Archived: Judges Close Surgery

Updated 19 July 2017

Judges Close Surgery is situated in the centre of the town of East Grinstead, in West Sussex. The practice serves approximately 8000 patients living in the town and surrounding areas.

There are four GP partners, three female and one male. The practice employs two practice nurses, two healthcare assistants, and three phlebotomists. Data available to the Care Quality Commission (CQC) shows the practice serves a higher than the national average number of patients over the age of 65. There are less than the local and national average numbers of patients between the ages of 0-4, 5-14 and under 18 years. Income deprivation is relatively low for both children and older people.

The practice is open from 7.30am until 6.45pm Monday to Friday. Extended access is available from 7.30am every weekday morning. GP appointments are available on three mornings from 7.30am and these are supported by a variety of practice nurse, healthcare assistant and phlebotomist appointments also commencing from 7.30am. Appointments can be booked over the phone, on line or in person at the surgery. When the practice is closed, patients are advised on how to access the out of hours service on the practice website, the practice leaflet or by calling the practice. Out of hours calls are handled by an out of hours provider (Integrated Care 24).

The practice provides a full range of NHS services and clinics for its patients including asthma, diabetes, cervical smears, childhood immunisations, family planning and new patient checks.

The practice provides services from the following location:-

Judges Close

High Street

East Grinstead

West Sussex

RH19 3AA

Updated 19 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Judges Close Surgery on 1 December 2016. The overall rating for the practice was good. However, we found breaches of regulation relating to the provision of safe services. The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Judges Close Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 21 June 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 1 December 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice remains rated good overall and provision of safe services is now rated as good.

Our key findings were as follows:

• Safety systems had been reviewed and updated.
• The practice had taken action identified in their fire risk assessment by carrying out fire drills.
• A comprehensive risk assessment of the premises had been carried out. Actions identified from the risk assessment had either been completed or scheduled.
• Medicine fridges were kept securely in locked treatment rooms.
• Outcomes for patients with long term conditions had improved. The practice provided us with unvalidated data to March 2017. This showed the number of patients diagnosed with dementia receiving a face to face review had increased from 77% to 84%. Overall performance for diabetes indicators had improved 2% from 96% to 98%.
• The practice closely monitored the number of patients they removed from the Quality and Outcomes Framework (QOF) indicators of good care for patients with long term conditions. For example, it had identified that over 30 patients diagnosed with depression had their diagnosis entered twice in their records. The patient therefore had to be excluded from the indicators for the repeat diagnosis. (QOF is a system intended to improve the quality of general practice and reward good practice).
• The practice had conducted a patient satisfaction survey between October and December 2016. This had been completed by 211 patients. Results of the survey showed improvement on the national patients survey results published in July 2016. For example, 98% of patients surveyed by the practice said the GPs were good at listening to them compared to 88% in the last national survey completed by 112 patients.
• The latest results from the friends and family recommendation test were from May 2017. During that month 14 patients completed the survey and eight said they were extremely likely to recommend the practice to others. The remaining six were likely to recommend the practice.

The areas where the provider should make improvement is:

• Ensuring an appropriate system is put in place to check, and record the checks, of oxygen held for use in a medical emergency.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 January 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.
• Practice performance against indicators for the management of long term conditions was comparable to local and national averages. For example the percentage of patients on the diabetes register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was 79% compared to the clinical commissioning group (CCG) average of 78% and the national average of 78%.
• A diabetes specialist nurse from the local hospital held a monthly clinic on site for practice patients with more complex needs.
• Longer appointments and home visits were available when needed.
• The practice had recall systems in place to ensure all these patients had a structured annual review to check their health and medicines needs were being met.
• For those patients with the most complex needs, the practice worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 19 January 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 did not attend for immunisations.
• Immunisation rates were relatively high for all standard childhood immunisations.
• The number of women aged between 25 and 64 who attended cervical screening in 2015/2016 was 81% compared to the clinical commissioning group (CCG) average of 84% and the national average of 81%.
• Appointments were available outside of school hours and the premises were suitable for children and babies. Toys were available for children to play with in the waiting area.
• The practice worked closely with midwives, health visitors and school nurses. A midwifery clinic was held on the practice premises on a regular basis.

Updated 19 January 2017

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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Every patient over 75 had a named GP. They were offered annual health reviews including dementia screening. Carers were also invited for an annual health check.
• The practice had employed care co-ordinators who reviewed discharges from hospital on a daily basis to ensure patients had access to the right care and support at home.
• The practice held six monthly drop in sessions for older patients which provided them with access to nurses and GPs without an appointment, as well as advice from representatives from older people’s support groups and the Citizens Advice Bureau.
• The practice provided flexible appointment lengths (between ten to 30 minutes as standard or longer if required) which could be co-ordinated with other services, for example phlebotomy, to avoid patients having to return to the surgery.

Updated 19 January 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 open from 7.30am until 6.45pm Monday to Friday and patients could access a range of early morning appointments with the health care assistant, the practice nurses, the phlebotomist and the GPs.
• 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 provided a text messaging service to confirm appointment times and dates.
• The practice provided flexible appointment lengths which could be co-ordinated with other services such as phlebotomy, to avoid patients having to return to the surgery.

Updated 19 January 2017

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

• The practice worked closely with the local mental health team and met weekly with the primary care mental health liaison worker. The practice had access to rapid phone support and staff could easily access relevant services.
• 90% of patients with a severe and enduring mental health problem had a comprehensive, agreed care plan documented in the record, in the preceding 12 months compared to the CCG average of 93% and the national average of 90%.
• The practice supported patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• 77% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months compared to the clinical commissioning group (CCG) average of 83% and the national average of 84%.
• Patients with dementia were offered advance care planning and the practice worked with patients and their families to ensure their wishes were identified, for example with do not attempt cardiopulmonary resuscitation decisions. These were followed up appropriately and kept under review.
• All staff had received dementia training from a local dementia charity to improve their understanding and awareness of patient needs.

Updated 19 January 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice identified patients living in vulnerable those with a learning disability.
• Longer appointments were available for patients with complex needs or a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice employed care co-ordinators who supported vulnerable patients to access the care and support they required.
• 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.