The Silton Surgery

Updated 8 November 2016

The Silton Surgery was inspected on Tuesday 11 October 2016. This was a comprehensive inspection.

The Silton Surgery is located in the town of Gillingham in Dorset and has an NHSE personal medical services (PMS) contract to provide health services to approximately 1900 patients. The practice is open between 8am and 6.30pm Monday to Friday. The practice offers a range ofappointment types including book on the day and telephone consultations

The practice has opted out of providing out-of-hours services to their own patients and refers them to an out of hour’s provider via the NHS 111 service. This information is displayed on the outside of the practice, on their website, and in the patient information leaflet.

Information published by Public Health England rates the level of deprivation within the practice population group as eight on a scale of one to 10. Level one represents the highest levels of deprivation and level 10 the lowest. There was no data available to us at this time regarding ethnicity of patients but the practice stated that 99% of their patients were White British

The mix of patient’s gender (male/female) is equal at 50% each. Public health data showed that 3.9% of the patients are aged over 85 years old which is higher than the local average (CCG) of 2.8% and higher than the national average of 2.3%.

There are two GPs working part time at the practice(one male and one female). This equates to whole time equivalent of 1 GP partner. Both of the GPs are partners who hold managerial and financial responsibility for running the business. The partners are also supported by one regular female locum GP. The GPs are supported by two practice nurses, the dispensary team and additional administration and reception staff.

The practice is open on Monday 8.30am to 4pm, Tuesday 8.30am until 7pm, Wednesday; 8.30am until 1pm, Thursday; 8.30am until 6.45pm and Friday 8.30am until 5pm. Appointments are offered anytime within these hours. Extended hours surgeries are offered at the following times; on Tuesdays between 5.30pm and 7pm and on Thursdays 5.30am and 6.45pm.

Outside of these times patients are directed to contact the Wiltshire's out of hour’s service by using the NHS 111 number.

The practice offers a range of appointment types including book on the day, telephone consultations and advance appointments.

This report relates to the regulatory activities being carried out at:

The Surgery, Gillingham Road, Silton, Gillingham, Dorset. SP8 5DF

Updated 8 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Silton Surgery on 11 October 2016. Overall the practice is rated as good.

• 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 been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

• Feedback from patients, and those who were close to them was completely positive about the way staff treat them. Patients were treated with dignity, respect and kindness during all interactions with staff and relationships with them were positive. Patients felt supported and said staff cared about them.

• The practice was in a rural location and travel to the local district hospital was often problematic for older patients. The practice worked closely with the local hospital consultants making active use of email advice to optimise patients care and reduce their need to travel to the acute hospital. In addition there were acute clinics including the RACE (Rapid Access Care of the Elderly) where elderly patients were seen by a consultant geriatrician within a few days of referral to get experienced clinician input about their condition and avoid hospital admission.

• The practice was a dispensing practice, this is where GPs were able to prescribe and dispense medicines directly to patients who lived in a rural setting. The Silton Surgery dispensed to patients who did not have a pharmacy within a mile radius of where they lived. The dispensary provided medicines in blister packs for older people with memory problems and had a weekly delivery service for those who struggled to get to the practice.

• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.

• Patients said they found it easy to make an appointment with a named GP and 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 found two aspects of outstanding practice.

• The practice worked hard to avoid unplanned admissions to hospital by working closely with secondary care providers. For example the practice was part of a local group of rural practices, they ran a local TCOP (Transforming care of the older patient) scheme. This involved sending birthday cards to patients over the age of 75. The card also included health questions for the patients to try and discover their health concerns or find any unmet health needs. Patients with issues raised on their birthday cards were then invited to a clinic at the practice to see the ‘Eldercare facilitator’, an experienced nurse, to review any unmet needs they had. A second aspect of the TCOP scheme was for the practice to perform extended face to face reviews of those patients over 75 to optimise their care. The practice worked hard to avoid unnecessary admissions to hospital and had one of the lowest unscheduled admission rates in Wiltshire.

• The practice were able to loan out equipment which monitored patient’s heartrates to check for irregularities. The practice had software on their clinical computer system which enabled them to interpret the data and implement a treatment plan. This service prevented patients from having to go to the district hospital for treatment and provided a swifter diagnosis of their condition.

The areas where the provider should make improvements are:

The practice had a good awareness of patients who performed a caring role, however their patient record system did not have a formal identification for carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 November 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 the management of patients at risk of hospital admission who were identified as a priority. The practice worked closely with the community specialists to gain timely, specialist advice.

• The practice prescribed anticipatory medicines for those with long term conditions, such as standby medicines for those patients with chronic respiratory disease and ‘just in case medicines’ for palliative care patients.

• Patients with long term conditions benefitted from continuity of care with their GP or nurse. All these patients had a named GP and a structured annual review.

• The practice worked with external agencies in other aspects of long-term condition management such as diabetic retinopathy screening and podiatry ensuring appropriate support was provided promptly.

• The practice had good facilities and was well equipped to treat patients and meet their needs. The practice provided enhanced services for near patient testing including in-house International Normalised Ratio monitoring (INR – the monitoring of blood thinning medicines).

• The practice were able to loan out equipment which monitored patient’s heart rates to check for irregularities. The practice had software on their clinical computer system which enabled them to interpret the data and suggest a treatment plan. This service prevented patients from having to go to the district hospital for treatment and provided a swifter diagnosis of their condition.

• All discharge summaries were reviewed on the day they were received ensuring medicines were adjusted and appropriate primary care follow-up was arranged.

• In order to ensure continuity of care for patients in the out of hour setting, details of any patient with complex long-term conditions, or an end of life diagnosis were entered onto the computer system which is visible by the out of hour’s service and ambulance service and contains useful information including treatment plans, escalation plan and past history.

Updated 8 November 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.

• 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 positive examples of joint working with midwives, health visitors and school nurses.

Updated 8 November 2016

• All patients over 75, or on an admission avoidance care plan had a named GP responsible for their care, but they were given the choice of seeing whichever GP they preferred.

• The practice worked hard to avoid unplanned admissions to hospital by working closely with secondary care providers. For example the practice was part of a local group of rural practices, they ran a local TCOP (Transforming care of the older patient) scheme. This involved sending birthday cards to patients over the age of 75. The card also included health questions for the patients to try and discover their health concerns or find any unmet health needs. Patients with issues raised on their birthday cards were then invited to a clinic at the practice to see the ‘Eldercare facilitator’, an experienced nurse, to review any unmet needs they had. A second aspect of the TCOP scheme was for the practice to perform extended face to face reviews of those patients over 75 to optimise their care. The practice worked hard to avoid unnecessary admissions to hospital and had one of the lowest unscheduled admission rates in Wiltshire.

• Home visits were undertaken as required and longer appointments were made available for those patients who needed more time.

• The practice had monthly multidisciplinary team meetings which involved other professionals from the community teams as necessary.

• The practice had monthly palliative care meetings to discuss patients approaching their end of life or those with complex needs. The practice regularly liaised with community support groups to provide further support to their patients if required. 

• Patients residing in care homes received visits by a GP whenever required, allowing early identification of illness and health decline.

• Services within the practice were provided on one level for easy access and included easy access for wheelchair users and pushchairs.

• The practice was in a rural location and travel to the local district hospital was often problematic for older patients. The practice worked closely with the local hospital consultants making active use of email advice to optimise patients care and reduce their need to travel to the acute hospital. In addition there were acute clinics including the RACE (Rapid Access Care of the Elderly) where elderly patients were seen by a consultant geriatrician within a few days of referral to get experienced clinician input and avoid an unplanned hospital admission.

• 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. 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.

The practice was a dispensing practice, this is where GPs were able to prescribe and dispense medicines directly to patients who lived in a rural setting. The Silton Surgery dispensed to patients who did not have a pharmacy within a mile radius of where they lived. The dispensary provided medicines in blister packs for older people with memory problems and had a weekly delivery service for those who struggled to get to the practice.

Updated 8 November 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.

• The practice offered NHS health checks to those aged 40-74. These were identified by running a monthly search on the computer to identify the patients eligible that month and then sending them an invitation letter.

• The practice offered health promotion services via the practice nurses such as weight loss, smoking cessation and sexual health services.

Patients who received repeat medicines were able to collect their prescription at a place of their choice, or at the practice itself if they were dispensing patients.

Updated 8 November 2016

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

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded from 01/04/2014 to 31/03/2015 was 100%, which was higher than the national average of 90%.

• 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. Two members of the reception staff were dementia friends. Staff had a good understanding of how to support patients with mental health needs and 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.

• The practice had a register for those patients with severe mental health illness and there were processes in place to ensure those patients attend their annual reviews.

• A psychologist, provided by the local mental health trust, held a clinic at the practice on alternate weeks.

In house mental health medicines reviews were conducted to ensure patients received the most effective medicines for their condition. In addition blood tests were regularly performed on patients receiving certain mental health medicines to ensure their treatment was optimally maintained

Updated 8 November 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice offered longer appointments for patients with a learning disability.

• 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.