Eastgate Surgery

Updated 2 December 2016

Eastgate Surgery was established in 1997 is based in the town centre of Dunstable and provides services from a two storey building on Church Street. There is a large car park adjacent to the practice and disabled access is available via the rear of the building.

The practice serves a population of approximately 2,650 patients with an average population age range. National data indicates the area served is one of lower than average deprivation in comparison to England as a whole.

The clinical team consists of one male GP partner, two male salaried GPs, a practice matron, a practice nurse and a health care assistant (HCA). The team is supported by a practice manager and a team of administrative staff.

The practice holds a General Medical Services (GMS) contract for providing services, which is a nationally agreed contract between general practices and NHS England for delivering general medical services to local communities.

Eastgate Surgery is open between 8.30am and 6.30pm Mondays, Tuesdays, Thursdays and Fridays and on Wednesdays between 8.30am and 12pm. Appointments are offered between 9am and 12pm and 4.30pm to 6.30pm on Mondays and Fridays, and Wednesdays between 9.00am and 12pm. The practice has an arrangement with a neighbouring surgery where patients can be seen on Wednesday afternoons if necessary. On Tuesdays and Thursdays extended opening hours appointments are available until 7.15pm.

When the practice is closed the out of hours service is provided by Care UK for patients requiring the services of a GP. Information about this is available in the practice and on the practice leaflet, website and telephone line.

Updated 2 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Eastgate Surgery on 7 June 2016 Overall the practice is rated as good.

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.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• The practice monitored performance using the information collected for the Quality and Outcomes Framework (QOF) and performance against national screening programmes to monitor outcomes for patients. (QOF is a system intended to improve the quality of general practice and reward good practice). We saw evidence of progress in performance as a result of regular monitoring and improvement work.
• The practice nurse had developed a diary for newly diagnosed diabetes patients to use to support and help them to understand and manage their condition.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and 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.
• All Care Quality Commission comment cards received were positive about the service experienced. Patients said they felt the practice offered an excellent service and staff were helpful, caring and treated them with dignity and respect.
• 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.
• The practice had higher than local and national averages for patient feedback.

We saw one area of outstanding practice:

• The practice had a number of patients aged over 100 years and they had been visited on their 100th birthday by the doctor and practice matron with flowers and cards.

The areas where the provider should make improvement are:

• Carry out fire drills on a regular basis.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 December 2016

The practice is 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.
• Performance for diabetes related indicators was comparable to the clinical commissioning group (CCG) and national averages. For example, the percentage of patients with diabetes, on the register, in whom the last blood glucose reading showed good control in the preceding 12 months, was 75%, where the CCG average was 77% and the national average was 78%. 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.
• The practice nurse had developed a diary for newly diagnosed diabetes patients to use to support and help them to understand and manage their condition.
• Patients with these conditions were invited to attend for annual or six monthly checks as appropriate for their conditions.
• All patients in this group were offered flu vaccinations at appropriate times. Poor attenders could be given review checks and seasonal vaccinations opportunistically.
• Telephone consultations were offered where appropriate.
• The practice worked closely with other community staff as required to direct patients to voluntary, medical and social services to improve their quality of life. For example pulmonary rehabilitation and the community diabetes team.

Updated 2 December 2016

The practice is 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.
• 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 84%, which was comparable to the CCG average of 83% and the national average of 82%.
• 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.
• Teenagers were given any vaccinations that may have been missed at school, in the surgery and all first year university students were offered the meningitis vaccine.
• Health checks were offered to all 16 year old patients and contraception and chlamydia screening for all those young patients who were sexually active.
• Maternity services including 25 week/post-natal checks and whooping cough boosters were all available to pregnant women.
• Ante-natal clinics were held on alternate Tuesdays by a community midwife in the surgery.

Updated 2 December 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 was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The GP and practice matron undertook home visits and conducted ward rounds in local care homes. Patients needs were assessed and referrals made to other community agencies, when and where appropriate. Seasonal vaccinations were offered and given at home if necessary.
• Discharged patients were monitored regularly and if an elderly patient had not been seen recently, they would be contacted by phone, particularly during the winter months. They were offered health checks along with dementia screening.
• Patients who had reached the age of 100 were visited by the GP and practice matron with flowers and cards on the occasion of their birthday.
• The practice matron and GP worked closely with families of older patients giving reassurance, guidance and support to help them make the right choices with and for their elderly relative.

Updated 2 December 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.
• The practice offered a ‘Commuter’s Clinic’ twice weekly from 6.30pm to 7.15pm for patients who could not attend during normal opening hours.
• 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.
• The practice had enrolled in the Electronic Prescribing Service (EPS). This service enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.
• The practice offered health checks to all new patients for everyone over the age of 16 and above and those aged 40 -74 years, these included blood tests.
• Extended hours appointments were available on Tuesdays and Thursdays, to accommodate this group of patients and others. The practice offered early morning appointments for blood tests and clinical checks for the working patients
• On-line services were available for booking appointments and requesting prescriptions and the practice offered an electronic prescription service which enabled patients to collect medication from a chemist of patients choice.
• Telephone consultations were available, so that results can be discussed over the phone without patients having to attend a face to face appointment.
• Blood pressure readings are taken opportunistically and the practice encouraged the use of the surgery health check area, whereby patients were able to check their own blood pressure.
• Students who return home for the holidays were accommodated as temporary residents, should they require medical care.

Updated 2 December 2016

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

• The percentage of patients with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months (01/04/2014 to 31/03/2015) was 91% where the CCG average was 86% and national average was 84%.
• The practice regularly worked 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.
• Performance for mental health related indicators were above or in line with local and national averages. For example, the percentage of patients with diagnosed psychoses who had a comprehensive agreed care plan was 100% where the CCG and national averages were 89%.
• 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.
• Patients suffering from depression were assessed regularly and reviewed. The practice liaised closely with local community mental health teams to ensure that appropriate referrals and timely care was given. Patients were advised to self-refer for counselling to SORTED, a free and confidential counselling service for young people aged between 10 and 25 years who live in central Bedfordshire. Adults were advised to self-refer to the East London NHS Foundation Trust (ELFT) counselling service.
• Dementia screening was offered, including ECG and bloods, prior to referral to secondary care where necessary.
• Patients and carers were offered support and signposting to relevant organisations, for example, Age Concern, Alzheimer’s’ Society, clubs and support groups for both patients and carers.
• Joint visits were arranged with Social Services to support patients and their families.

Updated 2 December 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 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 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.
• The practice had a register for carers, they had identified 2% of the practice list as carers. The practice made efforts to identify and support carers in their population.
• 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.
• Regular health checks were carried out for patients with learning disabilities. The practice had a telephone reminder system to support this group of patents to attend.
• An emergency line which gave direct access to the surgery if the main phone is busy was available to these patients.
• All identified vulnerable patients were referred to other agencies or voluntary services if appropriate.
• Patients with drug and or alcohol dependencies could be referred to Path 2 Recovery including on the day referrals if necessary.