Archived: The Laurels Surgery Also known as Dr Butcher and Partners

Updated 5 November 2015

The Laurels Surgery provides GP services to approximately 12,160 patients living in Boreham, Hatfield Peverel, and the adjoining rural areas delivered over two surgery sites. They also accept patients from Teling, North Springfield, Little Badow, Nounsley, Langford, Wickham Bishops and South Witham. The main site is at Boreham and the branch site at Hatfield Peverel. We travelled to the branch surgery to check and monitor the dispensing service as part of our inspection. Treatment and consultation rooms accessible for patients at both sites. The practice holds a Primary Medical Services Contract (PMS) with the addition of enhanced services for example; ‘Extended Hours access’, ‘Childhood Vaccination and Immunisation Scheme’, ‘Reducing unplanned admissions’, and the ‘Patient Participation’. The practice is a dispensing doctor practice providing a dispensing service to the practice population living more than one mile from a pharmacy.

The practice has a team of four GP partners, three male and one female, and three salaried GPs all female, meeting patients’ needs over the two sites and providing choice of clinician gender. The Laurels is a teaching practice with several registrars, who are fully qualified doctors receiving further training in general practice. There is a team of 10 nurses who run a variety of appointments for long term conditions, minor illness and family health at both sites. There are; two dispensers providing pharmacy support in the dispensary at the Hatfield Peveral site, a practice manager covering both sites, and a team of 16 non-clinical, administrative, secretarial and reception staff who share a range of roles. There is access to midwives, health visitors and district nurses.

The practice is open from 8.30am to 12.30pm and from 2pm to 6.30pm Monday to Friday. GP surgery hours are from 8.30am to 11.30 Monday to Friday and from 2pm to 6.30pm on Monday, Tuesday Wednesday and Friday with extended hour’s on Tuesdays and Thursdays from 7am to 8am, and on Thursdays from 2pm to 8pm. The practice also opened on Saturdays between 9am and 11.30am for pre-booked appointments that were available for all patients from either site.

Outside of these hours, GP services are accessed by phoning the NHS 111 service. The Out of Hour’s (OOH) service delivery for this practice population is provided by ‘Primecare’ when the practice is closed.

Updated 5 November 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Laurels Surgery on 11 August 2015. Overall the practice is rated as good.

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

• Documentation regarding complaints and safety incidents was recorded, monitored, reviewed annually, and actions were taken. Learning from complaints and incidents were shared and evidenced in practice meeting minutes.
• Safety risks to patients and staff were assessed and dealt with, although we did note a review of risk assessments to understand any trends or recurrent themes within the practice had not been carried out.
• Care was planned and assessments of patients’ needs followed best practice guidance.
• Staff had received training appropriate for their roles and further training was planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information was available about practice services and how to complain.
• Infection control procedures were completed to a satisfactory standard although documentation and staff guidance was not up to date. We observed reception staff did not follow the practice policy to use disposable gloves when handling specimens.
• The practice had up to date fire risk assessments and fire equipment but did not carry out fire drills to ensure staff knew how to act and keep people safe in the event of a fire.
• Patients said making an appointment with a named GP was relatively straightforward and that there was continuity of care. Urgent appointments were available on the same day requested.
• The practice had good facilities and was well equipped to treat patients and meet their needs. This included a lift to the first floor of the premises to access consultation rooms for patients.
• 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.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should

• Review of safety risks to patients and staff to understand any trends or recurrent themes within the practice.
• Review and bring up to date infection control policies, guidance, and procedures.
• Carry out fire drills to ensure staff know how to act and keep people safe in the event of a fire.
• Ensure reception staff use disposable gloves when handling specimens for the laboratory.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 November 2015

The practice is rated as good for the care of people with long-term conditions. Patients in need of chronic disease management and those at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. The practice offered a number of specialist clinics and the nursing staff had received enhanced training to facilitate these. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Those patients on the palliative care register in need of care were discussed at the three monthly multidisciplinary team meetings.

Updated 5 November 2015

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 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. Appointments were available outside of school hours and the premises had been adapted to make it suitable for children and babies, for example baby changing facilities.

We saw good examples of joint working with midwives, and health visitors with the combined weekly clinics at the practice for the convenience of patients. The practice also provides family planning services, baby and child development clinics, and maternity services, both with the GPs and the nurses, and long acting contraception advice.

Updated 5 November 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were similar to expected nationally for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of services, for example; identifying patients aged 75 or over with a fragility fracture and treating them with an appropriate bone-sparing agent, developing care plans as part of the admission avoidance enhanced service for people who are at risk of unplanned hospital admissions, and weekly visits to the nursing and residential homes for a ward round with a doctor and a nurse.

The practice offered older people home visits, and urgent appointments to meet their needs.

Updated 5 November 2015

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 their services offered to ensure these were accessible, flexible and offered continuity of care. The practice was proactive in offering online appointments and prescriptions as well as a full range of health promotion, screening, and health checks that reflected the needs for this population group.

Appointments were available each morning and evening at times that were flexible for chronic disease monitoring for this group within the clinics.

Updated 5 November 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). From the 2013-2014 data the percentage of patients experiencing poor mental health had received a comprehensive, agreed care plan documented in their records, in the preceding 12 was 92.9% which was 7% higher than the clinical commissioning group (CCG) and national average. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months was 98.1% which was 16.9% higher than the clinical commissioning group (CCG) at 81.1% and 14.3% higher than the national average at 83.7%.

The practice signposted patients experiencing poor mental health how to access various support groups and voluntary organisations. Patients in this population group who had attended accident and emergency (A&E) where they may have been experiencing poor mental health were followed up. Patients receiving certain medicines for their mental health had their levels monitored and adjusted if needed.

Updated 5 November 2015

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 in a care organisation or with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. Vulnerable people had been signposted how to access various support groups and voluntary organisations.

Staff had received training and knew how to recognise signs of abuse in vulnerable adults and children. They were aware of their responsibilities regarding information sharing and the documentation of safeguarding concerns. Staff knew who the safeguarding lead at the practice was and who to contact with any concerns.

Where necessary frail patients were given access to a social worker and a community matron to support their care and discussed at monthly frailty meetings.