Ryeland Surgery

Updated 9 January 2018

The Marches Surgery is based in the town of Leominster in Herefordshire and provides services to 9,100 patients in Leominster and the surrounding area. This is a rural area with a large elderly population.

The practice has a General Medical Services contract (GMS) with NHS England. A GMS contract ensures practices provide essential services for people who are sick as well as, for example, chronic disease management and end of life care. The practice also provides some enhanced services such as minor surgery, childhood vaccination and immunisation schemes.

The practice has two GP partners, four salaried GPs, a practice manager partner, a nurse practitioner, three practice nurses, three healthcare assistants, and receptionists and staff who provide administrative support. They have recently employed a former community paramedic as a primary care practitioner to provide minor illness clinics and attend home visits. There is a branch surgery at Bodenham which has a dispensary. Patients are free to book appointments at either practice. We did not visit the branch surgery.

The Marches Surgery is a training practice with trainee GPs, junior doctors and medical students from Keele University, and Physician Assistant trainees and student nurses from Worcester University.

The practice is open to patients between 8am and 6pm Monday to Friday and closed at weekends. Extended hours appointments are available at the practice on Tuesday and Wednesday evenings from 6pm until 8pm. Emergency appointments are available daily. Telephone consultations are available and home visits for patients who are unable to attend the surgery. Extended hours appointments are provided by Taurus (the seven day access service in Herefordshire) evenings and weekends (from 8am until 12pm both days). The practice does not provide an out of hours services. Patients are provided with information about the local out of hours services based in Hereford which they can access by using the NHS 111 telephone number.

Updated 9 January 2018

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

At this inspection we found:

• The practice had systems and processes to minimise risks to patient safety. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Learning was shared with staff and outcomes had been actioned.
• There was a system for recording, actioning and tracking patient safety alerts. All alerts had been reviewed and action taken where appropriate. All alerts were reviewed in clinical meetings.
• All appropriate recruitment checks had been carried out on staff prior to being employed by the practice. This included medical indemnity checks carried out on locum GPs employed.
• Feedback from patients about their care was consistently positive and this was reflected in the National GP Patient Survey results published in July 2017.
• The practice had good facilities and was well equipped to treat patients and meet their needs. This included appropriate arrangements for equipment and medicine that may be required to respond to a medical emergency.
• Information about services and how to complain was available to patients. The practice made improvements to the quality of care as a result of learning from complaints and concerns.
• There was a practice development plan that documented both their long and short-term priorities. This included actions they had taken in response to patient feedback about the difficulty in accessing appointments, and the plans for continued improvements.
• The practice had visible clinical and managerial leadership with audit arrangements in place to monitor quality.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 February 2015

This practice is rated as good for the care of patients with long term conditions, for example asthma and diabetes. The practice had effective arrangements for making sure that patients with long term conditions were invited to the practice for annual and half yearly reviews of their health. Members of the GP and nursing team at the practice ran these clinics. The practice had a specialist diabetes nurse.

Patients whose health prevented them from being able to attend the surgery received the same service from one of the district nurses who arranged visits to them at home (including patients in the seven care homes the practice supports). Patients told us they were seen regularly to help them manage their health.

Updated 5 February 2015

This practice is rated as good for the care of families, children and young people. The practice held weekly childhood vaccination clinics for babies and children. Child flu vaccinations were also provided. A midwife came to the practice weekly to see expectant mothers. The practice provided a family planning service.

Updated 5 February 2015

This practice is rated as good for the care of older patients. Patients over the age of 75 had a named GP and many were included on the practice’s ‘avoiding unplanned admissions’ list to alert the team to people who may be more vulnerable. The GPs carried out visits to patient’s homes if they were unable to travel to the practice for appointments. The practice was in the process of delivering its ‘flu vaccination programme.  The practice nurse was arranging for these to be done at patient’s homes if their health prevented them from attending the clinics at the surgery. The practice worked with seven local care homes to provide a responsive service to the patents who lived there.

Updated 5 February 2015

This practice is rated as good for the care of working age patients, recently retired people and students. The practice had arrangements for people to have telephone consultations with a GP if needed. One GP specialised in musculoskeletal conditions, sports injuries and sports medicine.  

Updated 5 February 2015

This practice is rated as good for the care of patients experiencing poor mental health (including patients with dementia). The practice hosts a mental health worker, had a register of patients at the practice with mental health support and care needs and invited them for annual health checks. Staff described close working relationships with the local mental health team which worked with the practice to identify patients’ needs and to provide patients with counselling, support and information. The practice hosts a specialist dementia care nurse.

Updated 5 February 2015

This practice is rated as good for the care of patients living in vulnerable circumstances. One of the GPs was the lead for learning disability (LD) care at the practice and the practice had an LD register. All patients with learning disabilities were invited to attend for an annual health check.  Staff told us that the practice did not have many travelling individuals or families currently registered at the practice, although this had been greater in the past. We learned that when homeless people came to the practice the team provided appropriate care and treatment and supported them with establishing a correspondence address if possible. The practice was part of the local GP prescribing scheme for drug dependency.