New Road Surgery
Dedicated to providing excellent patient-centred care in the local community
Business Development Plan 2022
Purpose of the Business Development Plan
The purpose of this plan is to set out clear objectives about our business strategy and to
describe something about the practice and the changes we think are important to introduce
over the next year.
We have used feedback obtained from the GP patient survey, NHS Choices, complaints and
our Patient Participation Group to help identify areas for improvement. We have also taken
into consideration NHS England’s “General Practice Forward View” contract from 2019-2024
and the May 2022 Next Steps for Integrating Primary Care: Fuller-Stocktake Report as well
as the At-Your-Service Policy Exchange document A proposal to reform general practice and
enable digital healthcare at scale by Dr Sean Phillips, Robert Ede & Dr David Landau with
Foreword by Rt Hon Sajid Javid MP
We hope that our practice team, patients and other stakeholders will feel they understand
our direction and that as a business we continue to meet the challenges of providing
excellent primary care in a changing world.
We will also share this plan with the practice’s Patient Participation Group (PPG).
About New Road Surgery
New Road Surgery is a family doctors' practice led by four doctors in partnership serving
patients in Croxley Green, Sarratt and the surrounding area, from the main premises in
Croxley Green and a branch surgery in Sarratt.
This is also an accredited practice for training qualified doctors to become GPs.
We have around 10,500 patients, registered with a named GP but patients can see any GP in
the practice.
We pride ourselves on providing high quality care in a small traditional family GP practice.
We liaise well with our Grand Union PCN practices, other local practices, hospitals,
community services and the local ICS.
Our Statement of Purpose
Our aim is to provide patients with medical care of the highest quality and seek continuous
improvements in the health status of the practice population overall. We aim to achieve this
by developing and maintaining a practice which is responsive to people's needs and
expectations, reflects whenever possible the latest advances in primary health care and uses
NHS resources efficiently and effectively.
Our Mission Statement
As our mission statement says, we are Dedicated to providing excellent patient-centred
care in the local community
The New Road Surgery Practice Team
The practice team includes four GP partners, GPs, one or more GP registrars, practice
nurses, health care assistants, a dispenser, two pharmacists and a first contact
physiotherapist together with the receptionists and admin team led by our practice
manager. Within the Grand Union PCN we also have access to primary care mental health
professionals and social prescribers who can support patients with additional needs.
We are very proud of our team. We are dedicated and committed to providing a first-class
service to our patients. We aim to treat patients as we would wish to be treated ourselves.
The team often go above and beyond their usual duties to ensure we provide the highest
standard of care to our patients.
We have a low staff turnover and believe this is due to how we look after our team and our
approach to flexible working. Almost all of the team work part-time and this reduces the
stress and pressures that working in the NHS can bring. We encourage our staff to access
wellbeing support services as well as maintaining a positive, happy atmosphere in the
surgery.
Sometimes staff also choose to work in other GP practices or in wider healthcare roles
which we are comfortable with, as this can be of benefit to the practice by bringing in new
ideas and ways of working.
All staff are regularly reviewed and have an annual appraisal when the goals of the
individual, teams and practice are discussed and an agreement is reached on the way
forward. Regular reviews act as a way of reinforcing effective performance, highlight areas
for improvement and recognise developing strengths.
Training is the key to improving staff performance. Regular training sessions are to be
organised and attended by all relevant staff to ensure all clinical and administrative areas
function effectively. All staff have mandatory and statutory training plans to follow, but we
also encourage further development.
Skill Mix – Clinical and Administrative
We constantly review our skill mix in line with current activity and services offered by the
practice, both clinically and administratively.
GP Training
The practice is an approved as a Training Practice for doctors. Dr Claire Chesworth and Dr
Kunal Patel are accredited Tier 3 GP trainers supported by and Dr Ansuya Puri as an
accredited Tier 2 GP trainer.
The practice can offer training to up to 2 full-time registrars concurrently. Further GP
training is restricted by premises.
The practice aims to provide a high-quality training environment for doctors, nurses and
health professionals. The practice embraces multi-professional working in line with the
governments NHS General Practice Forward View.
Premises
The practice has completed scheduled premises checks including the 5-year electrical test in
June 2022 with PAT testing scheduled for July 22.
The practice provides services from two sites at New Road in Croxley Green and Church
Lane in Sarratt. There is good disabled access at the main surgery in Croxley Green. Space is
limited at Sarratt and patients requiring disabled access are asked to attend the main
surgery.
We recognise that the current premises are in need of upgrading and more space is needed.
This is especially important for us as a training practice because we would like to expand our
GP training programme. Our clinical rooms are also used by our new additional roles
clinicians including our pharmacists and our first contact physio.
The room usage at New Road is totally full and Sarratt is full during its current opening
hours. We continue to try to find innovative solutions to the issue of restricted clinical
rooms and administrative space including refurbishing our upstairs common room and the
moving secretaries office in order to allow for more hot desking.
New Premises
We have already met with the Herts Valleys Clinical Commissioning Group and NHS Property
Services as well as local councillors and property developers to discuss our need for
improved premises. We are constantly exploring a number of options including expanding
current premises or moving to new local surgery premises
Any premises expansion would be an ideal time to revisit all the services we currently
provide and would give us the opportunity to model and integrate services and resources in
order to increase our capacity to provide timely care and treatment in the most appropriate
setting for our patient population.
Expansion would enable the practice to continue to:
• Strengthen Primary Care keeping General Practice at the heart of the local community
and health and social care.
• Deliver high quality and accessible services (e.g. more consulting rooms, larger waiting
room)
• Ensure we can continue to provide (and hopefully expand) a wide range of services and
keep patient care close to home
• Provide additional and/or different types of appointments which would allow clinicians
more time to see patients with often complex needs, leading to fewer referrals and
admissions to secondary care
• Deliver integration of services with the wider care team (more space for professionals
allied to medicine e.g. Midwife, Mental Health Workers or Social Prescribers)
• Encourage staff in continuing to increase their skill-mix to provide services which meet
local health needs
• Support the retention and recruitment of staff including additional roles clinicians
• Support good working relationships between the practice and the Grand Union PCN
(additional consultation rooms could allow further scope for PCN services to be provided
within the practice).
• Foster good working relationships between primary and secondary care (additional
consultation rooms could allow further scope for secondary care services to be provided
within the practice).
Information Technology
Our IT has been accelerated due to COVID-19. We now have the facility to work off site, we
can directly text patients, request pictures or provide video consultations. Patients can also
complete Online Consultations as well as booking their appointments and requesting their
repeat medications online.
It is worth noting that these technology advances were in the GP contract to be achieved by
2024, (https://www.england.nhs.uk/gp/investment/gp-contract/digital-requirements-
guidance/) so had always been the direction of travel of NHS England.
COVID-19 vaccinations accelerated the use of the NHS app which allows patients to register
themselves to book appointments or request repeat prescriptions. They can also request
online access to their medical records (read coded entries) and test results via either the
NHS app or Patient Access (or other apps), From November 2022 the NHS has committed to
give all patients full online access to prospective data, subject to existing safeguards for
vulnerable groups and third party and system functionality.
In January 2022 our IT support was taken over by ITS Digital. They are upgrading our IT
infrastructure including replacing our server in July 22.
A number of our systems are now cloud based allowing for more security with off site
management and backup but leaves us dependent on our cloud connection.
Patient Wifi is in place in the practice but is currently being upgraded by ITS Digital.
We have implemented iGPR (medical reports online) to reduce secretarial workload and
ensure safe, secure transmission of medical notes / copy notes to insurance companies and
solicitors
In July 2022, we are changing our website provider to work better on newer technology e.g.
smart phones and this is an opportunity to review and update the content as well as the
look and feel of the website. A workstream (Primary Care Website Review) has been
established to consider how GP practice websites can enhance a ‘digital front door’ to
provide services, where patients can access advice, check symptoms and make
appointments.
In October 2022 we are scheduled for the ICS project to enable the Digitalisation of paper
records. This could alleviate some paper notes storage issues in the current premises.
Patient services
Since March 2020 Primary Care services have been disrupted by the COVID-19 pandemic.
During this time we continued to provide services whilst working within the Guidance and
standard operating procedures for General practice in the context of coronavirus (COVID-
19) and the NHS England mandated Infection Prevention and Control Guidance. Despite the
challenges involved in this we are proud to say that we only had one hour when our surgery
was closed due to overnight deep cleaning continuing into the morning opening hours. We
continued to see patients face to face all the way through the pandemic, if this had been
clinically assessed as required. We implemented a closed door tanoy system in order to
ensure effective COVID screening and we moved our appointment booking to telephone but
at no point was the practice closed.
In the NHS Digital 2021 survey of New Road Surgery came top of the practices in
Hertfordshire for the measure 98% of respondents describe their overall experience of this
GP practice as good.
Patient feedback has highlighted the difficulty patients are experiencing in trying to book an
appointment with a GP. The practice provides on the day and pre-bookable appointments
which are available 2 weeks in advance, a percentage of these are also available to book
online. The practice has acknowledged the difficulty patients are having and are working to
develop ways of managing the high demand.
The practice continues to always see patients who contact us with an urgent medical issue
on the same day. The number of these extras at the end of GP sessions can become too
many and constitute a potential clinical risk.
Our pharmacist is trained in managing minor illness and now has an afternoon clinic to help
meet acute demand and alleviate this pressure.
NHS England have provided the Community Pharmacist Consultation Service (CPCS) referral
service and we have just started to offer referrals where appropriate t New Road Pharmacy.
The practice participates in the Quality and Outcomes Framework (QOF). QOF is the annual
reward and incentive programme detailing GP practice achievement results. It is a system
intended to improve the quality of general practice, reward practices for the provision of
quality care and helps standardise improvement in the delivery of primary medical services.
It is a voluntary process for all surgeries in England and was introduced as part of the GP
contract in 2004. The indicators for the QOF change annually. QOF awards practices
achievement points for:
• managing some of the most common chronic diseases, e.g. asthma, diabetes
• managing major public health concerns, e.g. smoking, obesity
• implementing preventative measures, e.g. regular blood pressure checks
We are also working with the local CCG on data sharing with local hospitals (Your Care
Data). We strongly believe that data sharing of patient information with other clinical
professions is vitally important and improves patient care. However, we also acknowledge
patients’ concerns about data sharing; we will work with our patients to address these
concerns and ensure compliance with National Data Opt Out 31
st
July 2022.
During COVID-19 we received feedback about the difficulty in getting through to reception
on the phone. This has been due to increased patient demand and increased phone usage.
We have taken this feedback on board and recruited new members of staff to help cover
reception during busy periods. We have also implemented Online Consultations so that
patients can complete a form to contact the practice rather than trying to get through on
the phone. An increased number of patients are also using the NHS app for appointments
booking.
However, we do think that having a single phone-based appointments system is the only
way to enable a fair patient queuing system rather than reverting to the pre COVID
arrangement where we accepted patients making appointments in person. We feel this
unfairly prioritises those who are able to attend the practice in person and unfairly
disadvantages those who are too sick, frail, disabled or unable to attend in person for other
reasons. We are aware that some patients do not like this solution, but we need to maintain
fair access to our appointments especially at a time when appointment demand is still very
high. We are aware that there still needs to be further improvement, and this is something
we will continue to work towards.
The practice has the facility to use iPlato to text patients a reminder for their appointment
and also provide them with the opportunity to cancel their appointment by text in a bid to
help reduce wasted appointments. We also use AccuRX texting facility extensively to contact
patients and notify them of updates and further information. Patient take up has been
extensive and facilitates communication as well as freeing up telephone calls.
We are pleased to note that our Did Not Attend (DNA) rate is comparatively low and our
patients are pleased that since the lifting of the COVID-19 Infection Prevention Control (IPC)
restrictions we are now able to offer more appointments face to face.
Communication
The GP partners and practice manager meet informally every week, we then have a formal
monthly partnership meeting with a pre-prepared agenda.
We hold regular practice meetings for doctors and additional roles clinicians. There are
standing items on the agenda such as health and safety, IPC, safeguarding, prescribing,
targets and training.
We hold weekly nurse meetings and regular meetings with the whole reception team.
We also hold monthly palliative care multidisciplinary meetings and are starting quarterly
PPG meetings.
We believe our communication is reasonable but there is still plenty of room for
improvement. We want to explore different ways of communication with our staff as well
as reviewing the effectiveness of current communications. This Business Development Plan
is one strategy to improve communication.
Patient Participation Group (PPG)
We have relaunched our PPG and we are setting up a steering group to meet on a quarterly
basis. The first meeting PPG Steering Group meeting will be in July 2022 and will include the
appointment of a PPG chair and secretary. The Steering Group will also formerly adopt the
PPG Terms of Reference and create the PPG Development Plan. We are hoping that they will
include
• Encourage, collate and feedback patient concerns
• Positively promote the practice to patients
• Produce minutes of PPG Steering Group meetings
• Publish PPG information on the PPG section of the new practice website
• Produce a quarterly newsletter
• Produce & circulate annual patient survey
• Attend and provide input at PCN PPG meetings
• Attend flu and COVID vaccination clinics to promote patient care
• Assist patients with the NHS app online access to medical records from November
2022
The virtual PPG group have been contacted to check whether they wish to remain actively
involved in the virtual PPG. After processing Unsubscribe notifications, this group still has
over 700 active members.
We are aware of the need for the PPG to adequately reflect the makeup of the practice
population and do our best to encourage a variety of patients to join (thinking of age,
gender, ethnic origins and patient experience). The PPG relaunch has been promoted via
our website, social media and My Croxley News as well as waiting room posters – in order to
reach patients as possible. We hope the PPG will help us to reach an even wider audience in
promoting the practice, our services and the PPG.
Patient Screening Services
The practice has continued its screening services, but are concerned that the failure of the
North London Breast Screening Service to park in the Croxley Parish Council car park, may
have meant that less patients attended North Watford Asda for 2022 screening than
previously in when the screening bus service was has been based in Croxley.
New Road Surgery continues to encourage cervical screening uptake with an ongoing action
plan that includes telephoning non-responders to recall letters, setting up successful out of
hours smear clinics including Friday nights and weekends and making smear appointments
bookable online.
We continue to offer immunisation services including child immunisations, Flu and COVID
immunisations as well as offering travel services.
We are proactive in caring for our most vulnerable patients, including offering Learning
Disability reviews, in which we encourage patients to attend screening services.
Financial sustainability
The GMS contract offers us a total contract sum in order to provide appropriate care and
services to the patients registered with us. In addition we provide additional paid services
and targets work and a small amount of non NHS work in the preparation of some forms
and reports.
We need to ensure that our income continues to cover the costs of our staffing, premises,
equipment, information technology and other areas. This continues to challenge us,
especially as funding gets tighter each year. The practice recognises the need for robust
cash flow and financial planning to ensure we survive and continue to grow in the current
climate.
Management
Our practice manager has been with us since 2010 taking on the manager role in July 2019
and our management style is best defined as caring and supportive. We try to instil a stress-
free and lively environment, which encourages employees to remain focused and project a
positive attitude to the patients. A relaxed and friendly culture exists among the whole
team. We have an open door policy and encourage staff to speak to either the practice
manager or any of the partners about anything they need to.
We keep all our activities under review and are always looking for new ways to “work
smarter” and to improve the quality of our services and care of our patients.
Primary Care Network
New Road Surgery continues to be part of the Grand Union Primary Care Network. Dr Kunal
Patel and Cath Garibaldi represent New Road Surgery at monthly PCN Executive meetings
and feedback to New Road Surgery at the monthly partners meetings.
In April 2022, Dr Kevin Barrett stepped down as the PCN director and returned to working
an additional day at the practice. Dr Alex Careful from Bridgewater Surgeries has taken on
this role and the PCN continues to deliver its programme of work including providing COVID
vaccinations to over 40,000 patients in the Croxley and Watford areas.
Herts Valleys Clinical Commissioning (HVCCG) to Herts and West Essex Integrated Care
Board (ICB)
From 1st July 2022 Herts Valleys Clinical Commissioning Group has joined with East and
North Herts and West Essex CCGs to become the Hertfordshire and West Essex ICB. For
further details see https://hertsandwestessexics.org.uk/
Summary
This business development plan gives all our staff and others interested in our progress (the
patients, our staff, business partners and financial advisers) a picture of what we are doing
and some of the changes we intend to make over the coming months.
The plan will be reviewed regularly in order to keep up with ongoing changes in primary
care and the practice. We welcome any comments and suggestions
Summary of Goals and Objectives 2022
Area of work
to be
examined
Reasons
Tasks to be
Undertaken
Interim Measurement/
Actions
Timescales
Completion
Date
Patient
service
Due to COVID and increase in
demand patient service has
been compromised. Patients
and staff are not happy
Full staff meeting
Relaunch PPG
PPG feedback
F&F feedback
PM meets with RM
weekly
PM reports to GP
Partners monthly
Full staff meeting
29
th
September 2022
Ongoing
Relaunch
PPG
Critical friend patient feedback
PPG meeting
Review PPG contact
list
PPG Steering Group
meeting
PPG area on website
1
st
July 2022
11
th
July 2022
End July 2022
March 23
Telephone
service
Patient feedback around
difficulties in getting through on
the phone and communication
Change messaging
Increase online appt
booking (NHS app
use)
Phone management
software training
Monthly review of
phone reports
End July 2022
Sept 22
Appointment
booking
Patient feedback around
difficulties in getting F2F
appointments
Review appt booking
Online Consultation
software review
Continue to offer F2F
appointments on
patient demand am and
pm
7
th
July 2022
Ongoing
Extras
booking
Concerns re GP safe working,
staff wellbeing and patient
service
Extras review
Comms to staff
Change extras appts
Review - PDSA
7
th
July 2022
Aug/Sept 22
Appointment
times
Extend GP appointments to 15
minutes
Prohibitive reduction
in total number of
appointments
Review in future if
demand stabilises/
decreases
7
th
July 2022
Ongoing
Expand GP
Training
Programme
Support NHS GP training
Futureproof both the practice’s
and the wider NHS’s provision
of GP services
Currently restricted by
room space
The practice has 2 GP
trainers and can
currently accommodate
up to 2 full time
registrars.
n/a
As new
premises
space
becomes
available