The Wragby Surgery

Updated 28 January 2016

The Wragby Surgery provides primary medical care for approximately 3,600 patients living in Wragby and the neighbouring villages.

The service is provided under a General Medical Services contract with Lincolnshire East Clinical Commissioning Group.

The area is less deprived than the national average, but there are isolated pockets of deprivation particularly in some of the outlying rural communities. The practice serves a community with a higher than national average of patients over the age of 65.

The practice is a partnership and is staffed by three male GPs, two of whom are partners. There are two nurse practitioners who are also partners, a nurse and a health care assistant. They are supported by dispensers, receptionists and administration staff. Whole time equivalent equates to 1.75 general practitioner, 2.00 nurse practitioner and 1.01 health care assistants. In an average week there were 15 GP sessions and 16 nurse consultant sessions.

The practice is a dispensing practice and dispenses to 95% of its patients..

The practice is open between 8am and 6.30pm Monday to Friday, excepting Thursday when the surgery is open until 8.30pm. Appointments are from 8.30am to 12.30 pm and 3.30pm to 6pm daily, excepting Thursday when appointments are available until 8pm.

When the surgery is closed GP out-of hours services are provided by Lincolnshire Community Health Services NHS Trust which is accessed via NHS111.

Updated 28 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Wragby Surgery on 8 December 2015. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• 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 practice was a high achiever in terms of patient satisfaction across a wide range of indicators.

We saw areas of outstanding practice including:

• Effective use of additional funding to care for  those patients over 75 which had resulted in a significant decrease in the number of accident and emergency and un-planned admissions to secondary care for patients in this age group.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should ;

• Ensure that multi-disciplinary meetings are properly recorded.

• Implement a written policy to instruct staff on how to ensure the security of prescription pads.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 January 2016

The practice is rated as good for the care of people with long-term conditions. Nurse Consultants had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a named GP and were recalled every six months for a review to check that their health and medication needs were being met. For those people with the most complex needs, the practice worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 28 January 2016

The practice is rated as good for the care of families, children and young people. Immunisation rates were relatively high 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. Nurses had attended local schools, youth clubs, Young Farmers and other youth groups to promote first aid and health topics.

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

Updated 28 January 2016

The practice is rated as outstanding for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The practice nurse took a lead role in coordinating and managing manage the health needs of those patients aged 75 and over.

In particular the nurse provided additional support for all over 75 patients in the following groups;

• Those that had been discharged from accident and emergency departments or hospital

• patients referred by a staff member who was concerned

• all patents resident in nursing or care homes

• all patients with a diagnosis of dementia

• any elderly patient who had suffered a significant bereavement

• any patientover 75 who did not attend for a routine review.

Updated 28 January 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, include on-line booking of appointments and repeat prescriptions 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.

Updated 28 January 2016

The practice is rated as good for the care of people experiencing poor mental health. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice made a room available for the Community Psychiatric Nurse and the nurse had been involved in joint consultations with patients.

It carried out advance care planning for patients with dementia. Health checks for the over 40’s included questions to identify patients with concerns about their memory.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Staff had received training on how to care for people with mental health needs and dementia . All staff had received instruction and were now ‘Dementia Friends’.

Updated 28 January 2016

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

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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.