Walnut Tree Surgery

Updated 26 June 2017

Walnut Tree Surgery, located at 14 Carlton Road, Southampton, SO15 2HQ is a converted dwelling that was converted prior to the practice moving to the location in 2001. The practice is located close to the centre of Southampton.

The practice works under a general medical service contract from the Southampton Clinical Commissioning Group and provides services to about 5,000 patients in the north area of the city. In the last years there has been a substantial increase in patient numbers with an Increase in student population, hostels, Social housing and multi-national patients. The practice also provides GP care to a local nursing home – Northlands House which has 90 residents.

The practice population is a lot higher than the national average for males and females in the 20 years to 30 years. This is due to the high number of patients attending city universities.

Care and treatment is provided by four GP partners, comprising of one male and three female partners providing 15 clinical sessions in practice and two clinical sessions in a local nursing home. The practice has two practice nurses, a practice manger and is supported by four receptionists/administrators.

The practice is open from 8.00am to 6.30pm Mondays to Fridays. The practice offers appointments with GPs or nurses from 9.00am to 11.30am and 4.00pm to 5.30pm Mondays to Fridays. Extended hours appointments are available on Mondays from 7.30am to 8.00am and 6.30pm to 7.00pm. Thursday 7.30am to 8.00am and on one Saturday in the month.

Consultations were by appointment and could be made in person at reception, over the telephone or online. The practice offered advice by telephone. Patients were advised that if the wanted some advice to let the receptionist know and a telephone consultation with either a doctor or a practice nurse as appropriate would be arranged.

Out of Hours urgent medical care was provided via the NHS 111 service when the practice was closed.

Updated 26 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Walnut Tree Surgery on 11 May 2017. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a named GP and 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.
• The provider was aware of the requirements of the duty of candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 June 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• For the period 2015-2016 the practice scored 100% for diabetes care. There was a high exception rate of 16% overall. This figure has been reduced in 2016-2017 to a comparable figure to the clinical commissioning group.
• 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.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• 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.

Updated 26 June 2017

The practice is rated as good for the care of families, children and young people.

• 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.

• 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.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• 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.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 26 June 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• 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.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Where older patients had complex needs, the practice shared summary care records with local care services. For example the practice had quarterly care plan reviews and shared health records with Community Care Teams.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.
• The practice had a dementia GP lead, a frailty GP lead and GPs make regular nursing home visits.

Updated 26 June 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• 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.
• 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.

• The practice offered extended hours on a Monday and Thursdays, for working patients who could not attend during normal opening hours.
• The practice had self-help advice posters and leaflets in the surgery and on their website.

Updated 26 June 2017

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

• The practice carried out advance care planning for patients living with dementia.
• 100% of patients diagnosed with dementia that had their care reviewed in a face to face meeting in the last 12 months, which is higher than the national average.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example there were reminders on patient’s notes for aggression issues and the practice had an awareness of frequent attenders.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs. The practice held daily prescription arrangements for monitoring purposes with regular follow ups.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 26 June 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 homeless people, travellers and those with a learning disability.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• 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.