The Grove Medical Centre

Updated 25 July 2016

Bute House Surgery is situated in the market town of Sherborne, Dorset. Sherborne is close to the Somerset border and approximately 10% of the patients came from Somerset. This meant the practice liaised with community health teams and secondary care services across the two counties. There were approximately 5850 patients registered at the practice. The practice list contained a higher than average elderly and teenage population and a higher than average population with long term conditions. The patients list was a diverse socio-economic group, including pockets of deprivation and a rural population with poor local transport.

The practice was purpose built and shares the site with another separately registered GP practice. There is parking at the practice and ground floor consulting rooms.

There are four GP partners (two female and two male), three nurses and three health care assistants. There is a practice manager and deputy practice manager. One of the GPs worked part-time. As a dispensing practice there is a dispensary manager and two additional dispensary staff. The team is supported by receptionists and administrators.

The practice is a teaching practice for medical students.

The practice is open between 8am and 6.30pm Monday to Friday. On four evenings a week (Monday to Thursday) bookable appointments are available until 7pm. GP patient consultations start at 8.30am except on Wednesdays, when this is from 9am. Nurse consultations start at 8.30pm every morning except Thursday when they start at 8am.

When the practice is closed patients are directed to the Dorset Emergency Care Service, accessed via the national NHS 111 telephone service for health advice.

We previously inspected the practice on 21 January 2014 and found the practice was meeting all the standards that we inspected. We have re-inspected the practice under our new inspection regime and to award a rating to the practice.

All regulated activities are carried out from the following location:

Bute House Surgery

Grove Medical Centre

Wootton Grove

Sherborne

Dorset

DT9 4DL

Bute House Surgery holds a personal medical services contract with NHS Dorset Clinical Commissioning Group (CCG).

Updated 25 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bute House Surgery on 26 May 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.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• The practice had safe and effective systems for the management and dispensing of medicines, which kept patients safe.
• 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.
• Patients said they found it easy to make an appointment with a named GP and that 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 provider was aware of and complied with the requirements of the Duty of Candour.

We saw areas of outstanding practice:

• As part of an over 75s initiative piloted at the practice, the practice employed two community health care assistants, who bridged the gap between clinical and social care. Older patients were identified in various ways from clinicians, reception staff, frailty measures and outside agencies who may be at risk of hospital admission. These patients were comprehensively assessed in their own homes for their social, physical and mental well-being. They were offered an over 75s health check and then their care was discussed at multi-disciplinary meetings to ensure appropriate services were provided.
• Patients’ emotional needs were seen as important as their physical needs. The practice could demonstrate caring and empathy toward patients in time of loss and bereavement. Staff told us that if families had suffered bereavement, their usual GP contacted them or sent them a sympathy card. This call was either followed by a patient consultation at a flexible time and location to meet the family’s needs and/or by giving them advice on how to find a support service. On the anniversary of the loss of the family member the practice sent a ‘thinking of you’ card to family members to express further sympathy and offer on-going support.
• Patient satisfaction with overall care received at the practice, quality of consultations at the practice and satisfaction with accessing primary care were the highest of all GP practices within the locality clinical commission group (CCG). Patient satisfactions within the CCG were above the national averages. Patients thought Bute House Surgery staff provided high quality compassionate care.
• The practice held daily weekday surgeries at Sherborne Girls School (a boarding independent school) to meet the particular challenges of teenage girls living away from home. The practice had engaged with teenage patients at the girls’ school through a cycle of three yearly surveys to capture the views of the cohort of youngsters regarding services and facilities. This led to reviewing the frequency of drop in sessions at the school.

The area where the provider should make improvements is:

• Review the monitoring of vaccine refrigerator temperatures.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 July 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.
• Diabetes indicators for the monitoring of patients with this condition were in line with local and national averages, with low exception rate reporting. (This is when patients are excluded from the statistics, for example, due to failure to attend for a review or extreme frailty.)
• Longer appointments and home visits were available when needed.
• 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.
• Practice nurses were qualified and specialised with diplomas in the management of diabetes, asthma, and chronic obstructive pulmonary disease (COPD).
• Patients were provided with condition-appropriate care plans.
• All patients were encouraged to self-manage their condition and those needing support had access to ‘My Health My Way’, a local health coach service.

Updated 25 July 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.
• The percentage of patients with asthma who had a review of their condition and advice on control their condition was 83%. This was slightly higher than the local CCG average of 78% and national average of 75%.
• 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 percentage of women who were invited for and attended a cervical screening test was 82%, which was in line with local and national averages.
• The premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• The health visiting team were co-located in the practice and met with the practice team frequently. Health visitors were on the same clinical records system and shared comprehensive patient records.
• The practice policy was to see children on the same day, to avoid unnecessary A&E attendances.
• Appointments were available outside school hours and children’s clinics such as flu immunisation were scheduled for school holidays.
• The practice liaised with local schools, for example with regard to challenging students, particularly with regard to attendance where health concerns may be an influencing factor.
• The practice held daily weekday surgeries at Sherborne Girls School (a boarding independent school) to meet the particular challenges of teenage girls living away from home.
• The practice had engaged with teenage patients at the girls’ school through a cycle of three yearly surveys to capture the views of the cohort of youngsters regarding services and facilities. This led to reviewing the frequency of drop in sessions at the school.

Updated 25 July 2016

The practice is rated as outstanding for the care of older people.

The predominant patient group for the practice population was for those over 65. This was significantly above the national average; for example 15% of the practice list were aged between 75 – 85 years, compared with the national average of 8%.

• The practice offered personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice believed that care was at risk of becoming fragmented through the multiple initiatives and multiple registers of patients at risk. They had brought together patient registers for end of life, avoiding unplanned admissions, frail and also any patient identified by the GPs or nurses to form a single supportive care register. This formed the basis for discussion at multi-disciplinary team meetings.
• As part of an over 75s initiative set up by one of the GPs at the practice, the practice employed two community health care assistants, who bridged the gap between clinical and social care. Older people at risk of hospital admission were identified in various ways from clinicians, reception staff, frailty measures and outside agencies. These patients were comprehensively assessed in their own homes for their social, physical and mental well-being. They were offered an over 75s health check and then their care was discussed at multi-disciplinary meetings to ensure appropriate services were provided.
• Patients residing in nursing and care homes received routine regular visits by a GP, allowing early identification of illness and health decline. The practice believed this had improved relationships with the homes and staff and reduced unnecessary unplanned admissions to hospital.
• Patients received a birthday card from the practice on their 90th and 100th birthday.
• The practice had established links with the community matron and the partnership for older people (POPP) ‘Wayfinders’, a voluntary organisation that signposted patients to appropriate services, such as advice for homecare and pension advice.

Updated 25 July 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.
• There were extended hours clinics which ran from Monday through to Thursdays until after 7pm.
• Flu clinics were held on a weekend.
• The practice offered telephone consultations, as well as an opportunity to email the practice.

Updated 25 July 2016

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

• 86% of patients diagnosed with dementia that had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the local CCG average of 85% and the national average of 84%.
• The percentage of patients with mental health needs who had been seen in the preceding 12 months and had an agreed, comprehensive care plan was comparable with local CCG and national averages.
• 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. For example, staff were Dementia Friends and had completed the training from the Alzheimer’s Society.
• The practice provided facilities for Improving Access to Psychological Therapies workers (IAPT) and child and adolescent mental health services (CAMHS) to consult patients in a convenient and familiar environment.
• The Citizen’s Advice Bureau provided fortnightly sessions within the practice specifically for people with mental health issues.
• The practice had a dementia and vulnerable adults lead, member of staff who co-ordinated regular multi-disciplinary team meetings at the practice to discuss the care needs of such patients.

Updated 25 July 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 patients, travellers and those with a learning disability. For example, the practice said they had one transient patient who registered the practice address as their permanent address for the receiving of post.
• There were long appointments and home visits available for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations, such as The Rendezvous for young people and community alcohol and drug advisory services (CADAS) for addiction issues.
• 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.
• One of the GPs was chair of the Sherborne Voluntary Ambulance. This service provided transport and social outings to vulnerable local residents, including patients registered with the practice.
• The practice had a carer’s lead who helped carers to access help and support from various agencies.
• The practice had a higher than average population of patients with severe learning disability. These patients received comprehensive annual health checks and were seen regularly to build a good relationship with patients and carers to identify early onset of illness.
• The practice used the ‘yellow health book’ designed to aid communication for patients with a learning disability. The book’s intention was to enable patients to better look after their own health and was produced in an easy to read format. Topics covered included an individual’s eating habits, best methods of communication, family history and immunisation records.
• The practice worked with Age UK to identify the support patients need to enable safe and independent living (SAIL).
• The practice funded community health care assistants (HCAs) visited vulnerable patients of concern in their homes, for example if a GP or nurse was unable to make contact on the telephone then the HCA conducted a home visit to check all was well.