Gillingham Medical Practice

Updated 29 September 2016

Gillingham Medical Practice is located in the town of Gillingham, Dorset. The practice operates from two sites; The Barn Surgery and Peacemarsh Surgery.

Together both practices have an NHSE general medical services (GMS) contract to provide health services to approximately 12,059 patients (this is divided equally between both practices but patients can visit either site). Both practices are open between 8.30am and 6.30pm Monday to Friday. In addition, pre-bookable appointments can be booked on line and up to six weeks in advance. Telephone appointments are also available with additional slots for GPs to see these patients if required. A plan is in place to introduce extended hours appointments from October 2016.

The practice has opted out of providing out-of-hours services to their own patients and refers them to an out of hours provider via the NHS 111 service. This information is displayed on the outside of the practice, on their website, and in the patient information leaflet.

There is an independent pharmacy attached to the practice. Patients stated they appreciated this facility.

The mix of patient’s gender (male/female) is almost 50% each. 4.3% of the patients are aged over 85 years old which is higher than the national average of 2.2%. There was no data available to us at the time of our inspection regarding ethnicity of patients but the practice stated that the majority of their patients were white British. The deprivation score was recorded as 9, on a scale of 1-10. One being more deprived and 10 being less deprived.

There are a total of nine GPs working at the practice. This equates to just over seven whole time equivalent GPs. Six of the GPs are partners who hold managerial and financial responsibility for running the business. The permanent GPs are also supported by three salaried GPs. There are five female GPs and four male GPs in total. The GPs are supported by a practice manager, three nurse practitioners, six practice nurses, two health care assistants and additional administration and reception staff.

The practice has recently had an inspection from the university of Exeter and is about to become a training practice and ready to accept new GPs trainees.

This report relates to the regulatory activities being carried out at:

Peacemarsh Surgery

Marlott Road

Gillingham

Dorset

SP8 4FA

and

The Barn Surgery

Newbury

Gillingham

Dorset

SP8 4XS

Updated 29 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Gillingham Medical Practice on Thursday 1 September 2016. 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 an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• The continued development of staff skills, competence and knowledge was recognised as integral to ensuring high-quality care. We saw evidence and staff we spoke with told us they are supported to acquire new skills and share best practice.
• Clearly followed, methodical recruitment procedures and checks were completed and documented efficiently to ensure that staff were suitable and competent.
• High standards were promoted and owned by all practice staff with evidence of team working across all roles. We observed the practice proactively sought feedback from staff and patients, which it acted on.
• 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 easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients 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 leadership drove continuous improvement and staff were accountable for delivering change. There was a clear proactive approach to seek out and embed new ways of providing care and treatment.

• The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

The leadership, governance and supportive culture of the practice was used to drive and improve the delivery of high quality person-centred care. Governance, administration and performance management arrangements were non-hierarchical, organised, detailed, structured and kept under review by the whole team. The management and leadership had an inspiring shared purpose and motivated staff to succeed and develop services. As a result there were high levels of staff satisfaction and pride in working for the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 September 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.
• 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 reviewed and 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.
• The practice used a single point of access telephone number to refer patients for help in a timely manner (often from their home) for access to home physio, occupational therapy, social services, rapid care or admission.

• The nurse practitioner visited housebound patients to carry out reviews of diabetes and chronic obstructive pulmonary disease.
• There were alerts on patient notes at risk of hospital admission so that patients could access priority visits or same day telephone advice.

Updated 29 September 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, for example, children and young people who had a high number of A&E attendances. 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 and were recognised as individuals, and we saw evidence to confirm this.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• There were links on the practice website for patients to access advice on child and teenage health advice from local support centres.
• The practice computer system alerted staff to use a traffic light system for the assessment of children with high temperatures or were showing signs of sepsis.
• There were separate children's waiting area in both practices and toys available.
• There were daily emergency appointments available with GPs and nurse practitioners. Phone call advice was also available from the GPs in the morning and during afternoon surgery.

Updated 29 September 2016

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.
• The GPs employed two members of staff to coordinate and review the care of vulnerable patients over the age of 75. Housebound patients on this scheme were offered health checks.

• Systems were in place for avoiding unnecessary admissions of the over 75s. This included ensuring care plans were in place for patients most at risk of admission, the sharing of common health records with community care teams and acting on hospital discharges within 48 hours.
• The GPs and nurse practitioners provided a primary medical service to patients who lived in care homes in the area.

Updated 29 September 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, 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.
• Self-help advice was available within the practice and on the website
• 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.
• Patients could book appointments and order medication online 24 hours a day and could access pathology results
• The practice used the website, social media sites and local press to communicate any updates to their services.

Updated 29 September 2016

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

• Between April 2015 and June 2016, 79.7% of patients on the mental health register had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.
• The practice regularly worked with multi-disciplinary teams in the case management of patients 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

• The practice was a Dementia Friendly Practice with suitable signage, being a place of safety and a designated ‘safe haven.’ The practice was also part of the dementia friendly town project with the local council and involving the PPG.

• There were daily and weekly prescription arrangements for monitoring medicines associated with the treatment of mental health.
• There was effective communication with the adult and elderly community mental health teams.
• A community resource team was located in Peacemarsh surgery for patients to access further support.
• Patients could be referred to the Steps 2 wellbeing service and counsellor at the Peacemarsh medical centre (The Steps to Wellbeing Service is a free, confidential, NHS service for people aged 18+ across the county of Dorset and in Southampton. A range treatments are provided for people experiencing problems with low mood/depression, anxiety, stress or other common mental health problems).

Updated 29 September 2016

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 and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability and between April 2015 and June 2016 had performed 60.4% of the annual health checks. Further invite letters had been sent and further appointments booked to improve this position.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients. The multidisciplinary team met monthly to discuss vulnerable patients or patients at risk of admission or adult patients about whom there were safeguarding concerns.
• 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.
• There were clinics for substance misusers held at the Peacemarsh medical centre

• Practice staff were aware of the risk of sexual exploitation of females, patients at risk of radicalisation and how to alert social services to vulnerable young mothers / partners.