Background to this inspection
Updated
17 August 2017
NHS Yeovil Health Centre is located in the centre of Yeovil. The practice has recently been taken over by Symphony Healthcare Services Ltd (SHS) which is one of the NHS England Vanguard schemes, known as South Somerset Symphony programme. The practice also participates in the Somerset Practice Quality Scheme (SPQS) (along with most other Somerset practices that have opted out of the QOF); and the South Somerset Healthcare Federation (SSHF). The SPQS allows GP practices to innovate new ways of integrated working with other providers and pilot new ways of working together across practice groups, whilst continuing to provide assurance of clinical quality.
The practice serves some 5,500 patients, including significant numbers of patients who do not have English as a first language; and significant numbers of patients who present with issues relating to misuse of drugs or alcohol; or who face other social challenges. The practice occupies premises above a retail pharmacy and there is no dedicated parking on site.
The address from which regulated activities are provided is:
NHS Yeovil Health Centre
37 Middle Street
Yeovil
Somerset
BA20 1LS
Patient Age Distribution (2015 data):
0 - 4 years old: 9.2% (higher than the national average of 5.9%).
5 - 14 years old: 9.7% (lower than the national average of 11.1%).
15-19 years old: similar to the national average.
20-39 years old significantly higher than the national average.
40-64 years old: lower than the national average.
Over 65 years old: 4.6% (significantly lower than the national average of 17.1%).
Over 75 years old: 1.8% (significantly lower than the national average of 7.8%).
Over 85 years old 0.5% (significantly lower than the national average of 2.3%).
The practiced has 45% (2014/15 data) of patients with a long standing health condition, which is lower than the Clinical Commissioning Group(CCG) average of 57% and national average of 54%.
Other Population Demographics
The percentage of patients in paid work or full time education:
67% (higher than the national average of 62%).
Index of Multiple Deprivation 2015 (IMD):
27 (higher than the national average of 21.8).
Income Deprivation Affecting Children (IDACI):
21.5% (higher than the national average of 19.9%).
Income Deprivation Affecting Older People (IDAOPI):
16.8% (similar to the national average 16.2%).
Average male and female life expectancy for the area is 78 and 82 years respectively, which are both one year less than the national averages and two years less than the Clinical Commissioning Group averages.
The practice has five salaried GPs, none of whom are partners (all employed by SHS); and are equivalent to 3.5 whole time employees. Between them they provide 108 hours of GP appointments each week. Four GPs are female and one is male. There are 14 practice nurses, whose working hours are equivalent to 5.75 whole time employees (WTE); including eight non-medical prescribers who offer the equivalent of 3.85 WTE per week. Nine Care Co-ordinators & Phlebotomists are also employed by the practice with combined hours of 3.1 WTE. The GPs and nurses are supported by over 20 management and administrative staff including a practice manager and assistant manager.
The practice is open seven days a week between 8am and 8pm, including Christmas Day and all other Bank Holidays. Appointments are available from 8am until 8pm. The practice operates a mixed appointments system with some appointments available to pre-book and others available to book on the day. The practice offers online booking facilities for non-urgent appointments and an online repeat prescription service. Patients need to contact the practice first to arrange for access to these services.
The practice has a Walk in Centre contract with the Clinical Commissioning Group; along with an Alternative Provider Medical Services (APMS) contract with NHS England to deliver health care services. The contract includes enhanced services such as childhood vaccination and immunisation scheme, facilitating timely diagnosis and support for patients with dementia and minor surgery services. Influenza and pneumococcal immunisations enhanced services are also provided. These contracts act as the basis for arrangements between the NHS Commissioning Board and providers of general medical services in England.
The practice provides out-of-hours services to their own patients who are offered bookable appointments with GPs outside of normal practice hours.
Updated
17 August 2017
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at NHS Yeovil Health Centre on 18 January 2017. The overall rating for the practice was good; however, the practice was rated as requires improvement for the provision of safe services. The full comprehensive report on the January 2017 inspection can be found by selecting the ‘all reports’ link for NHS Yeovil Health Centre on our website at www.cqc.org.uk .
This inspection was an announced focused inspection carried out on 8 August 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to breaches in regulations that we identified in our previous inspection in January 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.
Overall the practice is rated as good, including for providing safe services.
Our key findings were as follows:
- There was a safe system in place for medicines management, in particular the security of blank prescription stationery.
- We saw evidence of improvements in the arrangements for breast and bowel cancer screening resulting in increased percentages of eligible patients being screened.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
People with long term conditions
Updated
12 April 2017
The practice is rated as good for the care of people with long-term conditions.
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Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
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Performance for diabetes related indicators was comparable to or higher than Clinical Commissioning Group (CCG) and national averages. For example, 96% of patients with diabetes had a foot examination in the last 12 months, compared with the CCG average of 81% and the national average of 89%.
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The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
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There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
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All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
Families, children and young people
Updated
12 April 2017
The practice is rated as good for the care of families, children and young people.
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From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.
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Immunisation rates were relatively high for all standard childhood immunisations.
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Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
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The practice provided support for premature babies and their families following discharge from hospital. A care co-ordinator ensured support was offered and this could be provided through a team of health coaches.
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Appointments were available outside of school hours and the premises were suitable for children and babies.
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The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
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The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.
Updated
12 April 2017
The practice is rated as good for the care of older people.
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Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
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The practice offered proactive, personalised care to meet the needs of the older patients in its population.
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The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
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The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
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The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
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Where older patients had complex needs, the practice shared summary care records with local care services. For example, we saw that information could be shared between the practice and the local hospital.
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Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. For example a team of health coaches provided advice and support on health and social care issues.
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We saw evidence of the development of single, computer based, goal centred care plans for patients that could be shared with other health and social care providers.
Working age people (including those recently retired and students)
Updated
12 April 2017
The practice is rated as good for the care of working age people (including those recently retired and students).
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The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours and Saturday appointments.
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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.
People experiencing poor mental health (including people with dementia)
Updated
12 April 2017
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).
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The practice carried out advance care planning for patients living with dementia.
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71% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is better than clinical commissioning group (CCG) average of 47% and comparable to the national average of 84%.
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The practice specifically considered the physical health needs of patients with poor mental health and dementia.
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The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs. For example, the practice monitored prescribing through weekly support form a CCG pharmacist, a prescription clerk; and the use of the Eclipse Live computer system.
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Performance for mental health related indicators was similar to the CCG and national average. For example, 93% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had an agreed, comprehensive care plan documented in their record in the last 12 months, compared with the CCG average of 53% and the national average of 89%.
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The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
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Patients at risk of dementia were identified and offered an assessment.
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The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
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The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
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Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.
People whose circumstances may make them vulnerable
Updated
12 April 2017
The practice is rated as good for the care of people whose circumstances may make them vulnerable.
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The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
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End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
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The practice offered longer appointments for patients with a learning disability.
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The practice regularly worked with other health care professionals in the case management of vulnerable patients.
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The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
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Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.