Grey Gable Surgery

Updated 24 August 2016

Grey Gable Surgery is located in the village of Inkberrow, in Worcestershire. The practice area covers many nearby villages including Crowle, Tibberton, Studley, Alcester, and Pinvin and extends to the town of Redditch. It has three salaried GPs (two males and one female) operating from a purpose built building in Inkberrow.

Grey Gable Surgery provides primary medical services to patients in a mainly rural area and has a population of patient groups that is in line with local averages. The practice area is one of a lower than average rate of deprivation at 10% when compared with the local average of 17% and the national average of 22%.

The GPs are supported by a practice manager, an administration manager, two practice nurses, a healthcare assistant, a medical secretary and three receptionists. The practice is a dispensing practice with six dispensers. There were 4171patients registered with the practice at the time of the inspection.

The practice has a General Medical Services (GMS) contract with NHS England. The GMS contract pays GPs on the basis of meeting set quality standards and the particular needs of their local population.

The practice opens Monday to Friday from 8am to 6.30pm. Patients can attend the practice from 8.30am to 12pm for open access appointments. Bookable appointments are available Monday to Friday from 8.30am to 12.30pm and 2.30pm to 6pm. The practice is closed at weekends. The practice is part of the local Prime Minister’s GP Challenge Fund service to provide extended opening hours. These are available late evening and at weekends to improve access for patients.

The practice does not provide an out-of-hours service but has alternative arrangements in place for patients to be seen when the practice is closed. For example, if patients call the practice when it is closed, an answerphone message gives the telephone number they should ring depending on the circumstances. Information on the out-of-hours service (provided by Care UK) is available on the practice’s website and in the patient practice leaflet.

Home visits are also available for patients who are too ill to attend the practice for appointments. There is also an online service which allows patients to order repeat prescriptions and book appointments.

The practice treats patients of all ages and provides a range of medical services. This includes disease management such as asthma, diabetes and heart disease. Other appointments are available for maternity care and family planning. Minor surgery is provided by the practice.

The practice is a teaching practice for post graduate junior doctors from a nearby university.

Updated 24 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Grey Gable Surgery on 19 May 2016. The overall rating for this service is 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. Learning from incidents was shared with staff and regularly reviewed.
• Information about safety alerts was reviewed and communicated to staff by the practice manager in a timely way.
• Risks to patients were assessed and well managed through practice meetings and collaborative discussions with the multi-disciplinary team. Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Patients told us 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. Patients told us that they knew how to complain if they needed to.
• The practice had good facilities and was well equipped to treat patients and meet their needs. This included easy access for patients who used wheelchairs and baby changing facilities.
• Practice staff had made improvements to the way it delivered services following feedback from patients and the Patient Participation Group (PPG). The PPG were proactive in representing patients and assisting the practice in making improvements.
• There was a clear leadership structure and staff told us they felt supported by management. The practice proactively sought feedback from patients, which it acted on. Staff appeared motivated to deliver high standards of care and there was evidence of team working throughout the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 August 2016

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

• The practice nurses 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 patients diagnosed with a long term condition had a named GP and a structured annual review to check that their health and medicine needs were being met.
• Clinical staff had close working relationships with external health professionals to ensure patients received up to date and joined up care.

Updated 24 August 2016

The practice is rated as good for the care of families, children and young people.

• Same day appointments were offered to all children under the age of five.
• Childhood immunisation rates for the vaccinations given were comparable to local and national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 95% to 100% and five year olds from 89% to 100%. This compared with local averages of 83% to 99% and 93% to 98% respectively.
• 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.
• The practice’s uptake for the cervical screening programme was 84% which was in line with local and national averages.
• 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, health visitors and school nurses.
• The practice also offered a number of online services including booking appointments and requesting repeat medicines.

Updated 24 August 2016

The practice is rated as good for the care of older patients.

• The practice offered personalised care to meet the needs of the older people in its population. It was responsive to the needs of older patients, and offered home visits and rapid access appointments for those with enhanced needs.
• The practice offered a range of enhanced services, for example, in dementia and end of life care.
• Health checks were carried out for patients over the age of 75 years (84% of the practice list completed for 2015/16). Nationally reported data showed that outcomes for patients were good for conditions commonly found in older patients.

Updated 24 August 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 was proactive in offering online services as well as a full range of health promotion and screening services that reflected the needs of this age group.
• The practice nurses had oversight for the management of a number of clinical areas, including immunisations, cervical cytology and some long term conditions.
• The practice worked with local practices to provide evening and weekend appointments at the community hospital so that patients could access appointments around their working hours.
• Health promotion advice was offered and there was accessible health promotion material available at the practice and on its website.

Updated 24 August 2016

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

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. It carried out advanced care planning and annual health checks for patients with dementia and poor mental health.
• Staff were trained to recognise patients presenting with mental health conditions and to carry out comprehensive assessments.
• The practice had advised patients experiencing poor mental health how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.
• Patients with mental health concerns such as schizophrenia, bipolar affective disorder and other psychoses with agreed care plans in place were 93% which above the CCG and national averages of 88%. The practice exception rate was 0% which was below the CCG and national averages of 13%.

Updated 24 August 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 those patients with a learning disability. For example, the practice offered longer appointments for patients with a learning disability, and had carried out annual health checks for all 14 of the patients on their register.
• Clinical staff regularly worked with multidisciplinary teams in the case management of vulnerable patients. Alerts were placed on these patients’ records so that staff were aware they might need to be prioritised for appointments and offered additional attention such as longer appointments.
• Staff had been trained to recognise signs of abuse in vulnerable adults and children and the action they should take if they had concerns. There were lead members of staff for safeguarding, and GPs were trained to an appropriate level in safeguarding adults and children.