Archived: Dr Richard Guilding Also known as Eldene Health Centre ( Dr. Guilding's Surgery )

Updated 16 March 2016

Dr Richard Guilding’s Surgery is based within Eldene Health Centre and is a small single-handed practice offering GP services to the local community of Swindon, Wiltshire. The practice is one of 25 practices within Swindon CCG and provides personal medical services to approximately 2,450 registered patients.

All services are provided from:

• Eldene Health Centre, Eldene, Swindon, Wiltshire, SN3 3RZ.

The practice comprises of one GP (a male GP) who is supported by two long term locum GPs (both female).

The all-female nursing team consists of a nurse prescriber and a health care assistant.

The GP, nurse prescriber and a senior administrator perform the management duties of the practice and are supported by a team of three administrative staff who undertake the day to day running of the practice.

The practice population has a higher proportion of patients with a reported long-standing health condition and health-related problems in daily life compared to the national averages. This could result in an increased demand for GP services.

The practice population has a higher proportion of patients aged 40-54 compared to the national average and a small proportion of patients who reside in three local care homes.

The practice has core opening hours between 8.30am and 6pm every weekday with the exception of Fridays when the opening times are between 8.30am and 5.30pm. The practice opted out of providing the out-of-hours service. This service is provided by the out-of-hours service accessed via the NHS 111 service. Advice on how to access the out-of-hours service is clearly displayed on the practice website, on the practice door and over the telephone when the surgery is closed.

Updated 16 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Richard Guilding’s Surgery on 4 February 2016. Overall the practice is rated as good.

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

• The practice had a clear vision which had quality, safety and high-quality person-centred care as its top priority. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

• The practice had an effective governance system in place, was well organised and actively sought to learn from performance data, incidents and feedback.

• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.

• Risks to patients were assessed and well managed.

• Feedback from patients about their care was consistent and highly positive.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

We saw outstanding practice including:

• The latest GP National patient survey completed in 2015 and published in January 2016 showed the proportion of patients who would recommend this practice was 90%, which far exceeded the local Clinical Commissioning Group and national average. All of the 45 patient Care Quality Commission comment cards we received and the six patients we spoke with on the day were highly positive about the service experienced. Patients recalled episodes of high levels of care and compassion to overcome obstacles including a nurse attending patients home addresses to dress ulcers in her lunchtime if the community nurses cannot attend, rather than let an ulcer deteriorate. This was further backed up in performance data for the care of long-term conditions, patient testimonials presented by the practice, views from three local care homes we spoke with, reviews on NHS Choices and the Friends and Family Test survey.

However, there was an area of practice where the provider needs to make improvements. Importantly the provider should:

• Formalise the appraisal process for administration and reception staff.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 16 March 2016

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

• The GPs and nurse team had the knowledge, skills and competency to respond to the needs of patients with long term conditions such as diabetes and COPD (Chronic obstructive pulmonary disease is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease).

• The nurse prescriber had a special interest and further qualifications in the management of diabetes. We saw comprehensive and detailed diabetic care plans; Performance for diabetes related indicators was higher when compared to the CCG and national average. The practice achieved 93% of these targets compared to a CCG average of 90% and national average of 89%.

• Quality data demonstrated the monitoring of patients with long term conditions was better when compared to national averages. For example, 96% of patients with COPD had a review undertaken including an assessment of breathlessness in the preceding 12 months. This was 6% higher than the national average.

• Longer appointments and home visits were available when needed.

Updated 16 March 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. Immunisation rates higher when compared to the CCG and national averages.

• 78% of patients diagnosed with asthma, on the register, had an asthma review in the last 12 months. This was higher than the national average, 75%.  

• 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.

• The practice’s uptake for the cervical screening programme was 77%, which was higher when compared to the CCG average (73%) and the national average (74%).

• Staff had received training in recognising and acting upon domestic violence and female genital mutilation.

• Children under five were always seen on the day, appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 16 March 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 was responsive to the needs of older people. Longer appointments, home visits and urgent appointments were available for those with enhanced needs.

• The practice systematically identified older patients and coordinated the multi-disciplinary team (MDT) for the planning and delivery of palliative care for people approaching the end of life.

• We saw unplanned hospital admissions and re-admissions for the over 75’s were regularly reviewed and improvements made.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were higher than national averages. For example, the percentage of people aged 65 or over who received a seasonal flu vaccination was 13% higher than the national average (73%).

Updated 16 March 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.

• There was a range of appointments between 9.00am and 5.30pm Monday to Friday. Results from the national GP patient survey showed that patient’s satisfaction with how they could access care and treatment was higher when compared to CCG and national averages. For example, 83% of patients were satisfied with the practice’s opening hours (CCG average 72%, national average 75%).

• 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 provided a full travel vaccine service (excluding yellow fever).

Updated 16 March 2016

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

• 91% of people experiencing poor mental health had a comprehensive, agreed care plan documented in their medical record, which was higher when compared to the national average (88%).

• The practice carried out advance care planning for patients with dementia. For example, 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was higher when compared to the national average (84%).

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those 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 16 March 2016

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

• There were policies and arrangements to allow people with no fixed address to register and be seen at the practice.
• The practice provided an appropriate service for transsexual and gender dysphoria patients.

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

• It had carried out annual health checks for people with a learning disability and there was evidence that these had been followed up.

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

• 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.