Archived: Smallbrook Surgery

Updated 9 December 2016

Smallbrook Surgery is part of the Westbury Group Practice and was taken over in September 2015. The practice is located within Warminster Hospital premises in Wiltshire. The practice provides all of its services on the ground floor and there is an automatic door to the premises.

This report covers the practices at Smallbrook Surgery, there is a separate report for White Horse Health Centre which includes Bratton Surgery and we would recommend they were read in conjunction.

The practice team work across the White Horse Health Centre, Bratton Surgery and Smallbrook Surgery under the Westbury Group Practice and are managed by six GP partners (two female and four male).The practice is supported by five salaried GPs, (three female and two male), 17 practice nurses (including nurse practitioners) , 11 health care assistants and phlebotomists, a practice pharmacist, an administrative team and a management team including an operations manager, services support manager, service development manager, patient communications manager and a clinical lead manager led by the practice manager.

The practice has a Primary Medical Services (PMS) contract to deliver health care services to approximately 4,200 patients. A PMS contract is a locally agreed alternative to the standard General Medical Services contract used when services are agreed locally with a practice which may include additional services beyond the standard contract.

The practice delivers it’s services at the following location:

Warminster Hospital,

The Avenue,

Warminster,

Wiltshire,

BA12 8QS.

The general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in the third least deprivation decile. The prevalence of patients with a long standing health condition is 63% compared to the local clinical commissioning group average of 55% and the national average of 54%. Patients living in more deprived areas and with long-standing health conditions tend to have greater need for health services. An area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score. Average male and female life expectancy for the practice is 79 and 84 years, which is comparable to the national averages of 79 and 83 years respectively.

The practice is open between 8.30am and 6.30pm Monday to Friday. Between 8am and 8:30am calls are answered at White Horse Health Centre. Appointments are available between 8am until 11.30am every morning and 2.30pm to 6.30pm every afternoon.

When the practice is closed patients are advised, via the practice website and telephone answer machine that all calls will be directed to the out of hour’s service. Out of hours services are provided by Medvivo, accessed via NHS 111.

This inspection is part of the CQC comprehensive inspection programme and is the first inspection of Smallbrook Surgery. We visited all three locations providing GP services under the Westbury Group Practice (White Horse Health Centre and Bratton Surgery) as part of our inspection.

Updated 9 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Smallbrook Surgery on 19 October 2016. Overall the practice is rated as good.

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

• The practice recognised the value of learning from significant events. The practice carried out a thorough analysis of the significant events to look for root cause, ways to prevent any reoccurrence and identify any improvements needed.
• Risks to patients were assessed and well managed.
• The practice had employed two specialist nurses to provide a patient focussed approach to patients over 75 who may have health risks associated with frailty. The nurses conducted home assessments, worked with other providers to provide the best care package, conducted health checks and focussed on prevention and health education.
• 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.
• The practice had undertaken a number of analyses of the patient’s satisfaction and experience, they had looked at the length the appointment times and increased them and looked for any trends or areas for improvement.
• 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 provider was aware of and complied with the requirements of the duty of candour.
• This practice was taken over by the Westbury Group Practice in September 2015.

The areas where the provider should:

• Ensure the system for checking of emergency medicines is reviewed.

• Ensure the exception rates are reviewed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 December 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.

• The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (04/2014 to 03/2015) was 95% which was above the clinical commissioning group average of 91% and national average of 88%.

• 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 9 December 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.

• The practice offered a ‘No Worries’ service for young people aged 13 to 24 which offered sexual health care and advice whether registered at the practice or not. The practice held drop in clinics three times a week available at White Horse Health Centre and would offer on day appointments as required.

• The practice held lifestyle advice sessions for pre-expectant and expectant parents available at White Horse Health Centre.

• The practice had access to a counselling support service for young patients.

• 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.

• The practice’s uptake for the cervical screening programme was 81% which was comparable to the clinical commissioning group average of 84% and 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 and health visitors.

Updated 9 December 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 had employed two nurses for older patients to ensure they had the appropriate care assessment and treatment plan in place and work with other agencies as required to ensure a holistic approach. The scheme was still developing at Smallbrook Surgery. This also included support for patients in their own homes and residential homes, home assessments and support to prevent unnecessary hospital admissions.

Updated 9 December 2016

The practice is rated as good for the care of working-age patients (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 offered a drop in service at White Horse Health Centre for those needing a blood test.

• 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 had adjusted the access to results service following patient feedback to extend the access.

Updated 9 December 2016

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

• The percentage of patients with severe mental health problems who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months (04/2014 to 03/2015) was 94% compared to the CCG average of 93% and national average of 88%.

• 100% 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 was above the clinical commissioning group (CCG) average of 88% and the national average of 84%.

• 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 offered access to an Alzheimer’s support team, through White Horse Health Centre.

• 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 9 December 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 people, travellers and those with a learning disability.

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

• The practice had a disability advocate and a care coordinator to support staff and patients.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• Two of the GPs delivered drug and alcohol support and worked alongside drug and alcohol services, conducting joint visits with patients and providing shared care.

• 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.