Victoria Surgery

Updated 3 November 2017

Victoria Surgery is situated in Bury St Edmunds and provides a service to patients in Bury St Edmunds and the surrounding villages. The practice holds a Personal Medical Service (PMS) contract with the local clinical commissioning group (CCG) and offers health care services to around 10,850 patients. The practice is able to offer dispensing services to those patients on the practice list who live more than one mile (1.6km) from their nearest pharmacy. The practice has been a training practice for GP Registrars (qualified doctors who are undertaking training to become GPs) for the last four years. They are also a teaching practice for medical students training to be doctors.

• There are five GP Partners at the practice (two female and three male), three salaried GPs (all female), one nurse practitioner, two practice nurses and a health care assistant.
• The dispensary team includes two dispensary leads and three dispensers.
• A team of administration and reception staff support the management team. The practice manager is supported by a deputy manager and an assistant manager.
• The practice is open between 8am and 6.30pm Monday to Friday and appointments are available from 8.30am to 6.30pm. Patients are able to book evening and weekend appointments with a GP through Suffolk GP+ (Suffolk GP+ is for patients who urgently need a doctor’s appointment, or are not able to attend their usual GP practice on a weekday).
• If the practice is closed, Care UK provide the out of hours service, patients are asked to call the NHS111 service or to dial 999 in the event of a life threatening emergency.
• The practice demography differs to the national average, with slightly more 10 to 19 year olds, significantly less 20 to 39 year olds and significantly more patients aged 65 and over.
• Male and female life expectancy in this area is above the England average at 81 years for men and 85 years for women.

Updated 3 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Victoria Surgery on 8 May 2017. The overall rating for the practice was good, with requires improvement for providing safe services. The full comprehensive report on the 8 May 2017 inspection can be found by selecting the ‘all reports’ link for Victoria Surgery on our website at www.cqc.org.uk.

We undertook a desk based inspection on 16 October 2017 to check they had followed their action plan and to confirm they now met legal requirements in relation to the breaches identified in our previous inspection on 8 May 2017. This report only covers our findings in relation to those requirements.

Overall the practice is now rated as good, and good for providing safe services.

Our key findings from this inspection were as follows:

• Effective procedures were in place to ensure all staff had a Disclosure and Barring Service (DBS) and this included all staff who had unsupervised contact with patients.
• Patient Group Directions were up to date and had been signed by the nurses and a GP to ensure the nurses had the legal authorisation to administer the relevant medicines.
• Complaints information for patients was easily available and included correct information for patients who wanted to escalate their complaint if they were dissatisfied with the response from the practice. Staff at the practice confirmed this information was available in the waiting room and at reception.
• Improvements had been made to infection prevention and control in the practice. The practice had an infection control lead, who had completed relevant training and received updates. An infection control action plan was in place and actions had been completed.
• Infection control training had been completed by all staff, including dispensary staff.
• The practice recorded the receipt and disposal of patient returned medicines.
• Policies and procedures were in place; however they were not all up to date. One of the GPs had weekly, dedicated time to update the policies and procedures. The practice had recently commissioned a new website and all their policies and procedures would be available on there for staff to access easily.

The areas where the provider should make improvement are:

• Continue to update all policies and procedures.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 June 2017

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. Patients who had a hospital admission were reviewed on discharge.
• The practice had a nurse with responsibility for the management of patients with long term conditions. They undertook this role with support from a GP. The practice held a clinic for people with diabetes. A specialist diabetes nurse attended every four to six weeks to provide a joint clinic where patients with more complex needs were reviewed.
• Patients with complex needs had a named GP and structured reviews 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.
• The practice used the information collected for the Quality and Outcomes Framework (QOF) to monitor outcomes for patients (QOF is a system intended to improve the quality of general practice and reward good practice). Data from 2015/2016 showed that performance for diabetes related indicators was 100%, which was 4% above the CCG average and 10% above the England average. Exception reporting for diabetes related indicators was 16% which was above the CCG average of 13% and the England average of 12% (exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects). 2016/2017 unverified data from the practice (which excluded any exceptions) showed the practice had maintained performance in this area.
• Longer appointments and home visits were available when needed.

Updated 16 June 2017

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

• The practice provided GP appointments twice a week for children aged three to 18 at a nearby independent boarding school.
• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk. The practice met with a midwife and health visitor on a monthly basis to review children with safeguarding needs.
• Immunisation rates were above the CCG and national averages for most standard childhood immunisations, however they were below average for the percentage of children, aged 2, who had received the Pneumococcal booster. The practice was aware of this and had redesigned the childhood immunisation clinics. Dedicated administration staff reviewed the patients’ immunisation history and invited them to book an appointment directly with the practice. This enabled more flexibility for patients and reduced the number of patients who did not attend for their appointment.
• 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 offered a range of contraception services. Patients who requested a contraceptive implant were signposted to another service. The practice offered chlamydia screening.
• 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 and health visitors.

Updated 16 June 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.
• GPs and nursing staff provided home visits to patients living in the eight nursing and residential homes covered by the practice.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure were above the local and national averages. 2015/2016 QOF outcome data for patients with dementia was lower when compared to the local and national average, however 2016/2017 unverified data from the practice (which excluded any exceptions) showed the practice had improved performance in this area. The practice was aware of the need to improve and had engaged with an external company to review and improve their QOF management processes.

Updated 16 June 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.
• Patients were able to book evening appointments with a GP, nurse practitioner or a practice nurse from 6.30pm to 7pm Monday to Friday. Patients were able to book evening and weekend appointments with a GP through Suffolk GP+ (Suffolk GP+ is for patients who urgently need a doctor’s appointment, or are not able to attend their usual GP practice on a weekday). GPs from the practice were involved in the direct provision of this service.
• The practice offered online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 82%, which was in line with the CCG average of 82% and England average of 81%.

Updated 16 June 2017

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

• 83% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was above the CCG average of 79% and England average of 77%.
• 87% of patients experiencing poor mental health had a comprehensive care plan, which was above the local average of 74% and the England average of 76%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice had a mental health link worker who held an afternoon clinic every week to provide support and advice to patients and GPs. They met formally every month to review patients and discuss patients with complex needs.
• 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 16 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 those with a mental health need and those with a learning disability.
• A learning disability nurse was based at the practice one day a week. They supported the practice with preparation for annual health assessments for people with a learning disability, which were undertaken by the practice nurse, with the support of a GP where necessary. The practice had 21 patients on the learning disabilities register. 19 of these patients had received or booked a health review since April 2016.
• The practice offered longer appointments at the request of a GP.
• 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’s computer system alerted GPs if a patient was also a carer. The practice had identified 178 patients as carers (just under 2% of the practice list).