Knights Surgery

Updated 26 August 2016

Knights Surgery is a small practice, providing medical services to 1490 patients. It is located in a residential area of Basildon with a large commuter population. The practice is owned and managed by a GP partnership. Both GPs are male. They are supported by two female nurse practitioners jointly providing 16.5 hours of clinical time a week, an administrative team overseen by a practice manager (amounting to 1.75wte) and a cleaner.

The practice holds a general medical services contract with NHS England.

The practice was open and appointments were available between 8.30am and 6pm Monday to Friday (exception being Thursdays when the surgery closes at 12.30). During these periods patients can attend the GP hub service. Extended hours surgeries were offered all weekdays as well as weekends through the GP locality based hub appointments introduced in October 2015. Appointments could be booked up to four weeks in advance, urgent appointments were also available for people that needed them and daily telephone consultations. Patients could book and cancel appointments on line and consult a GP on line. Patients could receive text messages regarding blood and radiology results and the electronic prescription service enabled patients to collect their prescriptions at a nominated pharmacy.

The practice has opted out of providing their own out of hours provision. The out of hours provision is commissioned by Basildon and Brentwood CCG. Patients are advised to call NHS 111 service and are then signposted to relevant clinical services provided by South Essex Emergency Doctors Service until the end of November 2015 when the services will be transferred to IC24.

The practice has a comprehensive website advising patients of services and relevant support groups.

Updated 26 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Knights Surgery on 18 November 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.
• Risks to patients were assessed and managed with the exception of training for non clinical staff in infection prevention control and emergency life support.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles 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 staff were receptive to feedback and committed to resolving issues.
• 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.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff, patients and their patient participation group, which it acted on.

We saw one area of outstanding practice:

• The practice identified behavioural trends in patients suffering with poor mental health during periods of anxiety such as presenting at multiple accident and emergency departments during the same day. The practice were proactive at addressing this with the patient and in partnership with other health and social care services. They developed personalised care plans to assist the patients to manage their anxiety. For some they offered daily appointments at a time convenient for the patient and priority access to a GP over the phone. Thereby providing an accessible and caring response to a patients individual needs. This reduced their patients dependency on other health services and their attendance at accident and emergency departments. Once reassured by the accessibility of medical services the patients gradually reduced their need to attend daily appointments.

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

• Implement fire safety procedures in the absence of a mains connected fire alarm system.
• Ensure emergency medicines are securely stored.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 August 2016

The practice is rated as good for the care of people with long-term conditions. Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Patients identified on the admission avoidance register were managed through multi-disciplinary meetings and offered on the day appointments and telephone consultations. Longer appointments and home visits were available when needed. House bound patients were regularly reviewed and offered vaccinations at home, where appropriate. All patients had a named GP and a structured annual review to check that their health and medication needs were being met.

Updated 26 August 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. Family members were linked within the patient record systems and children at risk, in need or looked after were identified.

Immunisation rates were high for all standard childhood immunisations and the practice operated a recall system to identify children failing to attend appointments or requiring 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. Appointments were available outside of school hours and children under five years of age were offered same day appointments. The practice provided six week child checks and post natal examinations. Mothers could access contraception and sexual health services.

Updated 26 August 2016

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. Patients over 75 years of age had been informed of their named GP and were offered senior health checks. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits, daily telephone consultations and rapid access appointments for those with enhanced needs.

Updated 26 August 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 including students, had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. Patients could book appointments up to four weeks in advance and they offered extended hours on all weekdays as well as weekends through GP locality based hub appointments. Patients were sent text messages regarding blood and radiology results and the out of hours service was clearly advertised within the practice. A electronic prescription service operated for patients collecting their prescriptions at a nominated pharmacy.

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. For example, NHS health checks for people 40 to 74years of age, smoking cessation and healthy lifestyle choices and weight loss referrals.

Updated 26 August 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). People experiencing poor mental health were identified on the patient record system and assessed using recognised frameworks such as the dementia assessment tool and depression questionnaire. The practice prepared individual care plans for patients ensuring they were responsive to their needs, for example, providing patients with daily scheduled appointments where necessary. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

Staff were aware of how to access information and specialist support services such as those providing counselling, drug and alcohol advisory services, dementia crisis support, dementia carer support and mental health crisis lines.

Updated 26 August 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice maintained a register of patients living in vulnerable circumstances including those with a learning disability. Clinical staff were trained in learning disability awareness and undertook learning disability health checks working in partnership with the locality based learning disability nurse. Patients with a learning disability were recalled for annual health checks and were offered longer appointments.

The practice had told vulnerable patients about how to access various support groups and voluntary organisations. Patients were offered self referral or GP referral to the Therapy for You counselling response and access the Macmillan Occupational Therapy Referral Service. The practice held regular multi-disciplinary meetings including representatives from the community mental health teams, social services, community nursing and the local area coordinator service.

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.