Dr Sewell, Piotrowski & Yick Also known as Quantock Vale Surgery

Updated 30 July 2015

The practice of Drs Sewell, Piotrowski & Yick, Quantock Vale Surgery , Mount Street, Bishops Lydeard, Taunton, Somerset. TA4 3LH is located about 6 miles West of the centre of Taunton. The premises were built in the early 1970’s and have been extended twice; the most recent extension in 2000 included a practice pharmacy. The practice has approximately 5,550 registered patients. The practice area stretches from Crowcombe in the north, to Tolland in the west, Oake and Norton Fitzwarren in the south and Kingston St Mary and the outskirts of Taunton in the east. The practice works within Somerset Clinical Commissioning Group (CCG), which is responsible for the provision of health care throughout Somerset. The practice is also part of the Taunton Deane Federation of GP practices; t he GP practices in Taunton have come together to work collaboratively in commissioning health services for the population in this area.

There are three GPs and a team of clinical staff including a nurse practitioner, three practice nurses and a phlebotomist. One GP is female and two are male, the hours contracted by GPs are equal to three whole time equivalent employees. Collectively the GPs provide 24 patient sessions each week in addition they also provide extended hours for patients. Additionally the four nurses employed equal to 1.93 whole time equivalent employees. Non-clinical staff include secretaries, support staff and a small management team including a practice manager and practice assistant/medical secretary.

The practice population ethnic profile is predominantly White British and amongst the most affluent. There is a practice age distribution of male and female patients’ broadly equivalent to national average figures. However the 15 to 39 year age groups numbers of patients is slightly below national average figures and the 55 to 69 age groups are slightly above national average. There are about 2.4% of patients from other ethnic groups. The average male life expectancy for the practice area is 80 years compared to the National average of 79 years; female life expectancy is 84 years compared to the National average of 83 years.

The National GP Patient Survey published in January 2015 indicated just over 83% of patients said they would recommend the practice to someone new to the area. This was slightly above the Somerset Clinical Commissioning Group average of 82.7%. Local Public Health statistics (January 2014) demonstrate that Quantock Vale surgery has a relatively low level of social deprivation, the Index of Multiple Deprivation being 12.5 when compared to a England average of 23.6; the Somerset average is 16.9 and anecdotally the rural population is asset rich but cash poor.

The practice has a General Medical Services (GMS) contract to deliver health care services; the contract includes enhanced services such as extended opening hours, childhood vaccination and immunisation scheme, facilitating timely diagnosis and support for patients with dementia and minor surgery services. It also provides an influenza and pneumococcal immunisations enhanced service. These contracts act as the basis for arrangements between the NHS Commissioning Board and providers of general medical services in England.

The practice has opted out of providing out-of-hours services to their own patients. This service is provided by South Western Ambulance Service NHS Foundation Trust and patients are directed to this service by the practice during out of hours.

Updated 30 July 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Quantock Vale Surgery on 9 June 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well-led services. It was also good for providing services for older patients, patients with long term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report accidents, incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and learnt from their investigations.
• Risks to patients were assessed and appropriately managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Care and treatment of patients was carried out effectively by appropriately skilled staff.
• Patients said they were treated with compassion, dignity and respect by all staff 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.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments always available the same day.
• The practice had suitable 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.

We saw areas of outstanding practice including:

• The practice had a robust and secure model to deliver dispensary services to its patients. Every prescription, new or repeat, was clinically checked by the pharmacist against the clinicians’ record. If changes were required the pharmacist would discuss these with the prescribing clinician before phoning the patient and arranging a face to face meeting with them to explain the change in detail.
• One of the nurses from the practice had initiated a swimming group for patients diagnosed with diabetes who were overweight and who were conscious of their body image. The group was currently supported and led by one of the patient participation group committee.
• Young person’s appointments were available with the nurse practitioner where young patients could discuss contraception and receive sexual heath advice and information in confidence. The practice had signed up to provide free condoms through the national ‘C’ card scheme.
• The practice was part of a locally based project, called the Symphony project, which was aiming to provide enhanced support to patients with three or more diagnosed conditions.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider should:

• Review staff awareness of the Mental Capacity Act 2005 and establish an agreed process for recording how best interest decisions are reached.
• Review how best interest decisions can be consistently recorded in patients notes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 July 2015

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 that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

One of the nurses from the practice had initiated a swimming group for patients diagnosed with diabetes who were overweight and who were conscious of their body image. The group was currently supported and led by one of the patient participation group committee.

Updated 30 July 2015

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 good examples of joint working with midwives, health visitors and community based services.

Young person’s appointments were available with the nurse practitioner where young patients could discuss contraception and receive sexual heath advice and information in confidence. The practice had signed up to provide free condoms through the national ‘C’ card scheme.

Updated 30 July 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Updated 30 July 2015

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.

Updated 30 July 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). All patients experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It 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. 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.

Updated 30 July 2015

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. It had carried out annual health checks for people with a learning disability and the majority of these patients had received a follow-up appointment. It offered longer appointments for people with a learning disability. One of the practice GPs was a provider of food bank vouchers. A small number of patients were now being supported through this support.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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.