The Cranborne Practice

Updated 30 December 2016

The Cranborne Practice was inspected on Tuesday 29 November 2016. This was a comprehensive inspection.

The main practice is situated in the village of Cranborne in Dorset. The deprivation decile rating for this area is nine (with one being the most deprived and 10 being the least deprived). This meant that this area was amongst the most affluent nationally. The practice provides a primary medical service to 9,990 patients of a diverse age group. The practice is a training practice for GP trainees. There is currently a GP registrar at the practice.

There is a team of three GPs partners and five salaried GPs. Four were female and four male. Some work part time and some full time. The whole time equivalent is six GPs. Partners hold managerial and financial responsibility for running the business. The team are supported by an executive practice manager, assistant practice manager, two nurse prescriber, five practice nurses, five health care assistants and additional administration staff. There is also a dispensary supervisor and dispensary team at this dispensing practice.

Patients using the practice also have access to community nurses, mental health teams, midwives, counsellors and health visitors. Other health care professionals visit the practice on a regular basis.

The practice is open between the NHS contracted opening hours of 8am and 6.30pm Monday to Friday. Appointments are offered anytime within these hours. Extended hours surgeries are offered at the following times, from 6.30pm to 7pm Monday to Wednesday, on Fridays between 6.30pm and 7pm and on Saturday mornings from 9am until 12 noon.

Outside of these times patients are directed to contact the out of hour’s service by using the NHS 111 number.

The practice offers a range of appointment types including book on the day, telephone consultations and advance appointments.

The practice has a Personal Medical Services (PMS) contract with NHS England.

The Cranborne Practice provides regulated activities from two locations. The main location is The Surgery, Pennys Lane, Cranborne, Wimborne, Dorset BH 21 5QE. We visited this location during our inspection. We did not visit the branch location at Lake Road Surgery, Lake Road, Verwood, Dorset BH31 6EH.

Updated 30 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Cranborne Practice on Tuesday 29 November 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.
• This dispensing practice had safe and effective systems for the management and dispensing of medicines, which kept patients safe.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• 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 practice had a clear ethos which had quality and safety as its top priority. The ethos was to provide the highest standard of individualised healthcare in a safe, friendly and welcoming environment.
• The practice had an active Patient Participation Group (PPG) which met twice a year and carried out patient surveys annually. The PPG provided us with positive feedback about the practice.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

The practice was the first in Dorset to fund the “Tracker” system, which had been adopted across the Dorset Clinical Commissioning Group (CCG). Tracker monitors patients falling outside of health and social care and provides support via a health and social care co-ordinator who liaised between local support agencies, community nurses and the practice team. Patients then receive personal care, meals on wheels, household maintenance or other relevant support according to need. Tracker currently supported 400 patients at this practice, which was 4% of the patient list.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 December 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.

• The percentage of patients with diabetes, on the register, in whom the last blood sugar reading was within normal limits in the preceding 12 months was 100%, which was better than the national average of 78%.

• Longer appointments and home visits were available when needed.

• All patients had a named GP to allow continuity of care. The practice nursing staff team knew their patients very well and ensured timely monitoring of all patients with long term conditions.

• 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 30 December 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.

• The practice’s uptake for the cervical screening programme was 89%, which was better than the CCG average of 84% and the national average of 82%.

• 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.

• The practice used online social media websites such as Facebook to engage with young adult patients, together with its own dedicated website.

Updated 30 December 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.

• One GP specialised in patients aged over 75 years, providing specific surgery times which included the GP assisted by a pharmacist to help patients who used many different medicines (polypharmacy).

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

• The practice access system allowed flexibility, telephone advice and assessment by GPs and flagged up patients who were on the unplanned hospital admissions avoidance register for longer appointments.

• The practice had its own bereavement support group to help families of those who had died through that difficult time.

Updated 30 December 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.

• 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.

• Health promotion material was available on the practice Facebook page, on the practice website and on paper at the practice.

• The practice provided extended hours appointments on Monday, Wednesday and Friday evenings and on Saturday mornings, aimed at this population group.

Updated 30 December 2016

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

• 78% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was below the national average of 84%. The practice was in the process of carrying out its dementia reviews during the current winter period October 2016 to January 2017 which coincided with the time of our inspection.

• 97% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had had their alcohol consumption recorded in the preceding 12 months which was better than the national average of 90%.

• 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.

Updated 30 December 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, travellers and those with a learning disability. There were 37 patients registered with learning disabilities, all of whom had either received an annual review or were scheduled to receive a review by February 2017.

• 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 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.

• The practice was the first in Dorset to fund the “Tracker” system, which had been adopted across the Dorset Clinical Commissioning Group (CCG). Tracker monitors patients falling outside of health and social care and provides support via a health and social care co-ordinator who liaised between local support agencies, community nurses and the practice team.