Dr Haeger and Partners

Updated 30 June 2017

Dr Haeger and Partners also known as Blackwater Medical Centre is part of Mid Essex Clinical Commissioning Group and is a large rural surgery in Maldon Essex. Blackwater Medical Centre was previously known as Dr Roper & Partners and provides general medical services to approximately 13,900 registered patients. The practice has a branch surgery in a neighbouring village. The branch surgery was not inspected during this inspection.

• The main surgery is located within purpose built premises and has a dispensary as well as a community pharmacy located within the same building. The ground floor of the premises consists of the reception and all the GPs and nurses rooms and the pharmacy, the first floor accommodates all the office based staff and a large meeting room and staff rest areas. There is limited parking at the practice, but two car parks in the town within walking distance of the practice

• The practice comprises of seven GP Partners (six male and one female). The all-female nursing team consists of one nurse practitioner and five practice nurses. A practice manager and a team of reception and administrative staff undertake the day to day management and running of the practice. The independent pharmacy and dispensary is managed by a pharmacist supported by four dispensing staff.

• The practice has core opening hours between 8am and 6.30pm, Monday to Friday with appointments available from 8.20am to 5.50pm daily. Extended opening hours are on Monday, Wednesday and Friday from 7am and on Thursday from 7.30am.
• The practice has opted out of providing the out-of-hours service. This service is provided by the out-of-hours service accessed via the NHS 111 service. Out of Hours services are provided by Primecare. Advice on how to access the out-of-hours service is clearly displayed on the practice website, on the practice door and over the telephone when the surgery is closed.

Updated 30 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Haeger and Partners (Previously known as Dr Roper & Partners) on 4 April 2016 where the practice was rated as good overall. However the practice was found to be requires improvement for providing safe services. The full comprehensive report on the April 2016 inspection can be found by selecting the ‘all reports’ link for Dr Haeger and Partners on our website at www.cqc.org.uk.

As a result of that inspection we issued the practice with a requirement notice in relation to regulation risks to patient safety not been assessed and managed appropriately and safeguarding training.

This announced focussed inspection was carried on 14 June 2017 to confirm that the practice had carried out their plan to make the improvements required identified in our previous inspection on 4 April 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice is rated as good for providing safe services.

Our key findings were as follows:

• All staff except two new staff members had received safeguarding training. The two new staff were on their induction period and at the time of the inspection were shadowing existing staff.
• The practice had undertaken a health and safety risk assessment and a fire risk assessment had been completed as required by legislation.
• The practice business continuity plan in place for major incidents such as power failure or building damage was available and had been updated with all the current contact details.
• The practice had a documented strategy and business plan to support the practice mission. This was amended when the needs of the practice changed.

At our previous inspection on 4 April 2016 we said that the practice should implement a system to identify more patients who are carers and continue to monitor and ensure improvement to national patient survey results.

At this inspection we found that the practice had still only identified 0.75% of their practice list as carers and that the practice had not monitored and reviewed the national patient survey results to ensure improvement.

Therefore the provider should

• Review process and methods for identification of carers and the system for recording this to enable support and advice to be offered to those that require it.
• Monitor and ensure improvement to national patient survey results.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 September 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.

• Doctors and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Chronic disease reviews were offered in the surgery or at home if the patient was housebound. Diabetes Protocols were followed with support from the diabetes lead doctor and COPD/Asthma annual reviews and follow up appointments were actioned with a trained asthma nurse.

• A recall system was in place to ensure continuity of care for the disease management of all long term conditions. For example, medicine reviews and follow-up checks as and when required or requested.

Updated 16 September 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 74%, which was below the CCG average of 76% and the national average of 82%

• Appointments were available outside of school hours that could be booked in person on line or by telephone.A triage nurse was available to see patients with minor ailments.

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

• Some non-clinical staff had not received training in safeguarding children.

Updated 16 September 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.
• Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs in order to deliver care more effectively. Monthly meetings with wider members of the healthcare team were held to review more complex and vulnerable patients.
• Each GP maintained their own personal list to promote continuity of care and to establish strong relationships with individuals and their families.

• Longer appointments were available for patients. Urgent and non-urgent home visits for frail and house bound patients were triaged by a nurse.

• The practice used specific templates for the general older person health check that prompted a falls assessment, dementia screening, carer details and that also offered carers’ wellbeing/health checks.

• Some non-clinical staff had not received training in safeguarding.

• The practice patient list included residents living in nine care homes locally and each care home had a named GP.

Updated 16 September 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 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.

• Telephone consultations were available each day for those patients who had difficulty attending the practice due, for example, to work commitments.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

• The practice nurse provided travel immunisations and travel advice.  

Updated 16 September 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 patients experiencing poor mental health, including those with dementia for whom they carried out advance care planning.

• Each GP maintained their own personal list to promote continuity of care and to establish strong relationships with individuals and their families.

• 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.

• The practice had processes in place for monitoring prescriptions that were not collected from the dispensary, particularly where patients had been identified as experiencing poor mental health.

• For patients with dementia, written consent for relatives to share in medical information and treatment planning was encouraged.

• The practice told patients experiencing poor mental health and patients with dementia about how to access services including talking therapies and various support groups and voluntary organisations. Information was available for patients in the waiting area.

Updated 16 September 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.

• The practice had identified a low number of patients who were carers.

• 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 worked with multi-disciplinary teams in the case management of vulnerable people and informed patients how to access various support groups and voluntary organisations.

• The practice provided effective care and support for end of life patients and strove to deliver high quality palliative care. Patients were kept under close review by the practice in conjunction with the wider multi-disciplinary team.

• The practice held a list of patients registered as carers. The practice had identified 105 carers and this was 0.75% of their patient population.