Tasburgh Lodge Surgery

Updated 30 January 2017

Tasburgh Lodge Surgery provides primary medical services to approximately 3,900 patients from a single surgery situated in Woodhall Spa, Lincolnshire.

Woodhall Spa is an area of low deprivation .The practice has a higher number of older patients than the CCG and national average.

At the time of our inspection the practice healthcare was provided by five GP Partners (whole time equivalent WTE 1.8) , two nurse practitioners (WTE 1.00), three practice nurses (WTE 0.88) and three health care assistants (WTE 1.2). They are supported by a team of dispensers, management, administration, reception and housekeeping staff.

The present partners had taken over the practice in September 2013, with the one existing partner from the previous partnership retiring in May 2014. At that time the building was in need of major upgrading and re-furbishment. That process is now complete and the surgery now consists of six modern, high quality clinical consultation rooms, reception and waiting area and a range of administration areas.

The practice is located within the area covered by NHS Lincolnshire East Clinical Commissioning Group (CCG). A CCG is an organisation that brings together local GP’s and experienced health professionals to take on commissioning responsibilities for local health services.

The practice has a General Medical Services contract. (The GMS contract is a contract between general practices, the clinical commissioning group and NHS England for delivering primary care services to local communities) It is a dispensing practice.

The surgery is open from 8am to 6.30pm on Monday, from 8am to 7.30pm Tuesdays and Thursdays and from 8am to 7pm on Wednesdays and Fridays.

The practice has opted out of providing out-of-hours services to their own patients. The out-of-hours service is provided by Lincolnshire Community Health Services NHS Trust and is accessed by NHS111.

We had not previously inspected this practice.

Updated 30 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Tasburgh Lodge Surgery on 27 October 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.
• The practice was responsive to the needs of patients and tailored its services to meet those needs.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was an energetic and focused leadership team in place 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.
• There was a strong focus on learning and development at all levels within the practice.

The areas where the provider should make improvement are:

• Implement a system for tracking blank prescription forms through the practice in accordance with national guidance.

• Formalise the process of recording safeguarding meetings in line with recognised best practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 January 2017

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

• GPs and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Clinical indicators relating to patients with diabetes were above both CCG and national averages.

• 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.

• However comments from patients indicated a need for a more structured approach to reviews of patients with long term conditions to reduce the need for multiple appointments.

Updated 30 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.

• 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.

• 77% of eligible patients had attended for cervical screening compared to the national average of 74%.

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

• The practice provided a full range of immunisations for babies, children and young people which were clearly explained on the practice website. Immunisation rates were relatively high for all standard childhood immunisations.

• We saw positive examples of joint working with midwives, health visitors and district nurses. The joint working was promoted and enhanced by virtue of these other healthcare professionals holding clinics at the surgery.

Updated 30 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.

• Personalised care plans, incorporating the patient’s own health goals were reviewed annually or more frequently if necessary and following any hospital admission.

• GPs were assigned responsibility for the seven nursing and residential homes where 60 patients of the practice lived.

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

The practice was a pilot site for the Electronic Palliative Care Co-ordination System ( EPaCCS) which enabled the recording and sharing of people’s care preferences and key details about their care at the end of life.

Updated 30 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 reflected the needs for this age group.

The practice offered extended hours appointments on four evenings a week to help meet the needs of patients in this group

Updated 30 January 2017

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

• < >

  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 identified 26 patients experiencing poor mental health and told them how to access various support groups and voluntary organisations.

• Enduring mental health issues were managed by GP led care and regularly utilised dementia and depression screening tools for patients in this population group.

• 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 30 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 those with a learning disability.

• 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.