Archived: The Stansted Surgery

Updated 19 May 2016

The Stansted Surgery Practice provides primary medical services from 8.30 am to 7pm on Mondays, 7am to 7pm on Tuesday and Wednesday and 8.30am to 6.30pm on Thursday and Fridays. The practice provides medical services to approximately 9,000 patients living in the Stansted area.

The practice has a team of four GP's two female and two male. The GPs are partners meaning they hold managerial and financial responsibility for the practice. In addition, there are two primary care practitioners (primary care practitioners are nurses that have had extensive training and are able to see patients to diagnose treat and prescribe medicines within their remit), three practice nurses and two healthcare assistants. The practice also employs a practice manager, medical secretaries and a team of reception and administration staff.

Patients using the practice also have access to community staff including the community matron, district nurses, community psychiatric nurses, health visitors, counsellors, support workers, health visitors and midwives.

Routine appointments are available daily and may be booked up to six weeks in advance. Urgent appointments are made available on the day and telephone consultations also take place.

The practice provides services to a diverse population age group, in a semi-rural location.

Outside practice opening hours a service is provided by another health care provider by patients dialling the national 111 service. The Partnership of East London Co-operatives ltd (PELC) provides the out-of-hours GP services based at the community clinic in Dunmow Essex.

The practice was previously inspected in April 2015 and received an overall rating of inadequate and was placed into special measures for a period of six months. Requirement notices and a warning notice were served requiring the provider to take action to improve.

The practice is registered as a partnership with the Care Quality Commission (CQC) to provide the regulated activities of: treatment of disease, disorder or injury; diagnostic and screening procedures and family planning services; surgical procedures and maternity and midwifery services at one location.

Updated 19 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stansted Surgery on 10 February 2016. Overall the practice is rated as good. This inspection was a follow-up of our previous comprehensive inspection which took place in April 2015 when we rated the practice as inadequate overall. In particular the practice was rated as inadequate for providing safe and well-led services and requires improvement for providing effective, caring and responsive services and was placed into special measures for a period of six months.

After the inspection in April 2015 the practice wrote to us with an action plan outlining how they would make the necessary improvements to comply with the regulations.

The inspection carried out on 10 February 2016 reflected that the practice had made significant improvements to enable the practice to come out of special measures and achieve a rating of good overall. They had responded to the concerns raised and had complied with the requirement notices that we issued and the enforcement action taken.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.

• The practice was proactive in the management of long term conditions.

• The practice proactively sought to educate their patients to manage their medical conditions and improve their lifestyles. Additional in-house services were available and delivered by staff with advanced qualifications, skills and experience.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.

I confirm that this practice has improved sufficiently to be rated ‘Good’ overall. The practice will be removed from special measures.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Updated 19 May 2016

When we inspected in April 2015 all population groups were rated as inadequate due to the concerns found in safe and well led. The overall rating from this inspection was inadequate and the practice was placed into special measures for six months. The inspection carried out on 10 February 2016 reflected that the practice had made significant improvements in all population groups including this one. The practice is now rated as good for the care of people with long-term conditions.

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

• Registers were maintained of patients with long-term conditions such as diabetes, COPD and asthma.

• Performance for diabetes related indicators was similar to the CCG and national average. Overall they scored 72 out of 86 points (84%). This was 2% above the CCG average and 5% below the national average.

• Longer appointments and home visits were available when needed.

• GPs had lead role for the management of patients with long-term conditions.

• All patients had a structured annual review to check that their health and medicines needs were being met.

There was a dedicated member of staff who implemented the diabetes programme and co-ordinated the annual review appointments.

Updated 19 May 2016

When we inspected in April 2015 all population groups were rated as inadequate due to the concerns found in safe and well led. The overall rating from this inspection was inadequate and the practice was placed into special measures for six months. The inspection carried out on 10 February 2016 reflected that the practice had made significant improvements in all population groups including this one. The practice is now rated as good for the care of families, children and young people.

• 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. Immunisation rates were relatively high for all standard childhood immunisations.

• The percentage of patients with asthma, on the register, who have had an asthma review in the preceding 12 months was 71% this is slightly lower that the CCG and national figures.

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

• The practice’s uptake for the cervical screening programme was 87%, which was above the national average of 81%.

• Chlamydia testing was offered to all new patients aged 16-24. All clinical staff offered screening opportunistically.

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

We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 19 May 2016

When we inspected in April 2015 all population groups were rated as inadequate due to the concerns found in safe and well led. The overall rating from this inspection was inadequate and the practice was placed into special measures for six months. The inspection carried out on 10 February 2016 reflected that the practice had made significant improvements in all population groups including this one. The practice is now 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.
• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Care and treatment of older people reflect current evidence-based practice, and older people had care plans where necessary.
• The percentage of people aged 65 or over who received a seasonal flu vaccination was higher than the CCG and national averages.

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

The percentage of people aged 65 or over who received a seasonal flu vaccination was lower than the CCG and national averages: however the practice had increased uptake by 20% this year.

Updated 19 May 2016

When we inspected in April 2015 all population groups were rated as inadequate due to the concerns found in safe and well led. The overall rating from this inspection was inadequate and the practice was placed into special measures for six months. The inspection carried out on 10 February 2016 reflected that the practice had made significant improvements in all population groups including this one. The practice is now 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.

• The practice was proactive in offering online services such as booking appointments and ordering repeat prescriptions as well as a full range of health promotion and screening that reflects the needs for this age group.

• The practice offers extended hours appointments both morning and evenings

The practice runs smoking cessation, weight management and dietary advice clinics and give healthy living advice

Updated 19 May 2016

When we inspected in April 2015 all population groups were rated as inadequate due to the concerns found in safe and well led. The overall rating from this inspection was inadequate and the practice was placed into special measures for six months. The inspection carried out on 10 February 2016 reflected that the practice had made significant improvements in all population groups including this one. The practice is now rated as good for the care of people experiencing poor mental health (including people with dementia).

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in the record, in the preceding 12 months, agreed between individuals, their family and/or carers as appropriate was 87% this was similar to the CCG and national averages.

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

• The practice carried out advance care planning for patients with dementia.

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

• 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.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

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

Updated 19 May 2016

When we inspected in April 2015 all population groups were rated as inadequate due to the concerns found in safe and well led. The overall rating from this inspection was inadequate and the practice was placed into special measures for six months. The inspection carried out on 10 February 2016 reflected that the practice had made significant improvements in all population groups including this one. The practice is now 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 homeless people, travellers and those with a learning disability.

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

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

• 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.