The Lodge Surgery

Updated 12 January 2017

The Lodge Surgery is a GP practice located in the Wiltshire town of Chippenham. It is one of the practices within the Wiltshire Clinical Commissioning Group and has approximately 8,100 patients.

The practice building is purpose built with most patient services located on the ground floor, including: seven consulting rooms, two treatments rooms, a self-check-in appointment system and a toilet suitable for people with disabilities. One of the consulting rooms was on the first floor and accessed by stairs which had been fitted with a stair lift.

The area the practice serves has relatively low numbers of people from different cultural backgrounds and is in the low range for deprivation nationally, (although it is important to remember that not everyone living in a deprived area is deprived and that not all deprived people live in deprived areas). The practice has a higher than average patient population between five and 25 years of age and between 40 and 60 years of age. Average male and female life expectancy for the area is 82 and 85 years, which is broadly in line with the national average of 79 and 83 years respectively.

The practice provides a number of services and clinics for its patients including childhood immunisations, family planning, minor surgery and a range of health lifestyle management and advice including asthma management, diabetes, heart disease and high blood pressure management.

There are three GP partners and three salaried GPs (two male, four female) making a full time working equivalent of four. They are supported by an advanced nurse practitioner, three practice nurses, two health care assistants and an administrative and reception team of 15 led by the practice manager.

The practice is a teaching and training practice. (A teaching practice accepts medical students while a training practice accepts qualified doctors training to become GPs, who are known as registrars.) At the time of our inspection they had one registrar working with them.

The practice is open between 8am and 6.30pm on weekdays. GP appointments are available between 8.30am and 12.00pm every morning and 2.30pm to 6pm every weekday. Extended hours appointments are offered from 6.30pm and 7.30pm on alternate Monday and Wednesday, and on one Saturday morning each month. Appointments can be booked over the telephone, via their website or in person at the surgery up to four weeks in advance.

Patients who phone wanting an on-the-day appointment have their request triaged by a nurse trained in this procedure. The nurse phone the patient back, discussed their request and agrees an appropriate course of action which may include an appointment that day with a nurse or GP.

When the practice is closed patients are advised, via the practice’s website that all calls will be directed to the out of hours service. Out of hours services are provided by Medvivo.

The practice has a Personal Medical Services contract to deliver health care services. This contract acts as the basis for arrangements between NHS England and providers of general medical services in England.

The practice provides services from the following site:

• The Lodge Surgery, Lodge Road, Chippenham, Wiltshire, SN15 3SY

Updated 12 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Lodge Surgery on 15 November 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had been accredited as a Young Person Friendly practice by the local authority, and had been the first practice in Wiltshire to achieve this status.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and 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 one area of outstanding practice:

• The practice had worked with a national charity to identify young carers which had resulted in 11 young carers being identified and then actively supported them to meet with the practice staff.

The areas where the provider should make improvement are:

• Ensure all staff receive training in a timely manner when it is due.
• Ensure nursing staff receive clinical supervision and support appropriate to their role.
• The practice must ensure letters sent responding to complaints include details of how to escalate the complaint if they were unsatisfied with the result.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 January 2017

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.
• The practice had specialist diabetic nurse who saw patients with this condition.
• 98% of patients with diabetes on the register had an influenza immunisation in the period 8/2014 to 3/2015, compared to the clinical commissioning group average of 96% and national average of 94%.
• 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. 

Updated 12 January 2017

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 relatively high for all standard childhood immunisations.
• The practice recognised they had a higher than average number of children and young people and had worked to ensure they had services to meet their needs. They had a notice board in the waiting room dedicated to this age group and been accredited as a Young Person Friendly practice by the local authority and had been the first practice in Wiltshire to achieve this.
• The practice offered a “No Worries” sexual health service aimed at young people that offered advice as well as access to free condoms, pregnancy testing kits and chlamydia screening kits.
• They had worked with a nation charity to identify young carers.
• 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.
• 86% of women on the register aged 25 to 64 had a cervical screening tests performed in the preceding five years compared to the clinical commissioning group average of 85% and national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We were told of positive examples of joint working with midwives and school nurses. 

Updated 12 January 2017

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 was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• All patients over 75 have a named GP.
• Twice yearly meetings were held with local care and nursing home managers to discuss issues and developments, and offer some training updates.

Updated 12 January 2017

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.
• 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.
• Telephone consultations were available where appropriate.​
• A SMS text messages service was available to those patients who signed up which included appointment reminders.

Updated 12 January 2017

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

• 98% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, compared to the clinical commissioning group (CCG) average of 88% and national average of 84%.
• 92% of patients on the register with a psychosis had a comprehensive care plan agreed in the preceding 12 months compared to the CCG average of 93% and national average of 88%.
• 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. Young people were signposted to a specialist website.
• 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.​
• The practice was able to refer patients to the local NHS counselling service which held weekly clinics on site.

Updated 12 January 2017

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 homeless people, travellers and those with a learning disability.
• The practice had developed a rapid registration system for patients living in a local short stay service for homeless people who want to register at the practice.
• The practice worked with the local drug and alcohol service and pharmacies to provide care and treatment to patients with drug problems under a shared care agreement. GPs had undertaken specialist training to deliver this service.
• 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.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• 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.