Archived: Burnham Surgery

Updated 28 April 2021

Burnham Surgery is located centrally in the village of Burnham on Crouch, Essex. It is in close proximity to the train station and has parking available. The practice is in a privately-owned purpose-built building.

The practice holds a General Medical Services (GMS) contract with NHS England. The GMS contract allows the practice to deliver primary care to the local communities. The practice has a list size of approximately 8,960 patients and provides GP services commissioned by Mid Essex Clinical Commissioning Group (CCG). A CCG is an organisation that brings together local GPs and experienced health professional to take on commissioning responsibility for local health services.

The practice is registered to provide the following regulated activities: diagnostic and screening procedures, family planning, maternity and midwifery and treatment of disease, disorder or injury.

The clinical team comprises three GP partners, and one GP. There are six nurses and three healthcare assistants. The clinical team are supported by a business manager and assistant practice manager and a team of receptionists and administration staff.

Appointments are available from 8am and 6:30pm Monday, Wednesday, Thursday and Friday and from 7am and 18:30pm on Tuesdays. Unscheduled out-of-hours and weekend care is provided by a local hub, a service set up by the Clinical Commissioning Group (CCG) and patients who contact the surgery outside of opening hours are provided with information on how to contact the service.

National data indicates that people living in the area are in the eighth most deprived decile of the deprivation scoring in comparison to England.

The practice has a comprehensive website providing information for patients to understand and access services, including useful contacts for specialist support services.

Updated 28 April 2021

Letter from the Chief Inspector of General Practice

We carried out an announced focussed inspection at Burnham Surgery on 30 August 2017. This inspection was to confirm that the practice had carried out their plan to make the improvements required identified in our previous inspection on 31 January 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At our inspection on 31 January 2017, we looked at whether the improvements at both inspections had been made. This inspection was a follow up to our previous comprehensive inspection at the practice in March 2016 where breaches of regulation had been identified and the practice had been placed in special measures.

At the inspection in January 2017 and we found that the practice had improved. The practice was rated as requires improvement for providing safe services, and good for effective, caring, responsive and well-led services.

The full comprehensive reports on the March 2016 and January 2017 inspections can be found by selecting the ‘all reports’ link for Burnham Surgery on our website at www.cqc.org.uk.

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

• The practice had a written fire risk assessment that was completed in June 2017. The practice had undertaken actions from this and other work was underway.

• Systems were in place to monitor performance and quality ensuring tasks such as changes to prescriptions and coding of records was carried out safely. The practice had a consistent process to ensure that all changes to prescriptions were authorised by a clinician.

• A qualified dispenser who worked to an agreed protocol reviewed the medicines of patients discharged from hospital. This included referral to a GP where required. The practice had plans to commence regular monthly audits of 25 patient records to ensure that errors did not occur. However, on the day of our inspection this had not commenced.

• The practice had a contract with the pharmacy and the dispensary were looking to sign up to the Dispensary Services Quality Scheme (DSQS). The dispensary completed audits to monitor its effectiveness.
• The practice were continuing to demonstrate GP leadership to ensure improvements were implemented, embedded and sustainable to continue to improve patient care.
• The practice had a system in place to evidence and document that the learning from significant events and relevant information had been cascaded to all members of staff. However not all significant events had been documented on the incident reporting forms, despite them been discussed in clinical meetings.
• Practice policies and procedures were fully documented and the most up to date versions were easily accessible to all practice staff.

• The process for acting on patient safety and medicine alerts had been reviewed so that all relevant clinicians were able to action the alerts when received.

• The management had oversight to ensure that all practice staff had received all the training appropriate to their role and in the appropriate time frame.

Actions the practice SHOULD take to improve:

• Commence regular monthly audits that were planned to assure the practice the medicines of patients discharged from hospital were appropriately actioned in line with the protocol.

• Review the process for recording significant events to ensure the incidents are recorded in line with practice policy.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 March 2017

The practice is rated as good for providing services to patients 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.

• The practice used the information collected for the Quality and Outcomes Framework (QOF) to monitor outcomes for patients (QOF is a system intended to improve the quality of general practice and reward good practice). Data from 2015/2016 showed that

• Longer appointments and home visits were available when needed.

• Patients with complex needs had a named GP and a structured annual review to check their health and medicines needs were being met. There was a recall system in place to ensure that patients were invited and attended annual reviews.

• The practice offer blood anti - coagulation blood monitoring and dosing (INR) on site.

Updated 23 March 2017

The practice is rated as good for providing services to families, children and younger 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 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.

• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 80%, which was in line with the local CCG and the national average of 82%.

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

• The practice offered a full range of contraception services and chlamydia screening. Following the closure of a local sexual health clinic, the practice wrote to the local schools asking them to make young people aware that services were available at the practice. The practice told us that following this they saw an increase in the number of young patients seeking advice on contraception.

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

Updated 23 March 2017

The practice is rated as good for providing services to older people.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• A clinician prioritised requests for home visits and ensured appropriate and timely care for patients.
• The practice contacted patients who may not be able to request their own repeat prescriptions by telephone ensuring that they had adequate supplies of their medicines.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure, were in line local and national averages.

• The practice had identified 196 patients as carers (2.6% of the practice list).

• The practice was engaged with the local carers support group, which provided guidance, support, and respite for carers. Written information was available to direct carers to the various avenues of support available to them.

Updated 23 March 2017

The practice is rated as good for providing services to working age people.

• 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 where possible.

• 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 was situated very close to the local train station and offered early morning appointments for those that commuted.

• The practice offered an electronic prescription service, which meant that patients were able to collect the medicines from the pharmacy of their choice.

• Smoking cessation advice and support was available at the practice.

• Telephone consultations were available for those who wished to access advice this way.

Updated 23 March 2017

The practice is rated as good for providing services to people experiencing poor mental health.

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  The practice performance for indicators relating to mental health was 100%; this was 7% above the CCG and national average. The exception reporting for this indicator was 44% this was above the CCG average of 17% and the national average of 11%.

• 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.

• 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.

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

• The nurse practitioner had a special interest and with GP support managed patients who may be experiencing poor mental health and with GP support managed patients.

Updated 23 March 2017

The practice is rated as good for providing services to people whose circumstances may make them vulnerable.

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

• The practice regularly worked with other health care professionals in the case management of vulnerable patients, and held regular multidisciplinary team meetings.

• A practice nurse followed up patients that had been discharged from hospital.

• A dedicated telephone line number was given to those patients who may be a risk of unplanned admission. The staff were aware that these patients were assessed as a priority.

• 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.