October 2016

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

• The practice was aware of those patients on their register whose circumstances may make them vulnerable. For example, transient workers and those with a learning disability.
• If patients required a longer appointment due to complex needs or multiple medical conditions this was available. Housebound patients could also request a home visit.
• The practice offered discreet support to those who may require support with reading instructions or completing forms.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients. The practice held a monthly adult safeguarding MDT with relevant health and social care professionals.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations, such as counselling groups.
• Although we saw evidence that the practice was meeting the needs of some carers (including some not on the register), the number of carers on their practice register was low.
• The practice had policies and procedures in place for staff to identify and support children and adults who were vulnerable or at risk of abuse.