Orchard Surgery

Updated 4 October 2017

Orchard Surgery is located in Horsham within a purpose built premises that is attached to the town library. The practice provides medical services to approximately 9,333 patients.

There are five GP partners (three male, two female). Collectively they equate to approximately 4.5 full time GPs. The practice is registered as a GP training practice, supporting medical students and providing training opportunities for doctors seeking to become fully qualified GPs.

There are four female members of the nursing team; three practice nurses and one health care assistant. GPs and nurses are supported by the practice manager, a deputy practice manager, a care coordinator and a team of reception/administration staff.

Data available to the Care Quality Commission (CQC) shows the practice is located in an area that is considered to be in the least deprived decile nationally. The number of registered patients suffering income deprivation is much lower than the national average.

The practice is open from 8am to 6pm Monday to Friday with telephone cover available until 6:30pm. Outside of the opening hours the practice is serviced by an out of hours provider. There are presently no extended hours.

Appointments can be booked over the telephone, online or in person at the surgery. Patients are provided with information on how to access the out of hours service by calling the surgery or viewing the practice website.

The practice offers a number of services for its patients including; family planning, minor surgery, diabetes care (including insulin initiation), hypertension clinics and travel vaccines.

The practice has a General Medical Services (GMS) contract with NHS England. (GMS is one of the three contracting routes that have been available to enable commissioning of primary medical services). The practice is part of the NHS Horsham and Mid Sussex Clinical Commissioning Group.

The practice was based at a single location at Lower Tanbridge Way, Horsham, West Sussex, RH12 1PJ. We visited this location during our inspection.

Updated 4 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Orchard Surgery on 29 September 2016. At this inspection the overall rating for the practice was good. The four domains of safe, responsive, caring and well led were rated as good. One domain, effective, was rated as requires improvement. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Orchard Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 12 September 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection in September 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good in all domains and good overall.

Our key findings were as follows:

• Staff had received training appropriate to their role. The practice had improved training records and the oversight of training. All staff had completed fire safety awareness, infection control and information governance training. All staff had been provided with guidance to identify and locate adults at risk alerts on the practice computer system.
• The practice had completed infection prevention control audits in order to continually assess cleanliness and address concerns. Blinds and carpets had been regularly cleaned. A cleaning schedule and regular management reviews ensured monitoring of cleaning was undertaken.
• The practice had completed Disclosure and Barring Scheme (DBS) checks for all non-clinical staff who were trained as chaperones. All clinical staff had received a DBS check as standard practice.
• The practice had introduced improvements in the recording of appraisals which enhanced the management of the process.
• The practice ensured that all policies and procedures were dated at the time of writing and last review.
• The practice had reviewed the locations of emergency equipment and medicines.
• The practice had reviewed the appointment system with consideration of patient comments regarding not being given sufficient time to make decisions about their care and appointments not running on time. Extended time appointments were now offered by the practice and advertised to patients by staff and on displays in waiting areas.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 February 2017

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 were in line with national averages. For example, the percentage of patients with diabetes whose blood glucose level was 64mmol/mol or less in the preceding 12 months was 81% compared with a national average of 78%.

• Longer appointments and home visits were available when needed.
• We saw examples of personalised care plans for patients with long term conditions.
• 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 offered a range of services to people with long term conditions. This included clinics for diabetes with a specialist nurse, asthma and hypertension.

Updated 13 February 2017

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 90%, which was comparable to the CCG average of 84% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 13 February 2017

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

• All patients had a named GP, including those over 75.
• 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.

Updated 13 February 2017

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 was offered a full range of health promotion and screening that reflects the needs for this age group.
• The practice was proactive in offering online services including booking/cancelling appointments and an electronic prescribing service.

Updated 13 February 2017

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

• Data from the Quality and Outcomes Framework (QOF) showed results were in line with national averages for this population group. For example the percentage of patients diagnosed with dementia whose care had been reviewed in the preceding 12 months was 89% which was comparable to the CCG average of 86% and the national average of 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.
• 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.

Updated 13 February 2017

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.
• 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.