The Village Surgery - Formby

Updated 10 November 2016

The Village Surgery Formby is a partnership practice based in Formby, Merseyside. The surgery is located in a building that was purpose built in 1989, which is accessible to patients with limited mobility. There is car parking available outside the practice, with a number of clearly marked parking spaces for disabled patients. The practice is a teaching practice, hosting medical students and GP Registrars. At the time of inspection, the practice had approximately 9,500 patients.

The partnership is made up of five GPs, one female and four male who all work full time. The partnership team is complemented by two regularly retained locum GPs, one of whom is a former partner who continues to deliver a dermatology clinic each week, and another doctor who is a hospital consultant, who delivers a minor surgery clinic each week. The practice also retains the services of another female, locum GP, to provide holiday cover and provide greater access to female GPs for patients when this is required. The practice has been utilising the services of a Physician Associate (PA) as part of a pilot within the area. Physician Associates support doctors in the diagnosis and management of patients. They are trained to perform a number of roles including: taking medical histories, performing examinations, analysing test results, and diagnosing illnesses under the direct supervision of a doctor.

The clinical team is supported by an Advanced Nurse Prescriber (ANP), a practice nurse and three part time Health Care Assistants (HCA). The availability of appointments is monitored by the practice to ensure this meets patient demand. We saw that the work of post-graduate medical students and Registrars added to the number of available appointments for patients, when these were at the practice.

The practice clinical team is supported by a practice manager. In turn, the practice manager oversees the work of a reception manager. The practice administrative team is made up of eight receptionists, four administrators and two medical secretaries.

The practice building has one main reception area and seven consulting rooms and one treatment room on the ground floor. There are patient toilets with baby change facilities on the ground floor. All these areas are fully accessible. There are two further consulting rooms and a small patient waiting area on the first floor of the practice. The rest of of the first floor is given over to office administrative functions, staff toilets and rest areas, as well as store rooms and utilities for the building.

The practice is open from 8am to 6.30pm Monday to Thursday. On Friday the practice delivers an extended hour’s clinic, and opens from 8am to 7pm. A further clinic is delivered on Saturday morning, when the practice is open for pre-bookable appointments only, from 8.30am to 10.30am.

When the practice is closed, patients ringing the surgery are diverted by a telephone message to NHS 111. If the patient is found to require the services of a GP, they are then referred on to the contracted out of hours provider for the practice Go to Doc.

Updated 10 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Village Surgery - Formby on 29 September 2016. Overall the practice is rated as good.

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

• There was a clear, open and transparent approach to safety. Staff could explain and describe systems in place for reporting and recording significant events. We saw that these systems were effective.
• Risks to patients were assessed and well managed. All staff were trained to enable them to identify patients that were vulnerable and systems in place supported the safe care of these patients.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. All staff had access to clinical guidance updates.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Improvements were needed to increase the uptake of cervical screening for women eligible for this intervention.
• Patients said they were treated with compassion, dignity and respect. The latest published data from the National GP Patient Survey showed 92% of patients said the last GP they saw was good at giving them enough time, and 93% of patients said GPs were good at listening to them.
• The practice was a designated Yellow Fever Vaccination Centre.
• 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.
• Patients said there was continuity of care, with urgent appointments available the same day.
• 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.

There were areas where the provider should make improvements. The provider should:

• Effectively monitor progress to improve the uptake of chronic illness reviews and cervical screening.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 November 2016

The practice is rated as good for the care of people 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.

• One of the practice nurses was an independent and supplementary prescriber, who managed the care of patients with long term conditions. For example, we saw this nurse was qualified to actively manage patients with respiratory diseases, diabetes control and was trained in contraception and reproductive health.

• The practice had put measures in place to improve performance in the management of care for patients with respiratory disease and illnesses. The partners had recently recruited a practice nurse who had specialised in respiratory diseases at Broadgreen Heart and Chest Hospital (recently rated as Outstanding by CQC). The work of this specialist nurse will complement that of the Advanced Nurse Prescriber who has a Diploma in asthma care and has completed courses in spirometry and respiratory management.

• Longer appointments and home visits were available when needed for example, to visit housebound patients.

• 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 practice clinicians worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 10 November 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 for all standard childhood immunisations were higher than national averages and in line with local averages.

• 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 clinicians demonstrated that they were both vigilant and aware of younger people experiencing mental and/or emotional distress. We saw examples of how the practice had responded to this effectively and compassionately.

• 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.

Updated 10 November 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, and offered home visits and urgent appointments for those with enhanced needs.

• The GPs supported a number of patients in nursing homes in the area, who wished to remain with the practice.

• Clinicians had identified all older patients at risk of frailty and these patients received greater levels of support from GPs and community multi-disciplinary teams.

• Home visits were delivered to housebound patients, to deliver health checks and necessary immunisations, for example, annual flu immunisations.

• We saw that when delivering home visits, patients named GPs were made aware of the request and would visit themselves when possible to provide continuity of care.

Updated 10 November 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.

• We saw that GP and nurse appointments were available in an extended hour’s surgery on Thursday evening and on Saturday mornings.

• The practice had carried out work to increase the numbers of female patients attending for cervical smears. However, this had not been been effective as the numbers of patients receiving this intervention had decreased. An action plan to address lower than average uptake of cervical screening was in place but required review.

• 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.

• Flu vaccination clinics were organised each year to ensure quick and easy access for working age patients.

• The practice GPs were highly supportive of carers and were instrumental in securing secondary services such as respite care and respite breaks for carers.

Updated 10 November 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). In 2014-15 QOF data available to us at the time of inspection, we saw:

• 75% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was less than the national and local average.

• In the practice’s OQF data, which has not yet been published, but they shared with us, we saw this figure had increased to 80% of patients. Comparator figures for local and national averages are not yet available.

• 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 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 10 November 2016

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, and those that were housebound.

• 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 and we saw that patient information resources in the practice where kept up to date and refreshed regularly to take account of any new initiatives.

• Where patients could not immediately access services due to waiting lists, we saw GPs went above and beyond what is expected of them, for example, in putting forward urgent cases for consideration of respite care and respite breaks for carers, and in the support of patients who had experienced bereavement or other personal crisis.

• 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.