Archived: Dr John Cormack

Updated 26 September 2017

Dr John Cormack is also referred to as The Greenwood Surgery, Tylers Ride. The practice is situated in the heart of South Woodham Ferrers with free street parking available. The practice has approximately 5996 patients registered with the practice.

• The practice operates from a single location: Tylers Ride, South Wooden Ferrers, Chelmsford, Essex.

• 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 was owned and managed by the lead GP, there was a salaried GP both of which were male. Female locum or nurse practitioner were available if patients requested it.
• The all female nursing team consists of two nurse practitioners, a nurse prescriber, a practice nurse, two healthcare assistants and phlebotomist.
• The non-clinical team comprises of a practice manager, reception and administrative staff.
• The practice opens between 8am and 6.30pm on Mondays to Fridays, extended hours are offered on Tuesday 8am to 8.30pm. The practice operates a walk in nurse led emergency clinic every morning Monday to Friday from 9am to 10am. Booked appointments are from 9am to 12.30pm and 3pm to 5.50pm for GPs and 10.30am to 12.30pm and 2pm to 5.50pm for nurses. Emergency appointments are reserved for the end of the day.
• Pre-bookable appointments could be booked up to six weeks in advance; urgent appointments were also available for people that needed them.
• Out of hours care is provided by IC24, another healthcare provider. This can be accessed by patients dialling the practice or 111.

• The practice has a comprehensive website providing information on opening times, appointments, services, staff and patient group information.
• Female and male life expectancy was above the local and national averages. Serving an affluent community with lower levels of deprivation for children and older people than local and national averages.

Updated 26 September 2017

Letter from the Chief Inspector of General Practice

We first carried out a comprehensive inspection at Dr John Cormack on 10 November 2016. The overall rating for the practice was requires improvement. The practice was inadequate for providing safe services, requires improvement for providing effective and well-led services and good for providing caring and responsive services. As a result, the practice was issued with requirement notices for improvement.

The full report for the November 2016 inspection can be found by selecting the ‘all reports’ link for Dr John Cormack on our website at www.cqc.org.uk.

At our 23 August 2017 comprehensive inspection we found the practice had addressed all concerns highlighted from the previous inspection and improvements had been made. Overall the practice is rated as good.

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

• There were appropriate systems and support for staff to identify, report, investigate and learn from significant incidents.
• The practice have improved their system in place to action patient safety and medicine alerts.
• The practice had implemented a system to ensure that they effectively managed and acted on safeguarding issues affecting children and vulnerable adults.
• Staff carried out safe administration of medicines in line with national guidance.
• Recruitment checks undertaken for all staff were in line with guidance.
• Staff received appropriate supervision and training to carry out their roles. For example all clinical staff had completed Mental Capacity Act training.
• The practice had improved their infection control procedures.
• The practice had a supply of emergency medicines for use in relation to the services provided.
• The practice showed little improvement from the November 2016 inspection where they were required to improve on their quality improvement processes. We reviewed three clinical audits the practice had conducted and found they did not demonstate where improvements could be made.
• Complaints were dealt with appropriately however lessons learnt were not documented at the time of the complaint.
• The practice held regular clinical, administrative and reception meetings. The practice had reviewed and updated their policies and procedures. Staff were aware of policies when we asked them.
• The clinical team had access to NICE guidance and the nursing team were working within their Mid Essex formulary, shared care protocols and competency levels.
• The practice had consistently strong clinical performance in their QOF performance in 2015/2016. They achieved 97% with exception rates that were comparable to local and national averages.
• There was evidence of appraisals and personal development plans for all staff.
• Data from the national GP patient survey published in July 2017 showed patients rated the practice in line with or higher than others for all aspects of care.
• Patients consistently told us they received a personalised service where they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
• The practice was active and worked well with their Clinical Commissioning Group.
• The practice had an active and supportive Patient Participation Group. They represented the practice and patients within the wider health forums to improve services.

Actions the provider should take to improve:

• Improve the recording of the learning from the analysis of complaints and cascade them to all relevant staff.
• Improve the clinical audit process by identifying where improvements to services could be made and record and review the action taken.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 September 2017

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

• Patients at risk of hospital admission were identified as a priority and care plans put in place to reduce their need to be admitted to hospital. Patients and carers were given a direct telephone number to contact the GP during emergencies.
• Longer appointments and home visits were available when needed.
• The practice operated an annual and biannual review of patients with long term conditions reviewing their medication and conditions.
• The practice worked closely with other allied health professionals to conduct health assessments for patients with long term conditions such as chronic obstructive pulmonary disease and heart failure.
• The practice participated in multidisciplinary reviews meetings with health and social care professionals.

Updated 26 September 2017

The practice is rated as good for the care of families, children and young people.

• At the November 2016 inspection not all clinical staff had completed safeguarding training; during this inspection we found that all members of staff at the practice had completed safeguarding training relevant to their role.
• The practice had implemented a system to follow up on children who did not attend hospital appointments to ensure there was no safeguarding concerns.
• The practice offered preconception, antenatal and postnatal care and had fortnightly appointments in the surgery with the community midwife.
• The practice conducted six weekly baby checks and provided all childhood immunisations.
• 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.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 26 September 2017

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

• Previously the practice had not followed up on patients who failed to collect their prescriptions, since the previous inspection the practice had implemented a process to ensure there were no safeguarding concerns for these patients.
• The practice was responsive to the needs of older people, and offered home visits, longer appointments and urgent appointments for those with enhanced needs.
• The patients had a named GP who oversaw their care.
• The practice maintained a frailty register and designed and maintained care plans for patients in partnership with the community services.
• Senior health checks were offered and patients aged 75 and over. These were conducted by the healthcare assistant and nurse led clinics.
• The practice provided services to two residential/nursing homes.
• The practice participated in high priority programme and identified and supported patients to reduce their admission rates into hospital.
• Patients over 75 were encouraged to have the flu vaccination and the uptake was monitored.

Updated 26 September 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• Appointments could be booked in person, by telephone or via the practice website six weeks in advance.
• Extended hour appointments on Tuesday evenings were offered for patients that required them.
• The practice provided travel advice and vaccinations through the appointments system.
• The practice was a yellow fever vaccination centre. This service was provided to the practice patients and non-registered patients could be referred from other practices.
• Patients were offered a choice of services, locations and dates when accessing specialist health services.
• The practice offered a full range of health promotion and screening that reflected the needs for this age group.

Updated 26 September 2017

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

• The practice maintains a register of patients who experienced poor mental health. The register supported clinical staff to offer patients annual health checks and medication reviews.
• Patients were referred to appropriate support services such as psychiatry and counselling services which were available at the practice every Tuesday.
• The practice worked with adult and children mental and emotional health provision to deliver continuity of care.
• The practice conducted additional safeguarding checks on vulnerable patients to ensure they were accessing sufficient support at the weekends and over bank holiday periods.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

Updated 26 September 2017

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

• All staff had received safeguarding training and were aware of their responsibilities towards safeguarding concerns.
• 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 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. This was supported by all staff having completed the appropriate Mental Capacity Act 2005 training in relation to the capacity of a patient to consent to care and treatment.