Binscombe Medical Centre

Updated 14 March 2016

Dr AS Cook & Partners, also known as Binscombe Medical Centre, is located in a residential area in the north part of Godalming, just on the edge of Farncombe. The practice is located in purpose built premises with a community pharmacy sharing the premises.

The practice operates from:

106 Binscombe, Godalming, GU7 3PR

There are approximately 10,300 patients registered at the practice. Statistics show very little income deprivation among the registered population. The registered population is slightly lower than average for 15-35 year olds, and slightly higher than average for those aged over 35.

Care and treatment is delivered by seven GP partners and two salaried GPs. There are four male GPs and five female GPs working at the practice, two GPs work full time and seven work part time. The nursing team consists of four practice nurses and three healthcare assistants. 15 administrative staff work at the practice and are led by a Practice Manager.

The practice is a training practice and regularly has GP trainees working in the practice. There are three GP trainers one of whom is programme director for the local training scheme.

The practice is open from 8am to 6.30pm Monday to Friday. Patients can book appointments in person, via the phone and online.

Patients requiring a GP outside of normal working hours are advised to contact the NHS GP out of hours service on telephone number 111.

The practice has a General Medical Services (GMS) contract. GMS contracts are nationally agreed between the General Medical Council and NHS England.

Dr AS Cook & Partners was previously inspected in July 2014. There were no concerns found at the previous inspection.

Updated 14 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr A.S. Cook & Partners on 5 January 2016. Overall the practice is rated as outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• 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.

• Feedback from patients about their care was consistently and strongly positive.

• 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 several areas of outstanding practice:

• The practice had a clear vision to deliver high quality care and promote good outcomes for patients. This was documented as a covenant, based on a commitment to the whole of a patient’s life. We saw evidence of this in how the practice responded to individual needs, such as how older people were cared for.

• The practice had developed a proactive anticipatory care plan for patients which provided a framework for the patient, their family, carers and health care professionals to work together to plan care. The care plan was used in care homes and the practice was able to provide evidence of a significant reduction in hospital admissions from care homes. The care plan had been adopted by the CCG for use by other practices.

• GPs provided out of hours support for end of life care seven days a week, reducing unnecessary hospital admissions and helping patients achieve a dignified death in the place of their choosing. The practice also provided 24 hour on call cover seven days a week to a children’s hospice.

• The practice was proactive in providing equipment for patients for improved diagnosis and self care. For example, they provided cardiac memos and had 22 blood pressure monitors for patients to borrow to aid diagnosis and support self care. This enabled patients to get faster access to the treatment they needed.

• The practice had set up a patient library with books covering a wide range of topics including mental health issues which patients were encouraged to borrow. Patients had fedback that this facility was very helpful and gave them access to information they wouldn’t otherwise have had.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 March 2016

The practice is rated as outstanding for delivery of caring and well led services. The rating applies to all patient groups.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Diabetic patients were given an individualised care plan at their review.

• 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.

• Patients were offered the loan of blood pressure monitors to enable improved diagnosis and self care.

Updated 14 March 2016

The practice is rated as outstanding 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.

• 92% of eligible female patients had a cervical screening test compared to national average of 82%.

• 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. The practice nurse had attended a training day with the school nurses and the school nurse attended practice meetings quarterly.

• The practice provided 24 hour medical cover for a children's hospice. We spoke with the hospice who told us that they thought the quality of care and responsiveness offered by the practice was very high.

Updated 14 March 2016

The practice is rated as outstanding 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 identified those patients most at risk of hospital admissions. A Health Care Assistant (HCA) contacted patients after a discharge to offer assistance and support and updated care plans.

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

• The practice carried out weekly visits at five care homes for older people and feedback from the homes was very positive.

• The practice had developed a proactive anticipatory care plan for patients which provided a framework for the patient, their family, carers and health care professionals to work together to plan care. The care plan allowed care to be delivered in line with the patient’s wishes. The practice was able to provide evidence of a significant reduction in hospital admissions from care homes (from an average of 8 admissions per month to 5 admissions per month, a reduction of 37% for 2015 compared with the same time period in 2014).

• The GPs provided end of life support from 8am – 10pm seven days a week.

Updated 14 March 2016

The practice is rated as outstanding for delivery of caring and well led services. The rating applies to all patient groups.

• 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 and had a 30% uptake on repeat prescription requests compared to a national average of 4%.

• The practice offered a full range of health promotion and screening that reflects the needs for this age group.

• Topical health information was discussed on the practice blog and one of the GPs used social media to promote health related information.

• The practice website had a dedicated area for working people which referred to practice information as well as external resources that patients might find useful. For example, a local advice agency.

Updated 14 March 2016

The practice is rated as outstanding for delivery of caring and well led services. The rating applies to all patient groups.

• 91% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was better than the national average of 84%.

• 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.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

• One of the GPs had a special interest in dementia and had spoken at a local community event as well as contributing to national conferences and publications.

• The practice had set up a patient library with books covering a wide range of topics including mental health issues which patients were encouraged to borrow. Patients had stated that this had helped them to understand their condition better and deal with issues they were facing.

Updated 14 March 2016

The practice is rated as outstanding for delivery of caring and well led services. The rating applies to all patient groups.

• The practice held a register of patients living in vulnerable circumstances including homeless patients, travellers and those with a learning disability. These patients were flagged on the computer system so that they had priority for appointments.

• 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 patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations. There were strong connections with local support services and the practice gave an example of how they delivered high quality care for a particularly vulnerable patient.

• The practice provided support to a nursing home for adults with physical disabilities and feedback from the home was very positive.

• 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.

• A taxi fund was available for patients to attend the surgery urgently when other means of transport were unavailable.