Silverdale & Ryecroft Practice

Updated 14 November 2016

Silverdale & Ryecroft Practice is registered with the Care Quality Commission (CQC) as a partnership provider in Newcastle-under-Lyme, Staffordshire. The practice holds a Personal Medical Services (PMS) contract with NHS England. A PMS contract is a locally agreed alternative to the standard General Medical Services (GMS) contract used when services are agreed locally with a practice which may include additional services beyond the standard contract.

Overall, the practice area is one of moderate deprivation when compared with the national and local Clinical Commissioning Group (CCG) area. However there are pockets of high deprivation and low deprivation in the geographical area the practice serves. At the time of our inspection the practice had 12,279 patients. The practice has a higher proportion of patients aged over 65 (21%) and 75 (11%) when compared with the national averages of 17% and 8% respectively. The percentage of patients with a long-standing health condition is 60% which is above the local CCG average of 57% and national average of 54%. This may mean increased demand for GP services.

Silverdale & Ryecroft Practice provide services from two separate sites and patients can attend either of these. Silverdale Village Surgery is open between 8am to 6pm Monday to Friday except Thursday when it closes at 5.30pm. The practice offers extended opening hours on Mondays until 9.30pm. Ryecroft Surgery is open between 8am to 6pm Monday to Friday except Thursday afternoons when it closes at 1pm. Patients can book appointments four weeks in advance. The practice does not routinely provide an out-of-hours service to their own patients but patients are directed to the out of hours service, Staffordshire Doctors Urgent Care when the practice is closed.

The practice staffing comprises of:

• Three male GP partners and one female partner

• Six female salaried GPs

• A paramedic training to be an Advanced Practitioner

• Four female practice nurses

• A practice manager and assistant practice manager

• A team of administrative staff working a range of hours.

The practice provides a number of specialist clinics and services. For example long term condition management including asthma and diabetes. It also offers services for family planning, childhood immunisations, travel vaccinations and cervical smears. The practice is a training practice for GP registrars, doctors who are undertaking the two year general postgraduate medical training programme and medical students to gain knowledge, experience and higher qualifications in general practice and family medicine.

Updated 14 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at 12 September 2016 on Silverdale & Ryecroft Practice. 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.
• 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 could access appointments and services in a way and at a time that suited them.
• 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 the 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
• . As part of the NHS England General Practice Forward View to transform and stabilise the future of general practice, the practice was one of the first practices in the country to lead on a pilot to drive efficiencies in the workforce to free up GP time to see more patients.

We saw two areas of outstanding practice:

• The practice was proactive in working with the Patient Participation Group (PPG) to improve health outcomes for patients. For example, in collaboration with the PPG, the practice had developed an in-house series of health promotion booklets called ‘Let’s Talk about…’ that covered issues such as diabetes, healthy eating and substance misuse; established a monthly walking group called ‘Silverdale Steppers’ to help to reduce social isolation, reduce the risk of falls and promote healthy lifestyles and established ‘Silverlink’, a befriending service for patients who were lonely and isolated.

• Patients of no fixed abode and patients with substance misuse issues who were unable to adhere to the appointment system were provided with appointments out of standard appointment times to ensure they had access to health care when they needed it.

The areas where the provider should make improvement are:

• Ensure that all reception staff who chaperone stand in a position where they can clearly observe the intimate procedure taking place.

• Ensure blank printable prescriptions are stored securely.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 November 2016

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

• The practice had identified higher than expected numbers of patients with long-term conditions. The percentage of patients with a long-standing health condition registered with the practice was 60%. This was above the Clinical Commissioning Group (CCG) average of 57% and national average of 54%.

• Performance for all five diabetic indicators was in line with the CCG and national average. For example, the percentage of patients with diabetes whose last measured total cholesterol was within normal limits was 82%. This was similar to the CCG average of 80% and the national average of 81%.

• Patients with more than one long term condition were offered extended appointments to facilitate an annual review of all of their conditions within one appointment.

• All these patients were offered 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. Practice nurses reviewed housebound patients with long term conditions in their own home. also visit all housebound patients with long-term conditions.

Updated 14 November 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.

• Standard childhood immunisation rates for children were higher than local and national averages.

• The practice’s uptake for the cervical screening programme was 81%, which was comparable to the CCG and national averages of 82%. Their exception reporting rate was 3% which was lower than the CCG average of 5% and the national average of 6% which meant more people were included.

• 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 and health visitors.

• The practice had worked with the Patient Participation group (PPG) to develop Healthy Lifestyle booklets which covered issues such as ‘Developing Adolescent Sexual Health’.

Updated 14 November 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 had identified their 2% most vulnerable and elderly patients who were at increased risk of unplanned hospital admissions. The practice’s elderly care facilitator (ECF)contacted, visited and monitored 221 patients to assess their physical, mental, medical and social needs. Each of these patients had an individual care plan in place.

• The ECF offered visits to patients over the age of 85 years old. Eighty-eight per cent of this group of patients had been reviewed. 

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

• The practice provided two GP clinical sessions per week to two large nursing homes (93 patients in total) to review and monitor patients’ needs. The GPs that provided this care had additional knowledge and skills to meet the needs of this population group. For example, one GP had a diploma in palliative care and another GP worked in a local hospice.

Updated 14 November 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, 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 reflected the needs for this age group.

• The practice offered extended opening hours on Monday evening until 9.30pm for working aged patients who could not attend during normal opening hours.This included practice nursing appointments for smears, asthma reviews and other long term condition monitoring.

Updated 14 November 2016

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

• Eighty-four per cent of patients with a diagnosed mental health condition had a comprehensive, agreed care plan documented in their record, in the preceding 12 months. This was in line with the CCG average of 87% and national average of 88%.

• Eighty-seven per cent of patients diagnosed with dementia had had their care reviewed in a face-to-face review in the preceding 12 months compared with the CCG and national averages of 84%.

• The practice had increased the estimated diagnosis rate of patients with dementia from 69% in 2014 to 86% in 2015.

• 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.

• 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. Clinical and non-clinical staff had received specialised training appropriate to their role to support this group of patients.

Updated 14 November 2016

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

• The practice held a register of patients living in vulnerable circumstances including those of no fixed abode, patients with substance misuse problems and those 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.

• The practice informed vulnerable patients how to access various support groups and voluntary organisations. With the support of the practice and North Staffordshire AgeUK, the PPG had established a monthly walking group called ‘Silverdale Steppers’ to help to reduce social isolation.

• One of the GPs at the practice worked in partnership with a local church and the PPG and had established ‘Silver link’, a befriending service for patients who were lonely and isolated. Patients were referred to the service by the practice and Linkline (a local telephone Befriending Service).

• The practice worked with the PPG and had identified 348 patients as carers (3% of the practice list). The practice had won an award from the North Staffordshire Carer’s Association for putting carers first and for their work in providing carer and support to patients who were carers. Patients who had been identified as carers were offered flu immunisations and health checks to assess their physical and mental health wellbeing to enable them to continue to provide care.

• In collaboration with the PPG, the practice had developed an in-house series of booklets called ‘Let’s Talk about…’. Topics covered for example included healthy eating and substance misuse.

• The practice gave examples of how they had supported patients of no fixed abode to register and receive treatment at the practice. Reception staff was aware of these patients and where necessary, appointments were provided out of standard appointment times.

• Throughout 2015/16 two GPs at the practice had provided a substance misuse service to 260 patients. The practice had an open door policy and had registered patients which other practices did not feel able to support. If patients with substance misuse issues were unable to adhere to the appointment system, appointments were provided out of standard appointment times to ensure they had access to the care they required.