The Weobley and Staunton-On-Wye Surgeries

Updated 19 November 2015

Weobley and Staunton on Wye Surgeries are located near the town of Hereford and provide primary medical services to patients covering a large area of rural Herefordshire of approximately 200 square miles. This inspection focussed on the Weobley Surgery as we had no specific information about Staunton on Wye to lead us to inspect there on this occasion.

The practice building is purpose built, with good facilities and is well equipped to treat patients and meet their needs. Weobley Surgery is also a dispensing practice.

The practice has four GP partners including a female GP which provides a choice for patients. There is a management team which includes a practice manager, an assistant practice manager and a reception manager. The nursing staff team includes two practice nurses and two health care assistants. In addition there are dispensary, administrative and reception staff. There were 5647 patients registered with the practice at the time of the inspection.

The practice is open from 8.30am to 1pm and 2.45pm to 6pm Mondays, Thursdays and Fridays and from 8.30am to 1pm on Tuesdays and Wednesdays. The practice is closed at weekends. Home visits are available for patients who are too ill to attend the practice for appointments. There is also an online service which allows patients to book appointments and order repeat prescriptions. The practice does not provide an out-of-hours service but has alternative arrangements in place for patients to be seen when the practice is closed. Information on the out-of-hours service is provided to patients and is available on the practice’s website. There is a GP Walk-In Access Centre in Hereford which is open from 8am until 8pm seven days a week and every day of the year. Patients could also telephone 111. NHS 111 enables patients to access local NHS healthcare services in England.

Additional appointments are made available, particularly for working patients. These are provided by a company that has been set up by the GPs in Herefordshire to provide additional medical services to patients. There are three primary care hubs open in the county that provides GP and practice nursing services to all Herefordshire patients during the evenings and weekends. Patients can therefore access GP and nurse appointments seven days a week from 8am and 8pm.

Weobley Surgery treats patients of all ages and provides a range of medical services. They provide clinics such as asthma, diabetes, heart disease, well woman, and child and travel immunisation clinics. Other clinics include wound dressings, removal of sutures, family planning, minor injuries and ear syringing. Community staff provide other services in the practice such as midwifery, health visitors, community mental health, and healthy lifestyle and memory clinics.

Weobley Surgery has a General Medical Services (GMS) contract. The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities.

Weobley Surgery is an approved training practice for doctors who wish to be become GPs. A trainee GP is a qualified doctor who is training to become a GP through a period of working and training in a practice. Only approved training practices can employ trainee GPs and the practice must have at least one approved GP trainer. The practice is also a teaching practice and provides placements for medical students who have not yet qualified as doctors.

Updated 19 November 2015

Letter from the Chief Inspector of General Practice

We inspected this service on 28 April 2015 as part of our new comprehensive inspection programme.

The overall rating for this service is outstanding. We found the practice to be good for providing safe and effective services and outstanding for providing caring, responsive and well led services.

The practice was outstanding at providing services for older patients and patients with long term conditions. The practice was good at providing services for families, children and young patients, the working age population and those recently retired and patients experiencing poor mental health.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from incidents were maximised.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure they met the needs of patients.

• Information about how to complain was available and easy to understand.

• The practice held regular multidisciplinary clinical team meetings to discuss the needs of complex patients, for example those with end of life care needs or children who were considered to be at risk of harm.

• The practice had an open culture that was effective and encouraged staff to share their views through staff meetings and significant event meetings.

We saw several areas of outstanding practice including:

• Weobley Surgery had looked for innovative ways to develop services for patients in their area. They had been involved in a number of pilot schemes such as the provision of a specialist clinic to review all patients with Atrial Fibrillation (heart disease) who may be at additional risk of a stroke. These reviews resulted in positive outcomes for patients. The practice shared their learning from these and other pilots they engaged in with the CCG area.

• The practice had an equipment fund that was registered with the charities commissioners and managed by a committee of patient representatives. This fund enabled the purchase of additional equipment to be used for the benefit of patients. The practice told us that they contributed to this fund-raising by asking for donations rather than charge fees for some forms they were requested to complete. The fund had enabled them to purchase and loan equipment to patients such as syringe drivers (for pain management), heart monitoring recorder to aid diagnoses, blood pressure monitoring machines, an audiometer to assess hearing, and defibrillators in all GP cars for restarting a person’s heart in an emergency. There was a community defibrillator attached to the outside of the building for the use of the village first responder.

• The practice showed a high level of commitment to the needs of patients receiving palliative care and recognised that many of them wanted to receive the highest quality of care and support to enable them to die with dignity in their own home or care home. Effective systems were in place to ensure they received their end of life care in line with their expressed preferences. The practice operated a direct one to one on-call rota to provide individual care and support to patients in their end of life.

• The practice was one of the highest performing practices in Herefordshire for the care for diabetic patients. The practice had 300 patients diagnosed with diabetes. A dedicated community dementia worker provided clinics at the practice. There was a high uptake of flu vaccines (100% which was higher than the national average of 93%) and foot examinations (96% which was higher than the national average of 88%) for diabetic patients.

• Weobley Surgery was leading on trials for a standardised approach to practice nurse appraisal documentation. This documentation was to be used in the completion of appraisals towards continued professional development, leading to revalidation for nurses. The outcome of the trial was to share the documentation with all practices within the county. One of the GPs also coordinated a monthly educational evening in conjunction with a neighbouring practice. The evening was open to all local practices and consultants, and other experts were invited according to the learning needs identified by the group.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 November 2015

This practice is rated as outstanding for the care of patients 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 that their health and medicine 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 was one of the highest performing practices in Herefordshire for the care for diabetic patients. The practice had 300 patients diagnosed with diabetes. A dedicated community diabetes worker provided clinics at the practice. There was a high uptake of flu vaccines (100% which was higher than the national average of 93%) and foot examinations (96% which was higher than the national average of 88%) for diabetic patients. The quality monitoring data (QOF) for 2014/2015 showed that the practice was effective in supporting patients with diabetes to manage their health and had low accident and emergency admission rates.

Herefordshire had a high number of older patients many of whom had long term conditions. The practice had been involved in piloting specialist clinics to review patients with Atrial Fibrillation (heart disease) to identify those who may be at risk of a stroke. As a result of this pilot nine patients were identified to be at risk and preventative treatment was provided.

Updated 19 November 2015

This practice is rated as good for the care of families, children and young patients. Appointments were available outside of school hours and the premises were suitable for children and babies. The practice provided childhood immunisations and appointments for these could be booked throughout the week to provide flexibility for working families. Last year’s performance was above average for the majority of immunisations where comparative data was available. For example, childhood immunisation rates for the vaccinations given to under twos ranged from 95.2% to 100% comparable to the CCG average of 90.9% to 97.5%.

The practice provided a family planning service and a range of options for contraception. The GPs and nurses worked with other professionals where this was necessary, particularly in respect of children living in vulnerable circumstances.

There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk of harm, for example, children and young patients who had a high number of attendances at the accident and emergency (A&E) department of the local hospital.

Updated 19 November 2015

This practice is rated as outstanding for the care of older patients. The practice offered proactive, personalised care to meet the needs of older patients in its population and had a range of enhanced services for example, in dementia and end of life care. The percentage of patients diagnosed with dementia whose care has been reviewed for 2014 was 95% which compared with national rates of 83%.

The practice provided a responsive service to patients who lived in a local nursing home. The practice maintained a register of all patients in need of palliative care and offered home visits and rapid access appointments for those patients with complex healthcare needs. Other professionals and practice staff had access to clear information about patients receiving end of life care so they were able to respond in the event that medical assistance was needed. The practice held regular multidisciplinary integrated care meetings where all patients on the palliative care register were discussed.

Nationally reported data showed that the practice performed well against indicators relating to the care of older patients. Patients over the age of 75 had a named GP and GPs carried out visits to patients’ homes if they were unable to travel to the practice for appointments. The practice had exceeded the national average for providing flu vaccinations to patients over the age of 65. Data for the year 2014/2015 showed that 100% of patients had been given their flu vaccination compared with the national rate of 73%.

The practice had taken part in a pilot for a treatment approach to stroke prevention for those patients with Atrial Fibrillation (AF) (heart disease). GPs told us this was particularly relevant to their practice as Herefordshire had a large number of elderly patients potentially at high risk of strokes. This project was successful for the practice patients. Nine patients were found to be at risk and treated to minimise that risk. The programme was implemented across the whole of the county by the CCG.

Updated 19 November 2015

This practice is rated as good for the care of working age patients (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.

GPs in Herefordshire to provided additional medical services to patients. There were three primary care hubs open in the county that provide GP and practice nursing services to all Herefordshire patients during the evenings and weekends. Patients could therefore access GP and nurse appointments seven days a week from 8am and 8pm.

The practice offered a number of online services, including booking and cancelling appointments and requesting repeat medicines. They also provided a full range of health promotion and screening clinics that reflected the needs of this age group. The practice nurses had oversight for the management of a number of clinical areas, including immunisations, cervical cytology and some long term conditions.

Updated 19 November 2015

This practice is rated as good for the care of patients experiencing poor mental health (including patients with dementia). The practice held a register of patients living in vulnerable circumstances including those patients with a learning disability and dementia.

The practice invited patients to attend for an annual health check. Longer appointments were arranged for these and patients were seen by the GP they preferred. The annual reviews took into account patients’ circumstances and support networks in addition to their physical health. The percentage of patients diagnosed with dementia whose care has been reviewed for 2014/2015 was 95% which compared with national rates of 83%.

The practice had given patients experiencing poor mental health information about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for patients with mental health needs and dementia.

Updated 19 November 2015

This practice is rated as good for the care of patients whose circumstances may make them vulnerable. The practice held a register of patients living in vulnerable circumstances including patients with a learning disability. In 2014 there were nine patients on the learning disability register and an annual health check had been completed with all of them.

We saw the practice was proactive in responding to the needs of patients. They had put in place a system for patients needing support in an emergency. This was called the Message in a Bottle scheme which was a way for patients of keeping personal and medical information accessible quickly in an emergency.

Staff had received training and knew how to recognise signs of abuse in vulnerable adults and children who were considered to be at risk of harm. 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.

Patients were provided with information about how to access various support groups and voluntary organisations. For example, through leaflets, on the information notice board in the waiting area and on the practice’s website.