South Hermitage Surgery

Updated 8 April 2016

South Hermitage Surgery is located in South Hermitage, Shrewsbury, Shropshire. It is part of the NHS Shropshire Clinical Commissioning Group. The total practice patient population is 7,600 and increasing. The practice provides GP services to 123 patients in 22 care homes including learning disability/supported living homes.

The staff team comprises four full-time partners, who have all been with the practice for over 10 years. The practice is a training practice for GP Registrars and has two GP Registrars (a GP Registrar is a qualified doctor who is training to become a GP through a period of working and training in a practice), one is on maternity leave. The clinical practice team includes a lead practice nurse and two practice nurses and two healthcare assistants/phlebotomist (a person who takes blood). The practice is managed by a practice manager and a deputy practice manager and reception supervisor. The practice team is supported by, a prescription co-ordinator, eight receptionists, a practice administrator, two medical records administrators, two medical secretaries, an apprentice administrator and a care and community co-ordinator. In total there are 30 full or part time staff.

Routine appointments are available on Monday and Friday from 7:30am to 12:30pm and 2pm to 5.40pm, on Tuesday, Wednesday and Friday appointments are available from 8:30am to12:30pm and 2pm to 5.40pm. Telephone consultations are available daily and calls are returned after the morning and afternoon surgery. The practice nurses provide lunchtime time appointment slots which are pre-bookable. The practice does not provide an out-of-hours service to its own patients but has alternative arrangements for patients to be seen when the practice is closed through Shropdoc, the out-of-hours service provider. The practice telephones switch to the out-of-hours service at 6pm each weekday evening and at weekends and bank holidays.

The practice provides support for patients for example with long-term condition management including asthma and diabetes. It also offers child immunisations and minor surgery. The practice offers health checks and smoking cessation advice and support. The practice has a Personal Medical Services (PMS) contract with NHS England. This is a contract for the practice to deliver Personal Medical Services to the local community or communities. They also provide some Directed Enhanced Services, for example they offer minor surgery, childhood vaccination and immunisation scheme, and learning disability annual health checks.

Updated 8 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at South Hermitage Surgery on 22 February 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.
• 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 was a participant in the Prime Minister’s Challenge Fund pilot, offering evening and weekend appointments across the locality with a range of GPs allowing full data-sharing of records. This service worked with a number of practices to extend GP opening hours with appointments which could be made at the participating GP practices between 6pm and 8pm weekdays and 9am and 1pm on Saturdays.
• The practice had improved patient access to services following their Patient Participation Group (PPG) survey and provided early morning appointment for patients twice a week from 7.30am and lunchtime appointments with the practice nurses.
• 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 April 2016

The practice is rated as outstanding 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 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.

• Performance for diabetes related indicators were all better than the Clinical Commissioning Group (CCG) and national average.

• The practice provided a practice nurse-led weekly diabetic clinic, with concurrent foot screening. This included a recall system which they moved from six months to three months for newly initiated diabetic patients and they provided home visits for frail patients unable to attend the practice. The practice nurse encouraged patient self-management through the Diabetic Xpert patient scheme.

• The practice was a pilot practice for the diabetic specialist nursing service put in place to reduce admissions and out-patient attendances.

• One of the practice nurses had supported patients in the potential pre-diabetic blood test range to improve their health outcomes. In some patients there was evidence that the practice health information and pre-emptive support had reduced the need for diabetes medicine. This was also completed with the use of the health intelligence gathered from patients attending for NHS Health checks completed by the healthcare assistants.

• The practice nurse and GP partners initiated contact with the respiratory consultant specialist who reviewed all the patients diagnosed as having Chronic Obstructive Pulmonary Disease (COPD). The percentage of patients with COPD who had a review undertaken including an assessment of breathlessness in the preceding 12 months was 92.5%, which was slightly better than the national average of 89.9%.

• The practice nurses offered flexible appointments (including lunchtimes) to assist patients with asthma to attend the practice for regular reviews.

• The practice provided care closer to home with the provision of in-house spirometry, (Spirometry is a simple test used to help diagnose and monitor certain lung conditions by measuring how much air a patient can breathe out in one forced breath), 24 hour blood pressure monitoring and doppler’s . ( A doppler is a non-invasive test that can be used to measure blood flow and blood pressure).

Updated 8 April 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.  This included registers for children with a child protection plan in place and carers. I mmunisation rates were relatively high for all standard childhood immunisations.

• The percentage of patients with asthma, on the register, who have had an asthma review in the preceding 12 months that includes an assessment of asthma control, was 69.72% when compared to the national average of 75.35%.

• 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 practice’s uptake for the cervical screening programme was 83.29% which was comparable to the national average of 81.83%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• Flu immunisation rates for pregnant women were 66% which was higher than the CCG locality average.

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

• The practice provided a family planning clinic on Wednesday evenings which included booked or drop-in nurse and GP appointments and in-house family planning procedures (coils / implants) using the same regular specialist locum GP.

• The practice provided a confidential email facility for young people called “Ask Debs.”

Updated 8 April 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice completed ‘Advanced Care Plans’ for patients in care homes and these were reviewed when required or six monthly by the GP partner with a specialist interest in older people.

• The practice provided a ‘Discharge to Assess’ service for four beds in a local care home and attended weekly multi-disciplinary team meetings and 48 hour from discharge assessments.

• The practice had achieved 70% in the delivery of the shingles vaccine to 70 year old patients which was higher than the national average of 59% and CCG average of 67%. They also achieved 70% in the 78/79 year old uptake of the shingles vaccine which was higher than the national average of 57% and CCG average of 66%.

• The practice Care and Community Co-ordinator was located at the practice two days per week taking referrals from all clinicians and practice staff to provide a signposting role to community services and was a contact for the frail and vulnerable patients.

Updated 8 April 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 reflected the needs for this age group.

• The practice was a participant in the Prime Minister’s Challenge Fund pilot, offering evening and weekend appointments across the locality with a range of GPs allowing full data-sharing of records.

• The practice provided early morning GP appointments from 7.30am twice a week.

• The practice had set up a “Virtual” Patient Participation Group facilitating engagement from a wider range of patients which included those of working age.

• Text appointment reminders and recalls were offered to patients.

Updated 8 April 2016

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

• 80.22% of patients diagnosed with dementia  had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84.01%.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 92.59% when compared with the national average of 88.47%.

• The practice regularly worked with multi-disciplinary teams in the case management of people 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 and received training as “Dementia Friends.”

• The practice offered patients access to their mental health counsellor and with direct referral from the GPs access to the community mental health team rapid access nurse.

• The practice enabled alerts on their electronic patient records which flagged up to offer double appointments and the use of separate waiting area if needed.

Updated 8 April 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 those with a learning disability.

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

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. This was to review all palliative care patients, emergency admissions of patients on the frail and vulnerable register, any safeguarding concerns and mental health issues.

• 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.

• The practice maintained a frail and vulnerable register with care plans in place for vulnerable patients, including rapid post-discharge contact and same day appointment/home visit availability.The practice had identified 122 frail and vulnerable patients all had been contacted by the practice care coordinator, received post discharge telephone calls and regular reviews.

• The practice worked closely with ‘Aquarius’’ who provided a free confidential service to those who have a problem with alcohol, or were affected by someone else's drinking.

• The practice had set up a deceased patient’s notification system, followed by same day contact for the bereaved by their usual GP.

• Additional support was provided for those on the practice register of carers with “Carers Health Checks” one hour appointment with the health care assistant and Care and Community Co-ordinator.