Archived: Trent Valley Surgery

Updated 12 January 2017

Trent Valley Surgery provides primary medical services to approximately 4,300 patients from two sites, the primary site being at 85 Sykes Lane, Saxilby and a branch site at Main Street, Torksey. Both locations were visited during the course of our inspection. Both locations have a dispensary which dispense to approximately 60% of eligible patients.

The practice serves a rural community and the Sykes Lane location shares the premises with another practice, The Glebe Practice.

The service is provided by a male lead GP and two salaried GPs, one male and one female, who between them provide a total of 19 sessions per week. There was also a nurse practitioner, a practice nurse and a healthcare assistant, a dispensary manager and a dispensary team. They were supported by a practice manager, an assistant practice manager, reception and administrative staff.

The practice has a high percentage of older patients, notably aged between 65 and 75 and a lower percentage of patients under the age of 18 when compared nationally. The practice is located in an area of low deprivation. The practice has a high percentage of patients with long term health conditions and with caring responsibilities when compared nationally.

The practice holds a General Medical Services (GMS) contract for the delivery of general medical services.

The service is commissioned by Lincolnshire West Clinical Commissioning Group.

The Sykes Lane surgery is open between 8am and 6.30pm Monday to Friday and the Torksey surgery from 10.30am to 2.30pm. GP consultations are available from 8.30 am to 6pm. Appointments with nurses and phlebotomists were available from 8.10am.

The practice has opted out of the requirement to provide GP consultations when the surgery is closed. Out- of- Hours services are provided through Lincolnshire Out-of-Hours Service which is provided by Lincolnshire Community Health Services NHS Trust. Patients access the service via NHS 111.

Updated 12 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Trent Valley Surgery on 6 December 2016. Overall the practice is rated as good. The purpose of this inspection was to ensure that sufficient improvement had been made following the practice being placed in to special measures as a result of the findings at our inspection in June 2015. At a further inspection in March 2016, some improvements were found, following which the practice was rated as requires improvement overall but remained in special measures.

Following the most recent inspection we found that overall the practice was now rated as good and significant improvements had been made and specifically, the ratings for providing a safe service had improved from inadequate to good. The rating for providing a caring service had improved from good to outstanding.

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

• The practice had made further significant improvements since our last inspection and the new staffing structure was working effectively.

• The most recent results from the national GP patient survey published in July 2016 ranked the practice seventh in England.

• Feedback we received from patients reflected positively about the staff and said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• We found many positive examples to demonstrate how patient’s choices and preferences were valued and acted on.

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. The new system which had been introduced at our previous inspection was now embedded and we saw that learning was disseminated and identified actions were implemented.
• The practice had a number of policies and procedures to govern activity, all of which had been reviewed.
• The practice had sought feedback from patients and the recently formed patient participation group was developing.

• Risks to patients were assessed and well managed (with the exception of legionella).

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Information about services and how to complain was available and easy to understand.
• Patients expressed high satisfaction with the appointment system and 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.
• The leadership structure had strengthened further and staff felt supported by management.
• The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider should make improvements are:

• To ensure that daily resets of vaccination fridges are recorded.

• To review arrangements for mitigating the risk of legionella.

• To formalise supervision arrangements relating to the nurse prescriber.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 January 2017

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

• Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance for atrial fibrillation and chronic obstructive pulmonary disease indicators was better than the CCG and national average with the practice achieving 100 % of points in these areas. However performance for diabetes related indicators was lower than the CCG and national average with the practice achieving 86% of points in this area.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and 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.

Updated 12 January 2017

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. Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way.

• The practice’s uptake for the cervical screening programme in 2015-2016 was 82%. This was an improvement on the previous year and above the national average.

• Appointments were available outside of school hours.

Updated 12 January 2017

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were in line with or above local or national averages.

• The practice had a high percentage of older patients, notably aged between 65 and 75. The practice had looked at the needs of this patient group to look at further options to improve services for them.

Updated 12 January 2017

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. They had trialled extended opening hours but the uptake had been limited.

• 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.

Updated 12 January 2017

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

• Members of staff had undertaken ‘Dementia Friends’ training to enable them to better understand and support patients with dementia.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

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

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

Updated 12 January 2017

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 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. 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.