Ashingdon Medical Centre

Updated 9 November 2016

Ashingdon Medical Centre is located in a residential location within Ashingdon, Essex. At the time of inspection, the practice had a list size of approximately 2,900 patients which had grown gradually by about 200 patients in the last year. In addition to the main practice there is also a branch surgery called The Dome, located in a residential caravan park. The main practice has recently been developed to improve access, to gain an extra treatment room, to improve infection prevention and control and to improve lighting and the general condition of the building. The branch surgery has also undergone some building work to improve the facilities.

The practice has a larger than average population aged 45 and over, with a smaller than average population aged 44 and under. The practice did not have any registered patients living in care homes.

There are two male GPs, a female advanced nurse practitioner and a female healthcare assistant. There is a practice manager, a dispenser and five administrative/reception staff.

The practice has recently begun offering teaching facilities for medical students who attend the practice for two week placements.

The practice is open from 8am to 7pm Monday, Tuesday and Thursday. The practice is open from 8am to 6.30pm on Wednesday and from 7.30am to 7pm on Friday.

Appointments are offered from 9am to 12pm on Monday to Thursday and from 7.30am to 12pm on Friday. Appointments are then offered from 3pm to 6pm on Monday and Wednesday to Friday and from 3pm to 7pm on Tuesday.

Weekend appointments are also offered at the practice through the local GP Alliance, this service is provided by other GPs.

The branch surgery offers appointments from 12pm to 2pm on Monday and Wednesday. It is open from 12pm to 2pm on Friday but this is with a receptionist only and appointments are not available.

During the inspection, we visited the branch surgery but as it was closed we did not speak to any patients at this location.

Updated 9 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ashingdon Medical Centre on 3 March 2016. Overall the practice was rated as good but required improvement for providing safe services.

During our last inspection we found the provider had not ensured that all risks to patients were assessed and managed. In particular, specific risk assessments for health and safety, the control of substances hazardous to health and legionella. The provider was asked to remedy these and a requirement notice for these improvements was issued.

We also asked the provider to improve their identification of patients who were carers.

Following the inspection an action plan was put in place by the practice to ensure the timely progression and resolution of the concerns highlighted.

On 21 October 2016 we conducted a desk top review and found;

• The practice had revised their environmental risk assessment. This included an assessment of a broad range of risks such as hazardous substances, slips and trips, moving and handling and the management of clinical waste. All areas had identified actions, these had been assigned to a named individual, dates for completion set, progress reports provided or confirmation that the actions had been completed.
• The practice had revised their legionella assessment in March 2016 (Legionella is a term for a particular bacterium which can contaminate water systems in buildings).
• We found the practice had introduced a carer’s champion. The practice had spoken to their staff to increase their awareness of carers and the services available to them. The Healthcare assistant ensured all patients were asked if they were a carer as part of their new patient check. All identified carer’s had been invited to receive their influenza vaccination and had accepted.

We were satisfied that the practice had made the required improvements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 April 2016

The practice is rated as good for the care of people with long-term conditions.

• The advanced nurse practitioner had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The practice performance for diabetes was above average, for example 94% of patients on the diabetes register, had a record of a foot examination and risk classification within the preceding 12 months (01/04/2014 to 31/03/2015), this was above the national average of 88%.

• Longer appointments and home visits were available when needed.

• All these 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 8 April 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 high for all standard childhood immunisations.

• 77%of patients diagnosed with asthma, on the register, had an asthma review in the preceding 12 months that included an assessment of asthma control using the three RCP questions (01/04/2014 to 31/03/2015). This was comparable to the national average of 75%.

• 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.

• 88% of women aged 25 to 64 years old had a cervical screening test performed in the preceding five years (01/04/2014 to 31/03/2015), this was higher than the national average of 82%.

Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 8 April 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.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were above average. For example, 93% of patients with COPD had a review undertaken including an assessment of breathlessness using the Medical Research Council dyspnoea scale in the preceding 12 months (01/04/2014 to 31/03/2015); this was higher than the national average of 90%.

Updated 8 April 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.

• Extended hours were offered to allow patients who worked to access appointments.

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.

Updated 8 April 2016

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

• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was better than the national average of 8%.

• The practice performed above average for all mental health indicators. Exception reporting was high for these indicators due to the relatively low number of patients diagnosed with poor mental health and dementia on the practice list.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• 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.

Updated 8 April 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 patients with poor mental health and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice proactively offered health checks and reviews for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• 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.