Dr Wright & Partners Also known as Fern House Surgery

Updated 12 November 2015

Dr Teverson & Partners (Fern House Surgery) is located on the High Street in Witham, Essex. The practice provides services for 17000 patients living within the Mid Essex area. The practice holds a General Medical Services (GMS) contract and provides GP services commissioned by NHS England and Mid Essex Clinical Commissioning Group. A GMS contract is one between GPs and NHS England and the practice where elements of the contract such as opening times are standard.

The practice has two branch surgeries located in Wickham Bishops and Terling in Essex. Patients living in Wickham Bishops could access services at The Kelvedon Road surgery on Monday and Tuesday mornings and patients living in Terling could access appointments from Owls Hill Surgery on Tuesday mornings. We did not visit the branch sites as part of this inspection.

The practice population similar to the national average for younger people and children under four years, and for those of working age and those recently retired, and slightly higher for older people aged over 75 years. Economic deprivation levels affecting children, older people and unemployment are lower than the practice average across England. Life expectancy for men and women are similar to the national averages. The practice patient list has a similar to the national average for long standing health conditions and lower disability allowance claimants. The practice population of patients living in care homes at 0.4% which is similar to national figures.

Dr Teverson and partners is a dispensing practice (dispensing practices offer enhanced services to dispense medicines to patients who may experience difficulties in obtaining these form a local pharmacy).

The practice is managed by eight GP partners who hold financial and managerial responsibility for the practice. There are four female and four male GPs employed. The practice also employs three practice nurses, three health care assistants, a dispensary manager, three dispensers and two dispensary clerks and a phlebotomist. A practice manager is also employed and is supported by 11 receptionists, five administrators and two secretaries.

The practice is open between 8am and 6.30pm on weekdays. GP and nurse appointments are available between 8.30am and 12pm, and 1pm to 6.30pm. Emergency appointments are available throughout the day.

The practice has opted out of providing GP out of hours services. Unscheduled out-of-hours care is provided by the NHS 111 service and patients who contact the surgery outside of opening hours are provided with information on how to contact the service. This information is also available on the practice website.

Updated 12 November 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Teverson & Partners on 12 August 2015. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed. Learning from when things went wrong was widely shared with staff through meetings and discussions. People affected by safety incidents were offered an explanation and an apology.
• Risks to patients were assessed and well managed. There were systems for assessing risks including risks associated with medicines, promises, equipment and infection control.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Clinical audits and reviews were carried out to make improvements to patient care and treatment.
• Staff had received training appropriate to their roles. Staff performance was appraised and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Complaints were investigated and responded to appropriately and apologies given to patients when things went wrong or their experienced poor care or services.
• Patients said they found it easy to make an appointment with a named GP and that 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.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should:

• Review the procedures for checking and auditing medicines to include those in the dispensary and include any dispensary related errors, incidents or near misses as part of the practice significant events analysis procedures.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 November 2015

The practice is rated as good for the care of people with long-term conditions. GPs and nursing staff had lead roles in chronic disease management and provided a range of clinics including asthma, diabetes and chronic obstructive pulmonary disease (COPD). The practice performance for the management of these long term conditions was similar to or higher than other GP practices nationally. The practice had specialist diagnostic equipment including 24 hour ECG (electrocardiogram) machines and R equipment, a machine to help early diagnosis of heart disease and other cardiac related conditions.

Patients at risk of unplanned hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 12 November 2015

The practice is rated as good for the care of families, children and young people. The practice had increased the number of same day appointments to improve access to patients. Appointments were available outside of school hours. In-house midwifery services, post-natal and baby checks were available to monitor the development of babies and the health of new mothers.

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 similar to other GP practices for all standard childhood immunisations. 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.

Information and a range of sexual health and family planning clinics were available.

Updated 12 November 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people who accounted for approximately 17% of its patient population. The practice offered a range of enhanced services, for example, in dementia and end of life care. The practice had made improvements in its diagnosis of dementia within the previous 12 months and had the highest diagnosis rate locally. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. Medicines dispensing was provided where needed and medicines could be delivered to patients in their homes where this was appropriate.

The practice had two branch surgeries helping patients to access GP services close to home. GPs worked with local multidisciplinary teams to reduce the number of unplanned hospital admissions for at risk patients including those with dementia and those receiving end of life palliative care.

Updated 12 November 2015

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 had increased the number of nurse appointments to improve access to patients for routine health checks and the treatment of minor illnesses.

The practice was proactive in offering online services including on-line appointment booking and electronic prescribing (where patients can arrange for their repeat prescriptions to be collected at a pharmacy of their choice).

The practice offered a full range of health promotion and screening that reflects the needs for this age group including well man and well woman checks.

Updated 12 November 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice had made improvements in their diagnosis of patients with dementia and their diagnosis rates were the highest within the local CCG area, having previously performed just below CCG and national diagnosis rates.

The practice provided in house Improving Access to Psychological Services (IAPT) for patients with mental health needs.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with autism, mental health needs and dementia.

Updated 12 November 2015

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 a terminal illness and those with a learning disability. The practice proactively promoted annual health checks for patients with learning disabilities and carried out home visits for these reviews as needed.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. This helped to ensure that patients whose circumstances made them vulnerable were supported holistically and that patients who were at a higher risk of unplanned hospital admissions were supported to and treated in their home.

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.