Archived: Green Elms Surgery

Updated 6 November 2017

Green Elms Surgery provides primary care services for approximately 7,570 patients in the Jaywick and West Clacton surrounding areas. There is a branch surgery at Nayland Drive in Clacton also within the service provision. We did not visit the branch surgery as part of this inspection. The practice has an Alternative Provider Medical Services (APMS) contract to provide Primary Care Services. The APMS contract is commissioned by NHS England and performance managed by NHS North East Essex CCG.

Green Elms Surgery is part of a larger organisation known as Anglian Community Enterprise (ACE). ACE have four GP practices in this part of Essex, one in Clacton, one in Holland-on-sea, one in Frinton, and this practice in Jaywick. ACE, provide community care, health and well-being, primary care, and learning disability services in Essex. ACE is a not for profit staff owned social enterprise that delivers services under NHS contracting regulations. They have greater access to organisational resources than other local practices. This includes access to clinical staff leadership, information governance, risk, and health and safety management at an organisational level provided across their four practice locations.

Green Elms surgery population has a higher than average level of deprivation, homelessness, and addiction. The life expectancy of patients within the practice area is lower than local and national averages. There is also a greater number of deprived and vulnerable living in this area. These patients are often hard to reach and have little interest in their health. The practice staff work with these patient groups, and with local organisations to build up a relationship to enable them to offer primary care services with the approach these patients need.

The clinical team comprises three salaried male GPs and one regular locum female GP. There is also a clinical pharmacist, two nurse practitioner/prescribers, a practice matron, three practice nurses, and two healthcare assistants. The administrative team of thirteen staff work a variety of full-time and part-time hours with roles including receptionists, audit clerks, prescribing clerks, medical secretary, assistant practice manager and a practice manager.

The Jaywick surgery opening hours are:

Monday         7am to 6.30pm

Tuesday        8am – 6:30pm

Wednesday   8am – 7:30pm

Thursday       8am – 6:30pm

Friday            8am – 6:30pm

Weekend closed.

The Jaywick surgery appointment times are:

Monday        8am – 6:15pm

Tuesday       8:30am – 6:15pm

Wednesday  8:30am – 7:15pm

Thursday      8:30am – 6:15pm

Friday           8:30am – 6:15pm

Weekend closed.

The Nayland Drive surgery opening hours are:

Monday          8am – 1pm Closed for Lunch 2pm – 6pm

Tuesday         8am – 1pm Closed for Lunch 2pm – 6pm

Wednesday    8am – 1pm Closed for Lunch 2pm – 6pm

Thursday        8am – 1pm Closed for Lunch 2pm – 6pm

Friday             8am – 1pm Closed for Lunch 2pm – 6pm

Weekend closed.

The Nayland Drive surgery appointment times are:

Monday         8:30am – 11: 30pm 4pm – 5:45pm

Tuesday        8:30am – 11: 30pm 4pm – 5:45pm

Wednesday   8:30am – 11: 30pm 4pm – 5:45pm

Thursday       8:30am – 11: 30pm 4pm – 5:45pm

Friday            8:30am – 11: 30pm 4pm – 5:45pm

Weekend closed.

The practice has opted out of providing GP out of hour’s services. Patients calling the practice outside practice working hours are advised by the answerphone message to contact the 111 non-emergency services. Patients requiring urgent treatment are advised to contact the out of hour’s service provided by Care UK.

Updated 6 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Green Elms Surgery on 12 September 2017. Overall, the practice is rated as good.

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

• Staff members knew how to raise concerns, and report safety incidents.
• Safety information was appropriately recorded and learning was identified and shared with all staff.
• The infection control policy met national guidance.
• Risks to patients and staff were assessed, documented and acted on appropriately.
• The practice had arrangements and processes to keep adults and children safe and safeguarded from abuse.
• Staff assessed patient care in line with current evidence based guidance.
• The practice had an effective system to act on patient safety and Medicines and Healthcare products Regulatory Agency (MHRA) alerts.
• Staff showed they had the skills, knowledge, and experience to deliver responsive, effective care and treatment.
• There were 13 clinical audits undertaken and we saw five completed audit cycles enabling improvements to be measured.
• The system to monitor patients repeat prescriptions was effective.
• Patients said they were treated with compassion, dignity, respect, and involved in their care and treatment decisions.
• Information about the practice services and how to complain was available in the waiting room, and on the practice website in easy to understand formats.
• The practice was aware of and complied with the requirements of the duty of candour when dealing with complaints and significant events in an open and honest manner.
• The practice facilities, and equipment was appropriate to treat and meet patient’s needs.
• There was a clear leadership structure and in addition, staff members felt supported by the practice clinical and management team.

The area where the provider should make improvement are:

• Improve patient satisfaction in the GP National Survey.

We saw two areas of outstanding practice:

• The nursing and practice management staff built up a positive working relationship at the local Ex-Offenders group meetings with patients, held by social workers. The practice hadrecognisedthis hard to reach group of patients as not engaging effectively or appropriately, so offered to attend the meetings for the purpose of improving their health care andto gain this group of patients’ trust. As a result, many more patients now visited the practice and they were supported to manage their health in an improved way. We were told that this initiative had identified many patients suffering with long-term health conditions that had not previously been treated. All staff members had been trained to take a tolerant approach to these patients when they did not attend appointments, or arrived late due to their specific needs and to work with them to provide support. The practice population level of deprivation, homelessness and addiction was higher than any local and national averages. The practice staff worked with these patients, local organisations and the police to build up a relationship to offer primary care services with an approach these patients needed.
• The practice community matron visited a large local residential care home twice a week to up-skill staff, and support them dealing with minor issues previously reported to the practice. The matron also provided staff training to recognise when an ambulance should be called and when the practice could deal with the concern. This training has led to a reduction in calls for visits to the practice and considerable reduction of over 60% in the ambulance calls, as seen in an independent ambulance service usage analysis audit.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 November 2017

The practice is rated as good for this population group.

The practice has twice the national average of people with long-term conditions (LTC). Services provided by the practice for this population group were:

• Diabetes specialist nurse clinic checks.
• Chronic obstructive pulmonary disease (COPD) specialist nurse clinic monitoring.
• Asthma specialist nurse clinic checks.
• Chronic heart disease clinic checks.
• Nursing team staff and GPs held lead roles, and had received extra training in chronic disease management.
• Double appointments or home visits when needed.
• Those people with LTC had a named GP and a structured annual review to check that their needs were met.
• Telephone consultation and check-ups for patients with exacerbation of their LTC were provided to avoid unnecessary visits to the practice, and improve experience and self-management.
• Clinicians liaise with the community specialist LTC teams and utilises the ‘Consultant Connect’ service to provide optimal care.
• The clinical pharmacist provided dedicated medicine reviews focussing on patients prescribed complex medicines or those prescribed 10 or more medicines to ensure prescribing was safe, and to educate patients on the best use of their medicine.

Updated 6 November 2017

The practice is rated as good for this population group.

Services provided by the practice for this population group were:

• Family planning, including the insertion and removal of implants.
• Immunisation.
• Baby checks.
• Travel clinics.
• Cervical screening.
• Midwife Clinic at the practice.
• Appointments available outside school and college hours for example using an extended hour’s clinic on Thursday evenings from 6.30pm to 7.30pm.
• Premises suitable for children and babies.
• Automatic on the day appointments were available for all babies and children.
• Online services to book appointments and request repeat prescriptions.
• Ante/post-natal provision by Colchester Hospitals midwives.
• SMS telephone text reminders.
• Electronic prescribing service (EPS) from patients preferred pharmacy.
• A system to follow-up children living in disadvantaged circumstances or at risk, for example, those who had a high number of A&E attendances.
• Support from the ACE organisation safeguarding lead, and a link safeguarding nurse and GP at the practice.

Updated 6 November 2017

The practice is rated as good for this population group.

The practice offered personalised care to meet the needs of older people within its population, services included:

• Senior health and wellbeing checks.
• In-house minor surgery.
• Flu and travel vaccination.
• All older people had a named GP.
• The reception area had a hearing loop.
• A practice nurse provides a weekly ‘hard to reach’ session where she visited patients requiring nursing care that are housebound or struggle to attend the practice.
• The practice matron provides two afternoon clinics at the large local care home for the 40 patients registered.
• The practice offered home visits and urgent appointments to those that needed them.
• Palliative care meetings took place every month. Patients at risk of deteriorating health were discussed and care plans updated within a multidisciplinary team setting.
• There was a good uptake for shingles and flu vaccinations due to pro-active practice campaigning.

Updated 6 November 2017

The practice is rated as good for this population group.

Services provided by the practice for this population group were:

• On-line and mobile technology solutions for appointments.
• Electronic prescribing service (EPS) from patients preferred pharmacy.
• SMS telephone texting reminders.
• A full range of health promotion and screening that reflects the needs of this age group.
• Access to health advisors working with patient’s between 18-75 years of age at a one to one appointment followed by group sessions.
• Availability of health and wellbeing checks.
• Smoking cessation, weight management and medical checks for insurance and work purposes were available for workers.

Updated 6 November 2017

The practice is rated as good for this population group.

Services provided by the practice for this population group were:

• ‘On the day’ appointments were provided for people experiencing acute mental health issues.
• Double appointments were offered to support patients with complex needs, or a telephone review to provide reassurance and follow-up in a familiar home setting.
• Work with multi-disciplinary teams supported patients experiencing poor mental health, and included those with dementia.
• Staff were trained to safeguard adults and children from abuse.
• Staff were familiar with the details of the Mental Capacity Act.
• The staff had received guidance to direct patients that needed mental health support appropriately.
• Information in the waiting room and on the practice website told patients experiencing poor mental health how to access support groups and voluntary organisations.
• Patients that had attended accident and emergency who experienced poor mental health were followed up by the practice matron.
• Extended GP care advisor sessions provided guidance and support with the completion of forms, benefits claims and assessment for mobility aids.
• The practice was accredited as ‘Dementia Friendly’ in July 2016.
• The practice hosted a bi-monthly dementia clinic for patients, family members and carers provided by the Alzheimer’s society support worker.
• Currently the practice was undertaking audits to improve the diagnosis of dementia and patients subsequent care planning. 

Updated 6 November 2017

The practice is rated as good for this population group.

Services provided by the practice for this population group were:

• Recognition of patients living in vulnerable circumstances included the homeless, travellers, and those with a learning disability.
• Access to double appointments for patients with a learning disability.
• Case management of vulnerable patients with other health care professionals for treatment planning.
• Information for vulnerable patients about access to support and voluntary organisations.
• Staff were trained to recognise signs of abuse and manage safeguarding concerns.
• Safeguarding procedures at the practice and the policy met current legislation. Guidance and support was also provided by the provider organisation leads.
• The GP safeguarding lead at the practice attended forums when possible.
• GP care advisor sessions were provided to guide and support patient with the completion of benefit claims forms, and assessments for mobility aids.
• A weekly drop in session by the practice designated Social Care support worker gave all staff the opportunity to discuss any patients of concern.
• Vulnerable people where suitable had alerts attached to their records to allow staff members to act appropriately when dealing with them.
• The practice population level of deprivation, homelessness, ex-offenders and addiction was higher than average. The practice staff worked with these patients, and with the police and local organisations to build up a relationship to offer primary care services with the approach these patients need.
• Staff had built up a positive working relationship at the local ‘Ex-Offenders group’ meetings. After highlighting they were a hard to reach patient group that were not engaging effectively or appropriately, staff used these meetings to gain patients trust. All staff members had been trained to take a tolerant approach to these patients when they did not attend appointments, or arrived late due to their specific needs and to work with them to provide support. This initiative showed that patients in this group received care and treatment previously not sought by them.
• The practice community matron visited the large local residential care home twice a week to up-skill staff, and support them dealing with minor issues previously reported to the practice. The matron also provided care home staff training to recognise when an ambulance should be called and when the practice could deal with the concern.
• The practice staff maintained close links with organisations that could help support patients for example, Stroke Training and Awareness Resources (STARS) and Open Road to support those recovering from addiction.
• The nurse practitioner was trained and qualified to delivery Learning Disability (LD) health checks.