Tisbury Surgery

Updated 11 May 2016

Tisbury Surgery is located in a purpose built building near the centre of the village of Tisbury in Wiltshire. All the consulting rooms are on the ground floor.

The practice delivers its services under a General Medical Services contract (A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract) to approximately 3,700 patients at the following address: Tisbury Surgery, Park Road, Tisbury, Salisbury, SP3 6LF.

The practice is a registered yellow fever vaccine centre.

There are two GP partners and one part time salaried GP. Two are male and one is female. There are two practice nurses, one health care assistant, two cleaners and a team of six receptionists and administrators who support the practice manager. The practice employed a specialist asthma nurse on a sessional basis to offer specialist asthma clinics.

The practice is a training practice and at the time of our inspection they had one GP registrar working with them.

The practice has a higher than average number of patient over 45 and 27% of patients are over 65. The general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in the second least deprivation decile. (An area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score. 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). Average male and female life expectancy for the area is 81 and 84 years, which is broadly in line with the national average of 79 and 83 years respectively.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments with GPs are from 8.30am to 6.30pm. Extended surgery hours are offered from 6.30pm to 7.45pm one evening a week on alternate Tuesdays and Wednesdays, and 9am to 11am one Saturday per month.

The practice has opted out of providing out of hours services to their patients. The out of hours service is provided by MEDVIVO.  Out of hours the telephone system automatically diverts callers to the out of hours service.

This practice had not been previously inspected.

Updated 11 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Tisbury Surgery on 2 March 2016. Overall the practice is rated as good.

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• Feedback from patients about their care was consistently and strongly positive.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, installing a handrail in the corridor.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.
• The practice had a clear vision which had quality and safety as its top priority.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• The national GP patient survey showed 100% of patients found it easy to get through to this surgery by phone, compared to a national average of 73%.
• The practice had a longstanding and active patient participation group (PPG) which met at least three times a year and meetings were attended by at least of the GP partners. Members of the PPG had their contact details listed on the practice website so that patients could contact them directly if they wished.

We saw some areas of outstanding practice.

• They were proactive in communicating with patients. For example, following a recent drug safety alert the practice wrote a personal letter to all patients affected, signed by the GP, giving them further advice about the medicine and inviting them to contact the GP if they wanted to discuss it further.  

• The practice management was sensitive to the needs of the service and those working in it and had clear and robust systems in place.  For example the practice had a system for reviewing their policies and procedures which included recording the changes made and the reasons for them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 May 2016

The practice is rated as good for the care of patients 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.

•  99% of patients on the diabetes register had a foot examination and risk classification within the preceding 12 months (04/2014 to 03/2015) compared to the national average of 88%.

• The practice employed a specialist asthma nurse to offer asthma clinics for patients with this condition.

• 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 11 May 2016

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

• 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 patients who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• 73% of patient with asthma on the register had an asthma review in the last 12 months (04/2014 to 03/2015), compared to the national average of 75%.

• Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• 79% of women aged 25-64 on the register had a cervical screening test in the preceding five years (04/2014 to 03/2015), compared to the national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

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

Updated 11 May 2016

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

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 sent a birthday card and health questionnaire to patients on their 75th birthday and if appropriate they were contacted by a nurse or elderly care coordinator when the questionnaire was returned.

• The local palliative care nurse, district nurses, occupational therapist and care co-ordinator attended monthly practice meetings.

• The GPs routinely gave their personal phone number to patients on palliative care so if they need help out of hours they did not need to see the out of hours GP who may not know them.

Updated 11 May 2016

The practice is rated as good for the care of working-age patients (including those recently retired and students).

population groups.

• 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.

• The practice offered appointments on alternate Tuesday and Wednesday evening until 7.45pm and on one Saturday per month from 9am to 11am for working patients who could not attend during normal opening hours.

Updated 11 May 2016

The practice is rated as good for the care of patients experiencing poor mental health (including patients living with dementia). There were aspects of the practice which were outstanding and related to all population groups.

• 82% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months (04/2014 to 03/2015), which is comparable to the national average of 84%.

• 90% of patients with a psychosis had a comprehensive, agreed care plan documented in the preceding 12 months (04/2014 to 03/2015), which is comparable to the national average of 88%.

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

• The practice carried out advance care planning for patients diagnosed 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 11 May 2016

The practice is rated as good for the care of patients whose circumstances may make them vulnerable.   

• The practice held a register of patients living in vulnerable circumstances including homeless patients, travellers and those with a learning disability.

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

• The practice regularly worked with multi-disciplinary teams 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.