Drs Hawdon & Morgan - Care Quality Commission

Background to this inspection

Updated 13 April 2017

Drs Nodder Morgan and Taubman is a GP practice which is based in two locations collectively known as Sixpenny Handley and Broad Chalke Practice. The main location is based at Sixpenny Handley, which is situated in Dorset. The branch location Chalke Valley Practice is based in Wiltshire. The practice area covers parts of Wiltshire, Dorset and Hampshire and covers approximately 200 square miles.

The practice is commissioned by Wiltshire clinical commissioning group (CCG) and there are arrangements in place for funding from Hampshire and Dorset CCG. The practice is part of the Wessex area team.

Drs Nodder Morgan and Taubman provide a personal medical service to approximately 4500 patients. The practice is a dispensing practice and they dispense to all patients within their practice area, due to its rural location. The 2011 census data showed that the majority of the local population identified themselves as being White British. The mix of patient’s gender (male/female) is almost equal at 51% female and 49% male. Public health data showed that 3.8% of the patients are aged over 85 years old which is higher than the local average (CCG) of 2.9% and higher than the national average of 2.3%. Levels of deprivation are recorded at 8 out of 10. One being more deprived and 10 being less deprived.

There are three GP partners (two female and one male), one GP assistant, one GP registrar, four part time practice nurses and four healthcare assistants. The clinical team are supported by a team of four dispensers and seven receptionists. The practice also employ locality carers to visit and support end of life and vulnerable patients and employ its own cleaning team of two cleaners. At the time of inspection the GP partners were in the process of recruiting a practice manager. All staff work across both sites.

The practice is a training practice for doctors who wish to become GPs and undergraduate and postgraduate medical students.

The practice at Sixpenny Handley is open from 8am until 1pm Monday to Friday and from 2pm until 6.15pm on Monday, Wednesday, Thursday and Fridays. Calls on Tuesday afternoon are diverted to Broad Chalke surgery. Broad Chalke surgery is open between 8am and 1pm on Monday, Tuesday, Thursday and Friday. Calls are diverted to Sixpenny Handley on Wednesday mornings. Broad Chalke surgery was open between 2pm until 6.15pm on Tuesday, 2pm until 5.30 on Thursday and 2pm until 6pm on Friday. All other times calls are taken at Sixpenny Handley. Extended hours pre-bookable appointments with the GPs and nurses are available on Monday evenings from 6.30pm until 8.30pm.

The practice operates a telephone triage duty system so patients can be seen on the same day if needed. Out of hours patients are advised to contact the out of hours service provider via the NHS 111 service.

We inspected the main location at:

Sixpenny Handley Surgery

The Surgery, Dean Lane, Sixpenny Handley, Salisbury, SP5 5PA

The branch location is situated at:

Broad Chalke Surgery

The Surgery, Doves Meadow, Broad Chalke, Salisbury, SP5 5EL

Overall inspection

Good

Updated 13 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced focussed follow up inspection at Drs Nodder Morgan and Taubman on 8 March 2017. This inspection was to follow up on action taken after we inspected on 17 September 2015. At the inspection on 17 September 2015 the overall rating for the practice was good but we rated the safe domain as requires improvement. The full comprehensive report on the September 2015 inspection can be found by selecting the ‘all reports’ link for Drs Nodder Morgan and Taubman on our website at www.cqc.org.uk .

This inspection was an announced focused inspection carried out on Wednesday 8 March 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 17 September 2015. This report covers our findings in relation to the requirement and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings from this inspection were as follows:

Failsafe recruitment processes had been introduced to ensure pre-employment references were obtained and risk assessments introduced for staff assessed as not requiring a disclosure and baring service (DBS) pre-employment checks.
Medicines in the practice and dispensary continued to be managed well and had been further improved in relation to the ordering of controlled drugs.
The management of significant events at the practice continued to be managed well and trends had been identified which showed positive outcomes regarding the care of patients who were at the end of life.
Adult safeguarding policies had been improved immediately following the last inspection and were now based on current practice guidelines set by the Wessex area team.
The procedure for the insertion of intrauterine coils had been amended to align with practice guidance set out by the Royal College of Obstetricians and Gynaecologists.
The infection and prevention and control processes and environmental health and safety risk assessments continued to be managed well.
Systems were in place to maintain and monitor equipment in the practice was well managed.
Arrangements were in place to monitor staffing numbers and skill mix and included the introduction of locality carers to provide care for end of life and vulnerable patients.
Effective arrangements were in place to manage emergencies and incidents.

We saw one outstanding aspect of care:

The practice had been recognised by healthcare professionals and members of the local community for providing a high standard of care and treatment for end of life care. The GPs worked effectively with the district nursing teams to provide continuity of care and prompt symptom relief for patients at the end of their life in the rural community. The practice had received positive feedback from palliative care hospital consultants and many letters of thanks from patients’ relatives. The GPs reviewed end of life care as positive significant events which had identified effective team work, prompt pain relief and respecting patient’s wishes of where they chose to die. The practice had employed locality carers to help with the social needs of these patients and the lead GP for palliative care shared their personal mobile telephone number with district nurses and patient’s relatives so continuity of care could be provided in addition to the out of hours service provider. The practice sent relatives letters of the anniversary of the patients death and practice staff often attended patient funerals. Records for the use of locality carers showed that these staff had made 97 visits saving the Clinical Commissioning Group (CCG) £5,400 over a six month period.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice