Swan Surgery

Updated 23 February 2018

Swan Surgery is a purpose built practice situated in Bury St. Edmunds, Suffolk. The practice provides services for approximately 12,000 patients. It holds a Personal Medical Services contract with West Suffolk Clinical Commissioning Group (CCG). The practice is a training practice and teaches trainee GPs and Foundation Year Two doctors. The practice dispenses to patients who are eligible for this service.

There are ten GPs (six male and four female) at the practice. There are three female nurses, and two health care assistants. The operations and business managers are supported by a team of receptionists, data clerks, and medical secretaries and a team of five dispensers.

The most recent data provided by Public Health England showed that the patient population has a higher than average number of patients aged between five and 19, 35 to 54 and over 85 compared to the England average. The practice is located within an area of low deprivation.

Swan Surgery is open from Monday to Friday and offers appointments between 8am and 6.30pm daily, with extra appointments available for pre-booking on a Saturday morning between 9am and 12.30pm. The practice dispensary is also open during these hours. Extended hours appointments are provide by GP+ for whom the practice allows use of its premises. Out of hours care is provided by Care UK via the NHS 111 service.

Updated 23 February 2018

We carried out an announced comprehensive inspection at the Swan Surgery on 7 July 2017. The practice was rated as good for providing effective, caring, responsive and well led services and requires improvement for providing safe services. Overall the practice was rated as good.

We undertook a follow up focused inspection of Swan Surgery on 14 February 2018. This inspection was carried out to review in detail the actions taken by the practice to improve the quality of care and to confirm that the practice was now meeting legal requirements.

Overall the practice is still rated as good, and has been rated as good for providing safe services.

Our key findings were as follows:

• All equipment and medicines in the GP bags were within the expiry date. There was a policy and log in place to support the new checking system.
• There was a system in place to record, learn from, and discuss incidents such as near misses in the dispensary.
• Dispensary staff had easy access to the standard operating procedures.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 August 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles, supported by the data team, in managing the recall of patients with long term conditions.
• Data from the Quality and Outcomes Framework 2015-2016 showed that the practice performance in relation to diabetes was 100%. This was 3% above the local average and 10% above the national average. The practice exception reporting rate for the ten individual indicators relating to diabetes varied, some were slightly above and others lower when compared with the CCG and the national average (exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects). The practice held joint diabetic clinics twice monthly with the local hospital specialist diabetic nurse. This allowed the practice to treat diabetic patients in a timely manner.
• The practice performance in relation to chronic obstructive pulmonary disease was 100%; this was 1% above the CCG average and 4% above national average. Exception reporting was in line with the local and national averages.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured their care plans were updated to reflect any additional needs.
• There were emergency processes in place for patients with long-term conditions who experienced a sudden deterioration in health.

Updated 7 August 2017

The practice is rated as good for the care of families, children, and young people.

We found there were systems 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 accident and emergency (A&E) attendances.

The practice had met the national target for the standard childhood immunisations. Additional recall systems were in place to encourage further uptake.

Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

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

The practice worked with midwives, health visitors, and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

The practice had emergency processes in place for acutely ill children and young people, and for patients with acute pregnancy complications.

Practice staff had undertaken additional training in awareness of domestic abuse and female genital mutilation.

Updated 7 August 2017

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

• Practice staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• There was a named GP for these patients and GPs and a nurse practitioner, supported by a GP, undertook weekly visits to ensure proactive health care to patients living in local care homes. The nurse supported the homes with specialist areas such as complex wound care.
• The practice identified older patients who may need palliative care as they were approaching the end of life. The practice involved older patients in planning and making decisions about their care, including their end of life care. The practice proactively used special notes to ensure other health providers were aware of the patient’s wishes in relation to their preferred place of care.
• The practice followed up on older patients discharged from hospital and ensured their care plans were updated to reflect any additional needs.
• The practice worked with voluntary agencies such as Suffolk Family Carers and Age UK Suffolk to offer additional support to older patients.

Updated 7 August 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of this population group had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. For example, extended hours appointments were available at the practice on Saturday mornings for GPs and nurses. The practice was also part of a GP+ service; patients were able to be seen for evening or weekend appointments. The GP+ service operated from the Swan Surgery premises.

• Telephone consultations were available for those who wished to access advice this way.
• Patients were able to communicate with the practice via email. Systems and processes were in place to ensure this is safely managed.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs of this age group.
• NHS health checks were available at times convenient to the patient.

Updated 7 August 2017

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

• The practice carried out advance care planning for patients living with dementia.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• One GP at the practice was the clinical lead for mental health, dementia, and learning difficulties at the local clinical commissioning group (CCG).
• Data for the Quality and Outcomes framework from 2015 to 2016 showed the practice performance for mental health was 99.5%. This was 7% above the CCG average and the national average. The practice exception reporting rate for all the indicators relating to mental health were below the local and national averages.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia. A mental health link worker attended the practice regularly to support the GPs and ensure the patients with complex needs were well supported.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• The practice staff, including nurses and non-clinical staff, had received enhanced training which enabled them to build a rapport and support patients with mental health needs and dementia. Dementia friendly clocks were available in all five waiting areas. The practice had achieved a Dementia Friendly status as it had been assessed and had received an accreditation from West Suffolk CCG.

Updated 7 August 2017

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

• The practice was proactive in ensuring vulnerable patients were able to register for health care. For example, homeless patients and those living in local hostels.
• The practice held regular weekly meetings to ensure that patients who may be vulnerable were managed in a holistic manner.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients with a learning disability and held weekly meetings with the local learning disabilities nurse.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Practice staff we spoke with knew how to recognise signs of abuse in children, young people, and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies during normal working hours and out of hours.

The practice has close links with The Bury Drop In Centre; this centre provided a place for homeless people to access food, haircuts, and support. The practice had close links with other organisations such as those that provide emergency accommodation.