Little Waltham & Great Notley Surgeries Also known as Dr Bakewell & Partners

Updated 22 December 2016

Little Waltham & Great Notley Surgeries is situated in Little Waltham in Chelmsford, Essex. The practice boundary includes Little Waltham, Great Leighs, Pleshy and parts of High Easter and Felsted. The practice provides GP services to approximately 17, 500 patients.

There is a branch surgery situated in Great Notley and patients can choose to attend either practice. This location was not inspected as part of this inspection.

The practice is a dispensing practice. There is a dispensary located at Little Waltham and also at the branch surgery at Great Notley. The pharmacist specialist inspected the dispensary at both locations.

Little Waltham & Great Notley Surgeries is one of 48 practices commissioned by the Mid-Essex Commissioning Group. The practice holds a Personal Medical Services contract (PMS) with the NHS, although this is in the process of being changed to a General Medical Services (GMS)

contract. This contract outlines the core responsibilities of the practice in meeting the needs of its patients through the services it provides.

The practice population has a slightly higher number of children aged five to18 years compared to the England average and fewer patients aged over 65 years. Economic deprivation levels affecting children and older people are significantly lower than average, as are unemployment levels. The life expectancy of both male and female patients is higher than the local average by one year.

There are fewer patients on the practice’s list that have long standing health conditions. The practice is governed by a partnership that consists of three male GPs and three female GPs. The partnership is supported by five salaried GPs and two female GP registrars. A registrar is a qualified doctor who is training to become a GP.

There are four nurses, one of whom is a prescribing nurse, and five health care assistants. Administrative support consists of a full-time practice manager, a deputy practice manager, a head receptionist as well as a number of part-time reception and administrative staff. All staff work across the two locations.

The Little Waltham dispensary is led by a pharmacy manager, and there is a dispensary manager at the Great Notley site. There are eight dispensers who work across both sites.

The Little Waltham practice is open Monday to Friday from 08.30am until 1pm, closed between 1pm – 2pm and then open from 2pm – 6.30pm. Appointment times are from 09.00am until 11.30am in the morning and from 4.30pm until 6pm in the afternoon. Pre-bookable appointments are available from 8am until 11.30am on a Saturday.

Updated 22 December 2016

Letter from the Chief Inspector of General Practice

We carried out a focused follow up inspection at Little Waltham and Great Notley Surgeries on 21st November 2016 to check that improvements had been made.

At our previous inspection of 19th April 2016, the practice was rated good overall, with requires improvement for providing well-led services. It was rated as good for providing safe, effective, caring and responsive services, although we advised that there was action that the provider should take with regards to ensuring that services were caring. As a result of our inspection 19th April 2016, the practice was issued with a requirement notice for improvement and the practice sent us an action plan telling us how they were going to meet the regulations.

Necessary improvements have been made, and the practice is now rated as good in all domains.

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

• There had been improvements to governance arrangements.

• Policies were centrally located and accessible to all staff.

• Vaccines were kept securely.

• Nurses were using up to date directions to administer vaccines.

• Stationery was handled in accordance with national guidance.

• Emergency medicines were regularly checked which sought to ensure it was safe for use.

• Posters in the waiting area alerted patients to the availability of chaperones.

There continued to be one area where the provider should make improvements:

• The provider should identify and support carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 June 2016

The practice is rated as good for the care of people with long-term conditions.

• The practice had identified patients who had a number of long-term conditions and arranged for their routine checks to be carried out during one appointment.

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

• 98% of patients with diabetes had received a flu immunisation in the last year. This was better than the national average of 95%.

• Appointments with the diabetic specialist nurse were available at the practice.

• 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 14 June 2016

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

• Immunisation rates were relatively high for all standard childhood immunisations. For children under two, vaccination rates were between 93% and 99%, compared to the local average of 95% and 99%.

• There was joint working with midwives and health visitors through regular muti-disciplinary meetings. A midwife held weekly clinics at the practice and rooms were made available for professionals to hold meetings. This promoted the ongoing sharing of information.

• 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 were treated in an age-appropriate way and were recognised as individuals, and we found evidence to confirm this.

• The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding five years was comparable to other practices.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 14 June 2016

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

• Data available to us reflected that the practice was performing in line with local and national averages in relation to the care offered to older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• The percentage of female patients aged 50-70 years who had been screened for breast cancer within the last six months of invitation was 78%. This was in line with the local average of 78%.

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

• The percentage of patients aged 60-69 years who had been screened for bowel cancer in the last 2.5 years was 63%. This was in line with the local average of 62%.

Updated 14 June 2016

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

• Appointments were available on a Saturday morning so that working age people could access GP and nurse appointments outside of working hours.

• 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.

• Appointments could be made or cancelled in person, online or over the telephone and text reminders advised patients of their appointment time. Repeat medicines could be obtained online.

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 14 June 2016

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

• 90% of patients with schizophrenia, bipolar affective disorder and other psychoses had a care plan documented in their record, in the last 12 months. This was in line with the national average of 89%.

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

• Improving Access to Psychological Therapies (IAPT) had regular access to rooms at the practice so that they could meet with patients who were experiencing poor mental health.

• 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 14 June 2016

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

• The practice had a system to support patients who misused medicines or alcohol.

• The practice held a register of patients living in vulnerable circumstances. It provided a ‘care of’ address for patients who were at risk of domestic violence.

• The practice offered longer appointments for patients with a learning disability.

• A hearing charity regularly attended the practice to support patients who were deaf.

• 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 did not have systems in place to monitor the health needs of patients who were carers.