Southmead Surgery

Updated 12 February 2020

Southmead Surgery is a GP practice located in Farnham Common, South Buckinghamshire. The practice has approximately 6,600 patients and is one of the practices within Buckinghamshire Clinical Commissioning Group (CCG).

Clinical services are provided from:

• Southmead Surgery, Blackpond Lane, Farnham Common, Slough, Buckinghamshire SL2 3ER

The practice website is:

• www.southmeadsurgery.co.uk

There are two GP partners, three GPs, a practice paramedic and two clinical pharmacists at the practice. The nursing team consists of a lead nurse manager, a practice nurse and a health care assistant with a mix of skills and experience.

The practice manager and a team of reception and administrative staff undertake the day to day management and running of the practice.

According to national data there are high levels of affluence and minimal deprivation in Buckinghamshire, including the Farnham Common area. The age profile of the practice population is mixed, however there are significantly more patients aged 65 and over when compared to the national average.

The practice also provides GP services to a local prep school for boys (approximately 100 patients aged between seven and thirteen) and a proportion of patients in a local assisted living facility (approximately 45 registered patients) and a local nursing home (approximately 14 registered patients).

The practice has core opening hours from 8.30am to 6.30pm Monday to Friday to enable patients to contact the practice. Extended hours appointments were available with either a GP or Health Care Assistant on Monday mornings from 7.10am and with either a GP or Paramedic on Thursday evenings until 8pm. Patients at the practice could access improved access appointments at any of the eight practices across South Buckinghamshire. These improved access appointments were booked via the patient’s registered practice and offered a variety of appointments including up until 8pm Monday to Friday, selected hours on Saturdays and 9am until 1pm on Sunday and Bank Holidays.

The practice is registered by the Care Quality Commission (CQC) to carry out the following regulated activities: Diagnostic and screening procedures, Family planning, Maternity and midwifery services, Treatment of disease, disorder or injury and Surgical procedures.

Updated 12 February 2020

We carried out an announced focused inspection at Southmead Surgery, a GP practice in Farnham Common, South Buckinghamshire on 14 January 2020 as part of our inspection programme.

We carried out an inspection of this service following our annual review of the information available to us. This inspection looked at the following key questions:

• Are services effective?
• Are services well-led?

Following assurance received from our review of information we carried forward the ratings for the following key questions from the previous inspection in March 2017:

• Are services safe?
• Are services caring?
• Are services responsive?

We based our judgement of the quality of care at this service on a combination of:

• What we found when we inspected

• Information from our ongoing monitoring of data about services

• Information from the provider, patients, the public and other organisations.

We have rated this practice as good overall. We rated the practice as good for providing effective and well-led services and for the following population groups: older people; people with long term conditions, families children and young people; working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including dementia).

We found that:

• Patients’ needs were assessed, and care and treatment was delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways and tools.

• The practice had a comprehensive programme of quality improvement activity and routinely reviewed the effectiveness and appropriateness of the care provided.

• Staff had the skills, knowledge and experience to deliver effective care, support and treatment.
• The practice worked together and with other organisations to deliver effective care and treatment.

• There was compassionate, inclusive and effective leadership at all levels. This included working with and supporting the practice Patient Participation group (PPG).

• The practice had a clear vision and set of values that prioritised quality and sustainability.

• There were clear responsibilities, roles and systems of accountability to support good governance and management.

• There were clear and effective processes for managing risks, issues and performance.

We saw an area of outstanding practice:

• The practice provided an outstanding service to patients with caring responsibilities. This service was recognised by Carers Bucks (an independent charity to support unpaid, family carers in Buckinghamshire) and the practice was awarded an Investors in Carers GP Standard award. This was in recognition of the extra support they offer to unpaid carers who were registered at the practice. The practice had also engaged with the local boy’s prep school who accessed GP services from the practice and a local older person’s charity to create a buddy and pen pal initiative between the school and older people (including those with caring responsibilities) within the practice. This initiative was created to reduce loneliness, social isolation and also to increase engagement and community within the village.

Whilst we found no breaches of regulations, the provider should:

• Continue to improve uptake for cervical screening to ensure the practice’s meets the national target of 80%.

Details of our findings and the evidence supporting the change in rating are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Updated 4 May 2017

The provider had resolved the concerns for safety, responsiveness and well-led identified at our inspection on 14 July 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

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.
• Performance for diabetes related indicators showed the practice had achieved 99% of targets which was higher when compared to the CCG average (95%) and the national average (90%).
• Performance for Chronic Obstructive Pulmonary Disease (known as COPD, a collection of lung diseases including chronic bronchitis and emphysema) indicators showed the practice had achieved 100% of targets which was similar when compared to the CCG average (99%) and higher when compared to the national average (96%).
• 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.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• All these patients had a named GP and there was a system to recall patients for 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.

Updated 4 May 2017

The provider had resolved the concerns for safety, responsiveness and well-led identified at our inspection on 14 July 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• From the sample of documented examples we reviewed 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.
• Immunisation rates were above expected achievements in all four areas for standard childhood immunisations.
• The practice had a policy for following up all children who had not attended for immunisations with outside agencies, such as health visitors, and GPs reviewed all records to identify any vulnerabilities or concerns.
• 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.
• The practice provided support for premature babies and their families following discharge from hospital.
• 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 for acutely ill children and young people and for acute pregnancy complications.

Updated 4 May 2017

The provider had resolved the concerns for safety, responsiveness and well-led identified at our inspection on 14 July 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients 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 identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Where older patients had complex needs, the practice shared summary care records with local care services, such as out of hours GP services.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice worked with multi-disciplinary teams in the care of older vulnerable patients.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were higher than the average.
• For example, 96% of patients with dementia had been reviewed face-to-face in the previous 12 months compared to the CCG average of 85% and national average of 84%.

Updated 4 May 2017

The provider had resolved the concerns for safety, responsiveness and well-led identified at our inspection on 14 July 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• 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.
• 88% of women aged 25 to 64 had a cervical screening test in the last five years compared to the CCG average of 84% and national average of 81%.
• The practice offered extended opening hours on a Monday morning from 7.20am.
• Requesting repeat prescriptions and booking appointments could be done online.

Updated 4 May 2017

The provider had resolved the concerns for safety, responsiveness and well-led identified at our inspection on 14 July 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• 96% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is higher than the national average of 84%.
• 95% of patients with mental health conditions had an agreed, documented care plan, which is higher that the CCG average of 92% and the national average of 89%.
• 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.

Updated 4 May 2017

The provider had resolved the concerns for safety, responsiveness and well-led identified at our inspection on 14 July 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• The practice offered longer appointments for vulnerable patients.
• 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.
• We saw there were 15 patients on the learning disabilities register and nine of the patients (60%) had a recorded health check. The remaining patients had been contacted and invited to attend a health check if appropriate.
• 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.