Archived: The Shotgate Surgery

Updated 30 March 2017

The Shotgate Surgery is one of a number of practices managed by a corporate health provider. It is located in Wickford on a main road with designated parking facilities neighbouring the building. They have approximately 3228 registered patients.

The practice employs three GPs, one female and two male. There is one salaried GP and the remaining two are locum GPs but have worked for the practice for a number of years. The practice also has a Physician Associate who works Monday, Wednesday and Friday. The practice benefits from the attendance of a pharmacist who works Tuesdays and Fridays conducting medication reviews.

They are supported by two practice nurses and an administrative/reception team overseen by the practice manager and the area practice manager. The practice is supported by a regional and national management team including a corporate team of specialists in training and policies.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are from 8.10am to 11.30am and 4pm to 6pm on Monday to Friday. Extended hours appointments were offered on Tuesday 6.30pm to 7.30pm and Friday mornings 7.30am to 8am.

The practice does not provide out of hour’s services. Patients are advised to call the national 111 service who will advise patients of the service they require. Currently their out of hour’s service is provided by IC24 and commissioned by Basildon and Brentwood CCG.

The practice has a patient profile similar to the national patient profile, with slightly lower representation amongst the youngest and older age groups. Life expectancy for both male and females was above the local and national averages.

The practice has a website providing details of opening times, contact information and details of their staff and services offered.

Updated 30 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Shotgate Surgery on 13 April 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the April 2016 inspection can be found by selecting the ‘all reports’ link for The Shotgate Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 22 February 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 on 13 April 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.

At the announced February 2017 inspection we found;

• The practice had conducted comprehensive audits relating to medicine management performance and clinical care. All were aligned to guidance and showed improvements where appropriate.
• Quality improvement processes had been established and were jointly overseen by the practice manager and the clinical lead to maintain and build on improvements.
• The practice had continued to meet regularly with the patient participation group (PPG). The clinical lead had been in attendance at all three of their last meetings. The PPG told us there had been improvements in how the practice engaged with them.
• We found appropriate systems were in place to ensure legal authorities were obtained to administer vaccinations safely.
• Staff had received training in how to correctly code patient health conditions. The practice manager in partnership with the clinical lead undertook regular governance checks to alert them of any issues. We found the practices prescribing practices were consistent with the patients clinical coding.
• All staff were aware of the practice safeguarding lead and in their absence concerns were reported to the deputy safeguarding lead.
• We reviewed practice team meeting minutes and saw learning from complaints and safety incidents were shared and revisited to embed the changes into practice.
• Clinicians were apprised of changes to guidance at their monthly meetings. We saw alerts had been placed on the patient record system advising them of changes. We checked the patient record system and saw clinical adherence to national guidelines.
• The practice had introduced a policy for communicating with out of hour’s services. We found appropriate patients had been identified, clinical records had been appropriately updated and care plans were in place.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Updated 30 March 2017

The provider had resolved the concerns for effective and well-led identified at our inspection 13 April 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

We found;

• The practice nurses led on long term conditions such as diabetes.
• Longer appointments and home visits were available when needed.
• All patients had a named GP.
• Clinicians were aware of how to communicate with their out of hours services.

Updated 30 March 2017

The provider had resolved the concerns for effective and well-led identified at our inspection 13 April 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

We found :

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk.

• Immunisation rates were relatively high for all standard childhood immunisations.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw relationships were being built with partner services but some were in their infancy.
• Patients were advised of midwife and health visitor contact numbers.
• Mothers and children were invited for their six week check.
• Some vaccinations for children had not been appropriately authorised by a medical professional. However checked on the patient record system showed none had been administered.

Updated 30 March 2017

The provider had resolved the concerns for effective and well-led identified at our inspection 13 April 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

We found:

• The practice was introducing multidisciplinary meetings with partner health and social care services.
• The practice referred patients to their care coordinator who promoted and supported patients to maintain their independence. This they achieved through accessing additional services and mobility aids.
• The practice offered home visits and urgent appointments for those with enhanced needs.
• The practice nurse undertook some flu vaccination home visits in partnership with the district nursing team.

Updated 30 March 2017

The provider had resolved the concerns for effective and well-led identified at our inspection 13 April 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

We found;

• The practice offered extended hours surgeries on a Tuesday afternoon 6pm to 7.30pm and Friday morning 7.30am to 8am.
• The practice offered online services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 30 March 2017

The provider had resolved the concerns for effective and well-led identified at our inspection 13 April 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

We found:

• Patients experiencing poor mental health received an annual physical health check.
• Staff undertook dementia awareness training.
• The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health.
• The practice told patients experiencing poor mental health about how to access various support groups and they were supported to self-refer where appropriate.

Updated 30 March 2017

The provider had resolved the concerns for effective and well-led identified at our inspection 13 April 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

We found:

• The practice carried out annual health checks for people with a learning disability.
• The practice maintained a list of vulnerable adults. It was intended to be used to inform discussions at the forthcoming multidisciplinary meetings.
• The practice was reinstating multidisciplinary meeting with their health and social care partners in April 2016.
• Staff had undertaken safeguarding training to an appropriate level but not all members of the clinical team knew who the safeguarding lead for the practice was.