Archived: The Hollies Surgery

Updated 15 June 2017

The Hollies Surgery, previously called Dr Lester and Partners, is a practice in the centre of Benfleet, Essex with a list size of approximately 14,760 patients. The practice provides limited parking with a pay and display car park nearby. There are good transport links in the locality.

• The practice operates from a single location: 41 Rectory Road, Benfleet, Essex, SS7 2NA
• Services provided include: minor surgery, a range of clinics for long term conditions, health promotion and screening, family planning and midwifery. At the time of inspection, the practice had four GP partners, three male and one female.
• There are three part time practice nurses, two part time pharmacists, and two part time healthcare assistants.
• The non-clinical team comprises of a practice manager, business manager and 19 reception and administrative staff.

• The practice is a training practice, two of the GP partners are qualified trainers however currently no GP registrars are working at the practice. GP registrars are qualified doctors undergoing training to become GPs.
• The practice opens between 8am and 6.30pm on Mondays to Fridays. Appointments are offered from 8.30am to 11.40am daily and from 3pm to 6.20pm on Mondays to Fridays.
• On weekends, evenings and bank holidays, appointments are available through the local GP alliance at two alternative locations. Out of hours care is provided by IC24, another healthcare provider. This can be accessed by patients dialling 111.
• The practice has a comprehensive website providing information on opening times, appointments, services, staff and patient group information.

Updated 15 June 2017

Letter from the Chief Inspector of General Practice

We first carried out a comprehensive inspection at The Hollies Surgery on 28 January 2016 where the practice received a rating of requires improvement overall. The practice received requires improvement for providing safe, effective and well-led services and good for providing caring and responsive services. As a result the practice was issued with a requirement notice for improvement.

We then carried out a further focused inspection on 1 September 2016 to follow up on improvements and found that suitable improvements had not been made. The practice remained at requires improvement overall. The practice was rated as requires improvement for providing safe and effective services and inadequate for providing well-led services. As a result the practice was issued a warning notice and were to be compliant by March 2017.

A focused follow up inspection was carried out on 7 March 2017 to review the issues highlighted within the warning notice and we found that the practice had made the necessary improvements and were found to be compliant. As a result we carried out our most recent inspection on 4 May 2017 to follow up on areas of improvement and conduct a ratings review.

The full reports for the January 2016, September 2016 and March 2017 inspections can be found by selecting the ‘all reports’ link for The Hollies Surgery on our website at www.cqc.org.uk.

At our 4 May 2017 comprehensive inspection we found improvements had been made, overall the practice is now rated as good.

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

• There was an effective system in place for reporting and recording significant events. Staff confirmed discussions had been held and lessons learnt. We found evidence to demonstrate how learning had been shared and changes embedded into practice.

• Patient safety and medicine alerts had been appropriately responded to.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

• We found the practice had developed multiple quality improvement processes to monitor their medicines however, we found one area relating to patients being treated for thyroid conditions where appropriate reviews had not been undertaken.

• All staff had received a Disclosure and Barring Service (DBS) check and an appraisal within the last 12 months.

• We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

• We found that staff had a clear understanding of key issues such as safeguarding, Mental Capacity Act and consent.

• All practice policies and protocols were practice specific, updated and reviewed.

• The practice had identified 172 patients as a carer which was 1.2% of their patient list.

• Information about how to complain was available and easy to understand. Complaints were responded to at the time of reporting where possible. Learning from complaints was shared with staff.

• The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.

• The practice worked closely with their clinical commissioning group (CCG) to provide essential primary care to vulnerable adults within a domiciliary setting.

• The practice proactively sought and valued feedback from staff and patients, which it acted on. The patient participation group was active.

• There was a clear leadership structure and staff felt supported by management. The practice held regular staff, clinical and partner meetings.

• The practice had reviewed their national GP survey results and were implementing action plans to address the appointment availability issues that were raised.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

Actions the provider SHOULD take to improve:

Improve the system for reviewing patients taking prescribed thyroid medicines.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 June 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.
• The lead GP for diabetic patients and nurse monitored their patients and carried out the appropriate reviews.
• Longer appointments and home visits were available when needed.
• All 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.

Updated 15 June 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.
• The practice provided a combined baby check, post-natal check and immunisation appointment.
• Immunisation rates were high for all standard childhood immunisations.
• The practice offered contraceptive and sexual health screening for patients.
• Weight loss advice and support group information was encouraged by all clinical staff for patients who required it.
• The practice promoted the cervical screening programme. The practice’s uptake for the cervical screening programme was 77% which was above the national average of 73%.

Updated 15 June 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.
• The practice worked in partnership with the care coordinator team provided by the CCG to ensure patients are contacted regularly and upon discharge from hospital.
• The practice offered flu vaccinations at patients’ homes.
• The practice worked closely with their admission avoidance patients and allowed them access through a priority telephone number.
• Two GPs had special interests in frailty and were becoming leads in their area.

Updated 15 June 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.
• Routine pre-bookable weekend appointments were offered to all patients.
• The practice offered online services as well as a full range of health promotion and screening that reflected the needs for this age group.
• The practice promoted the Castle Point Association of Voluntary Services (CAVS), a social wellbeing CCG initiative to help individuals over the age of 18 with health, housing and wellbeing issues.
• Minor surgery services for family planning were provided by the practice.

Updated 15 June 2017

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

• The practice’s data showed that 97% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was higher than the national average of 84%
• The practice was comparable to the CCG average for their management of patients with poor mental health. For example, 86% of their patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in their records within the last 12 months.
• 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 and provided home visits for those unable to attend.
• 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.
• Patients and their family members were offered longer appointments to discuss concerns. Carers were highlighted on their patient record and offered appropriate vaccinations and health checks.

Updated 15 June 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 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.
• The practice provided sensory service support for sight or hearing loss.