The Tile House Partnership

Updated 11 February 2016

The Tile House Partnership is located in Brentwood, Essex. The practice has a general medical services (GMS) contract with the NHS. There are approximately 13578 patients registered at the practice.

The practice is registered with the Care Quality Commission as a partnership and there are six GP partners. There is one salaried GP. There is a mixture of male and female GPs. The GPs are supported by six nurses and a health care assistant that work a variety of full and part-time hours. The practice is a training practice.

There is a practice manager, an assistant and deputy practice manager, a reception manager, two prescription managers, nine receptionists and a number of clerical and administration members of staff.

The practice is open from Monday to Friday between the hours of 8am and 6.30pm and remains open at lunchtime throughout the week for the collection of prescriptions and for making appointments. When the practice is closed primary medical services can be obtained from the out of hour’s provider, Integrated Care 24. Patients can also contact the non-emergency 111 service to obtain medical advice if necessary.

The GP surgeries are available on Monday to Friday mornings between 8.30am and 12.30pm and each afternoon between 2.30pm and 6.30pm. Surgeries also run on Saturday mornings for pre-booked appointments only, between 9am and 11.30am. A GP and two nurses are available for consultations and patients can collect referral letters and prescriptions.

Updated 11 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Tile House Partnership on 08 December 2015. Overall the practice is rated as good.

• Our key findings across all the areas we inspected were as follows:
• Staff were aware of the procedures in place to raise concerns and report safety incidents and significant events and were encouraged to do so. They were analysed and areas for improvement identified and cascaded to staff working at the practice.
• All staff had received safeguarding training and understood the various types of abuse that could take place. Safeguarding concerns were discussed at staff meetings and information was available to support staff.
• Medicines alerts were received and acted upon by the GPs at the practice and discussed at clinical meetings. Audits took place to identify all patients affected by the alerts.
• The practice had a recruitment process and followed it when employing new staff. All relevant documentation was obtained prior to confirming employment, interviews took place and a role specific induction was in place.
• Patients on high risk medicines were subject to regular review and monitoring. Repeat prescriptions were reviewed at appropriate intervals. Regular medicines audits were carried out.
• Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Patient confidentiality was a practice priority.
• Staff were aware of relevant legislation in relation to consent including the Mental Capacity Act 2005 and Gillick competency.
• Clinical performance was monitored regularly and performance against targets was high and had been consistently maintained over the last two years. All staff understood their roles and were involved in achieving healthcare objectives.
• Data available to us, feedback on CQC comment cards and information received from the patients we spoke with reflected that patients were satisfied with the services provided.
• The practice had a clear vision and had identified the objectives of the practice. This was being discussed with staff and they felt informed.
• There was visible leadership and staff felt included and valued. There was a no blame culture and an ethos of continuous improvement.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 February 2016

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

• A register was in place for patients with palliative care needs. Support was provided from a variety of healthcare professionals. Multidisciplinary meetings took place monthly to discuss and plan the individual care and treatment needs of patients.
• A 24 hour system was in place to provide urgent care for patients in the last few weeks of their lives. This included a locality care plan for terminally ill patients to formalise their care and treatment needs.

• Nursing staff had lead roles in chronic disease management. Patients were monitored and received annual reviews of their health. Follow-up appointments with GPs took place to review their care needs.
• Care plans were in place for patients with hypertension, diabetes and chronic obstructive pulmonary disorder. Their conditions were being monitored effectively.
• Patients with a long term condition had a named GP. Their health and medicines were regularly monitored.
• Home visits took place for patients unable to attend the surgery.
• Systems were in place to refer patients to community nurses specialising in diabetes, heart failure and chronic obstructive pulmonary disorder.

Updated 11 February 2016

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

• All staff had received appropriate training in safeguarding children and young persons. A lead for safeguarding had been identified. Liaison took place with health visitors to discuss children at risk. The lead GP attended local authority safeguarding meetings.
• The practice was pro-active in identifying children who might be at risk, such as non-attendance for childhood immunisations or hospital appointments, or when attending A&E.
• The practice provided cervical screening services for their patients, including Saturday appointments. An effective recall and reminder system was in place.
• Ante-natal checks, pre-conception advice and post-natal checks were available through GP appointments.
• A dedicated GP specialised in child health and carried out developmental health and 6 to 8 week baby checks.
• Sexual health and contraception advice were available with GPs and nurses. Saturday morning appointments were available in addition to weekdays for this service.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Patients under the age of 16 could obtain appointments with GPs and nurses without a parent/guardian being present. Their capacity to understand care and treatment was assessed by clinical staff prior to receiving it.
• Children were treated as a priority and a duty GP system was in place for urgent advice. Emergency medical equipment was readily available that was suitable for use on children.
• Literature was available for young persons to help them understand their patient rights and that their confidentiality would be maintained.
• Child immunisations were monitored and recorded to ensure patients were up to date with their vaccinations.

Updated 11 February 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 identified patients with multiple illnesses and conditions and co-ordinated their care to reduce the number of times they had to attend the practice.
• Older patients were monitored to reduce the risk of an unplanned hospital admission. The practice liaised with healthcare partners and planned patient’s care. Patients discharged from hospital were reviewed so they could receive appropriate care in their own homes.
• Patients with complex needs could book double appointments. A system was in place to identify them and offer this service. Same day appointments, home visits and telephone consultations were also available.
• All patients over 75 had a named GP for continuity of care.
• The practice had made reasonable adjustments for patients that were disabled or with limited mobility.
• A safeguarding lead had been appointed and all staff had received safeguarding training.
• Prescription managers conducted regular reviews and monitoring of patient prescriptions.

Updated 11 February 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.
• Appointments were available until 6.30pm each weekday and the surgery opened Saturday mornings for pre-booked non-emergency appointments.
• Patients could book appointments on-line and receive telephone and email consultations.
• Patients could order their repeat prescriptions on-line and have them sent to a pharmacy of their choice without the need to attend one locally.
• Students returning from university could register as temporary patients during term holidays.
• The practice offered a range of health promotion and screening that reflected the needs for this age group. Health checks were available for those patients over the age of 40.

Updated 11 February 2016

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

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. This included young children.
• A register was in place and health reviews were carried out annually. An effective monitoring system was in place to ensure patients received them.
• Patients suffering with depression received a follow-up assessment within two weeks of the first diagnosis.
• Psychological support was available for new mothers including access to midwives and health visitors.
• Staff had received training to support people with mental health needs and dementia.
• Longer appointments were made available for patients with mental health issues so time could be given to their health care needs.
• There was ready access to a mental health and dementia crisis team for those patients in distress.
• Patients discharged from hospital had their medicines reviewed and liaison made with their pharmacist.

Updated 11 February 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 those with a learning disability. Annual health reviews were carried out including home visits if required.
• Longer appointments were made available for this purpose and at times when it was less stressful for the patients concerned.
• An effective system was in place to follow-up patients who failed to attend for their annual review to ensure they were well.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of safeguarding procedures. A lead for safeguarding had been identified.
• The practice advised vulnerable patients about how to access various support groups and voluntary organisations.
• Carers or relatives were identified and consulted about the care and treatment needs of patients after consent was obtained. Staff were aware of the Mental Capacity Act 2005 guidance in relation to the capacity to make decisions.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• Homeless patients and those from the travelling community were able to register at the practice.