Archived: Pathfinder Medical Practice

Updated 30 November 2017

Pathfinder Medical Practice is based within the South West Herts Health Centre. The premises are shared with an additional GP practice and NHS staff providing a range of community services.

Pathfinder Medical Practice provides primary medical services to approximately 4,040 patients in South Oxhey, Hertfordshire. The registered provider is Phoenix Primary Care Limited who are part of the Practice Group; a company that provides services on behalf of the NHS. The practice has one registered manager in place. (A registered manager is an individual registered with CQC to manage the regulated activities provided).

The practice serves a higher than average population of those aged from 0 to 14 years and from 30 to 39 years. The practice serves a lower than average population of those aged from 45 to 84 years. The practice has a diverse patient population and levels of social deprivation within the local area.

The practice employs four salaried GPs, all of whom are female. The practice regularly uses male locum GPs. There is one nurse practitioner, who is qualified to prescribe certain medicines, two practice nurses and one health care assistant. The practice team consists of a practice manager, a deputy practice manager, one administrator, one secretary and three members of the reception team.

The practice is open to patients between 8am and 8pm Monday to Friday. Appointments with a GP are available between these hours. Emergency appointments are available daily. A telephone consultation service is also available for those who need urgent advice. The practice is open from 8.30am to 12.30pm every Saturday.

Home visits are available to those patients who are unable to attend the surgery and the Out of Hours service is provided by Herts Urgent Care and can be accessed via the NHS 111 service.

Updated 30 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Pathfinder Medical Practice on 12 October 2017. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Results from the National GP Patient Survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• The practice maintained a list of vulnerable patients and dedicated staff contacted these patients on a weekly basis to check their health and wellbeing.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvements are:

• Continue to monitor and ensure improvement to immunisation rates for children.
• Continue to monitor and ensure improvement to patient waiting times.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 November 2017

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

• Nurses had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was comparable with the local CCG and national average. The practice had achieved 87% of the total number of points available, compared to the local average of 89% and national average of 91%.
• 75% of patients diagnosed with asthma, on the register, had received an asthma review in the last 12 months which was comparable to the local average of 75% and national average of 76%.
• Longer appointments and home visits were available when needed.
• All patients with a long-term condition had a named GP and there was a system to recall patients for 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 multi-disciplinary package of care.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

Updated 30 November 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 identified as being at possible risk, for example, children and young people who had a high number of A&E attendances.
• Immunisation rates were relatively high for most of the standard childhood immunisations. However, some rates were below the required standard.
• The practice’s uptake for the cervical screening programme was 80%, which was comparable to the local average of 82% and national average of 81%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice offered a range of family planning services. The practice worked with midwives, health visitors and school nurses in the provision of ante-natal, post-natal and child health surveillance clinics.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

Updated 30 November 2017

​​The practice is rated as good for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of their life.
• GPs involved older patients in planning and making decisions about their care, including their end of life care.
• A named GP carried out a weekly visit to three local care homes for continuity of care. Senior staff members at these homes were positive about the standard of service received.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.
• The practice provided an annual review for patients aged over 75 years and had reviewed all of these patients within the previous 12 months.

Updated 30 November 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 8am to 8pm on weekdays and Saturday mornings. 
• The practice carried out routine NHS health checks for patients aged 40 to 74 years.
• The practice was proactive in offering online services such as repeat prescriptions, appointment booking and an appointment reminder text messaging service, as well as information about a full range of health promotion and screening that reflects the needs of this age group.
• Unverified data from the practice showed:
  • 60% of patients aged 60 to 69 years had been screened for bowel cancer in the last 30 months compared to the local and national average of 58%.
  • 68% of female patients aged 50 to 70 years had been screened for breast cancer in the last three years which was below the local average of 72% and national average of 73%.

Updated 30 November 2017

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

• The practice carried out advance care planning for patients living with dementia.
• 96% of patients diagnosed with dementia had their care reviewed in a face to face meeting within the previous 12 months, which was above the local CCG average of 87% and national average of 84%.
• The practice held a register of patients experiencing poor mental health and offered regular reviews and same day contact.
• Performance for mental health related indicators was comparable with the local CCG and national average.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff we interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 30 November 2017

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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. There were 13 patients on the practice’s learning disability register at the time of our inspection and 10 (77%) had received a health review in the past 12 months.
• The practice offered longer appointments for patients with a learning disability.
• The practice maintained a list of vulnerable patients and dedicated staff contacted these patients on a regular basis to check their health and wellbeing.
• Vulnerable patients had been told how to access support groups and voluntary organisations.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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 held a register of carers with 127 carers identified which was approximately 3% of the practice list. The practice displayed information on a carers’ notice board.