Willingham-by-Stow Surgery

Updated 23 December 2016

Willingham-by-Stow Surgery is a two partner practice which provides primary care services to approximately 3850 under a General Medical Services (GMS) contract.

• The practice is situated in a purpose built building and has two branches that are open twice a week for one hour. The branches are situated in rural areas and are for patients that are unable to attend the main practice for GP consultations.

• The main site has a car park at the back of the building with a disabled car parking space at the front next to the door. There is a small dispensary that dispenses to 88% of the practice patients.

• Services are provided from The Surgery, High Street, Willingham-by-Stow, Gainsborough, Lincolnshire, DN21 5JZ with branches at 11 The Old Courtyard, Marton, Gainsborough, DN21 5XX and 38a Middle Street, Corringham, Gainsborough, DN21 5QS.

• The inspection team visited the The Surgery, High Street site for the inspection.

• The practice consists of two partner GPs (male) and one salaried GP (female).

• The nursing team consists of two practice nurses, one health care assistant (HCA) and a phlebotomist.

• The practice has a practice manager who is supported by a patient services manager, five dispensing staff and seven clerical and administrative staff to support the day to day running of the practice.

• When the practice is closed patients are able to use the NHS 111 out of hours service.

• The practice has a higher than average number of patients aged 45 and over and a lower than average under 45 years of age.

• The practice has low deprivation and sits in the fourth least deprived centile.

• The practice is registered to provide the following regulated activities; surgical procedures; family planning, diagnostic and screening procedures, maternity and midwifery services; and treatment of disease, disorder or injury.

• The practice lies within the NHS Lincolnshire West Clinical Commissioning Group (CCG). A CCG is an organisation that brings together local GPs and experienced health professionals to take on commissioning responsibilities for local health services.

• The practice is open between 8am and 6.30pm Monday to Friday. The branch at Marton is open Monday and Fridays 12.30pm to 1.30pm and Corringham Tuesday 12.30 to 1.30pm and Thursday 12pm to 1pm. Appointments are available from 8.30am to 6pm at the main practice with appointments in the designated times at the branches, bookable at Willingham. GP appointments are available on the day and pre-bookable appointments can be booked up to six weeks in advance.

Updated 23 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Willingham-by-Stow Surgery on 6 December 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 been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patient survey figures showed patients rated the practice consistently higher than others for all aspects of care.
• 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.
• 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.
• Safety alerts and alerts from Medicines and Healthcare products Regulatory Agency (MHRA) were reviewed and cascaded to the appropriate persons.

• There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular meetings.

• The practice had identified 105 patients as carers (2.7% of the practice list).

The areas where the provider should make improvement are:

• Complete an annual review of significant events including near misses and complaints to identify trends and themes.
• Update action plans accordingly to evidence completed actions
• Consider including dispensing staff in clinical meetings.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 December 2016

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

• One of the GPs had lead role in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The nursing team were trained in long term conditions and the practice worked alongside community specialist nurses such as the community respiratory team.

• Performance for diabetes related indicators was comparable to CCG and national averages. (96% compared to 92% CCG average and 90% national average).
• Longer appointments and home visits were available when needed.

Updated 23 December 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.

• Immunisation rates were in line with CCG averages 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.

• The practice’s uptake for the cervical screening programme was 84%, which was similar to the CCG average of 80% and the national average of 76%.

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

Updated 23 December 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 worked at identifying patients at risk of hospital admission to reduce the risk and reduce the amount of unplanned admissions.

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

• The practice had two bi-weekly sessions at the branch surgeries which had areas of a high elderly population.

• Dosette boxes and a delivery service for those patients that needed it provided from the dispensary.

• The practice worked with the multi-disciplinary teams in the care of older vulnerable patients.

Updated 23 December 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 and flexible.

• Patients could book appointments on line, in person or on the telephone.

• The practice offered a same day urgent triage and telephone consultations if required.

• 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.

Updated 23 December 2016

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

• 70% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was below the CCG average of 80% and the national average of 79%.

• 100% of patients experiencing poor mental health were involved in developing their care plan in last 12 months which was higher than the national average of 92%.

• 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. All staff had completed a training session on dementia.

Updated 23 December 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 branch surgery was within walking distance from one of the learning disability/psychiatric facilities.

• The practice offered a flexible appointment for these patients to reduce stress if attending the practice.

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

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• 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.