Archived: Woodville Surgery

Updated 6 August 2015

The Woodville Surgery provides primary medical services to approximately 9,120 patients through a general medical services (GMS) contract. The services are provided from a single purpose built practice.

The practice is situated in a former mining community. The practice population live in one of the less deprived areas of the country, yet the number of children and older people affected by income deprivation is above average.

The practice team comprises four GP partners (two male and two female) providing 32 sessions per week. They are supported by two part time practice nurses and two part time healthcare assistants (who are all female). The practice employs a practice manager, an assistant practice manager and eight administrative and reception staff.

The practice is not currently designated as a training practice but they are a teaching practice with a medical student on placement.

The practice is open between 8.00am to 6.30pm Monday to Friday. Appointments are available from 9.00am to 12.00pm every morning and 4.00pm to 6.00pm each afternoon. The practice has opted out of providing out-of-hours services to their own patients. This service is provided by Derbyshire Health United when the practice is closed.

The practice declared non-compliance with Outcome 8 (Cleanliness and Infection Control) at the point of registration with CQC. This was due to not having lead within the practice for infection control and not having flexibility with their arrangements for cleaning. The practice has since appointed a lead for infection control and appointed a contract cleaning firm.

Updated 6 August 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Woodville Surgery on 20 May 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, responsive, caring and well led services. It was good for providing services for older people, people with long term conditions, families, children and babies, working age people (including those recently retired) and people experiencing poor mental health (including people with dementia) and required improvement for people whose circumstances may make them vulnerable.

Our key findings were as follows:

• Systems were in place for the learning and improvement from safety incidents. Staff understood and fulfilled their responsibilities to raise concerns and report incidents. Learning from incidents was shared internally and externally.
• Risks to patients were assessed and well managed.
• A multi-disciplinary approach to patient care was evident; the practice worked well with other agencies to ensure care and support was coordinated.
• Patients’ needs were generally assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Annual health checks had not been undertaken for patients with a learning disability in the last 12 months, however, the majority of these patients had been seen by a doctor in this time.
• Feedback we received from patients during the inspection, and through comment cards, was overwhelmingly positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about how to make a complaint was available and easy to understand. Complaints were dealt with appropriately and in a timely manner.
• 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.

We saw an area of outstanding practice:

• The practice employed a pharmacist on a contract basis to provide a consultation and advice service. The pharmacist’s role involved carrying out medicines audits, reviews of patients’ medicines, and checks on patients to determine whether they had had any negative side effects from medicines or from being prescribed several medicines. The pharmacist sent out a monthly newsletter updating all clinicians on any changes to medicines guidelines or medicines alerts which highlighted any actions which were necessary to ensure patients received appropriate treatment. The pharmacist also did a patient search and identify affected patients to ensure action was taken as needed.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Strengthen systems to assess and demonstrate the competence of healthcare assistants for specific tasks.
• Ensure routine checks undertaken on equipment are documented.
• Review policies and procedures to ensure these are robust, for example ensuring recruitment policy includes pre-employment checks required by legislation.
• Ensure governance systems are strengthened to include more detailed recording of meetings and information disseminated.
• Ensure staff have had appropriate training to undertake annual health checks for patients with a learning disability and undertake these checks as soon as possible

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 August 2015

The practice is rated as good for the care of people with long-term conditions. The practice had GP leads for long term conditions as well as practice nurse leads for some conditions, including diabetes and chronic obstructive pulmonary disease (COPD).

We found that practice nursing staff had the skills and knowledge to respond to the needs of patients with diabetes, asthma, COPD and cardiovascular disease. Patients diagnosed with diabetes were recalled in the month of their birthday and this system was being rolled out across other long term conditions as well as inviting patients with multiple long term conditions to one annual review. The practice had improved their monitoring of patients with diabetes through the use of this system. For example, the percentage of patients with diabetes receiving an influenza immunisation had increased from 76.3% to 98.2%.

If patients were unable to attend the surgery, practice nurses and GPs undertook home visits. For those who attended the surgery for appointments, these were offered with flexible times and days.

The practice was aware of patients at risk of an unplanned admission to hospital and demonstrated a multi-disciplinary team approach to care planning.

Updated 6 August 2015

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

There was a named safeguarding lead at the practice. The staff we spoke with demonstrated knowledge and understanding in relation to safeguarding children and were aware of their responsibilities to report concerns. The practice held regular meetings with health visitors and school nurses to discuss children at risk.

Two of the practice GPs fitted contraceptive implants. Antenatal clinics were run twice per week from the practice by the midwife. The practice operated a call and recall system for baby checks and immunisations and flagged issues of concern to the health visitor.

Flexible appointment times were offered for mothers at the beginning and end of the day to avoid long waiting times. Babies and young children were seen on the same day in the practice’s sit and wait clinic.

Updated 6 August 2015

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

All patients over 75 had a named GP for continuity of care. The practice was responsive to the needs of older people, and offered homes visits for those with enhanced needs. Some services were offered in house to minimise travel for older patients, such as phlebotomy (collecting blood samples for testing). The practice had an enhanced care register.

The practice had recently implemented a system of planned visits to the five local care homes it served on a monthly basis to prevent unplanned hospital admissions. The practice had a Carers’ Champion who identified and met with carers to signpost them to local support services. The practice had an attached care coordinator who organised monthly multidisciplinary meetings and provided the practice with a link to social services which the GPs told us was timesaving for them.

Updated 6 August 2015

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, for example, the practice had recently started piloting 8:00am appointments. Pre-bookable appointments were available up to four weeks in advance and the practice offered telephone consultations.

The practice was proactive in offering online services as well as a range of health promotion and screening that reflected the needs of this age group. The practice used technology and IT to communicate with this population group. For example, the practice sent out appointment reminders via text message and was trialling using text messaging to communicate normal blood test results. The practice had a presence on social media with a profile on Facebook and Twitter.

The practice had an active patient participation group (PPG), a number of whose members were of a working age. The PPG are a group of patients who work together with the practice staff to represent the interests and views of patients so as to improve the service provided to them.

Updated 6 August 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). 92.5% of patients with a mental condition had a comprehensive, agreed care plan in place.

The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

The practice had a lead GP for mental health. The practice healthcare assistants were trained to undertake mini mental tests for patients who had been experiencing memory problems which facilitated early diagnosis of dementia. The practice manager had recently attended dementia awareness training and was planning to involve Alzheimer’s Society in planning for their new surgery building to ensure this was dementia friendly.

The practice offered longer appointments for patients experiencing poor mental health as required and offered home visits for those patients unable to attend the surgery.

Updated 6 August 2015

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

We saw evidence of support for people whose circumstances may make them vulnerable such as working closely with social care colleagues to enable patients to remain living at home. The practice held regular multi-disciplinary community support team meetings at which vulnerable people were discussed. Details of how to access support groups and voluntary organisations were available via the practice website and in the reception area.

The practice recognised patients whose circumstances may make them vulnerable, for example those who were homeless and those who had experienced drug and alcohol misuse. Staff gave an example of having registered a patient with no fixed abode.

The practice offered longer appointments where these were necessary, for example due to communication difficulties. The practice had access to interpretation services if necessary and a practice nurse was able to communicate using basic sign language. The practice had a wide range of easy read information available.

The practice had not undertaken any annual health checks for patients on its register with a learning disability in the last 12 months due to not having any staff trained to undertake these. However, the majority of patients on the register had seen a doctor in that time and general health had been reviewed opportunistically.