Wistaria & Milford Surgeries

Updated 14 October 2016

The partnership between Wistaria & Milford Surgeries is located in two purpose built premises both of which were built in 2002. Wistaria Surgery is located close to the main high street in Lymington. Wistaria is one of three practices in the town. Milford Medical Centre is on Sea Road, adjacent to the Milford Memorial Hospital. The entrances and all rooms are wheelchair accessible. We visited Wistaria Surgery on the day of our inspection. The practice provides its services under the General Medical Services (GMS) contract.

The current staff of the practice includes:

• 10 GP Partners (6 males and 4 females – 5.6 whole time equivalent WTE)

• 2 Salaried GP and GP retainer (1 WTE)

• 3 GP Registrars (2.4 WTE)

• 1 Practice Manager (1 WTE)

• 9 Practice Nurses (4.9 WTE)

• 1 Health Care Assistant (0.54 WTE)

• 1 Phlebotomist (0.19 WTE)

• 23 Receptionists/Admin/Secretarial (16.82 WTE)

The practice list size has steadily increased over the years and is currently at 15,320. The south coast is a popular retirement area, this is reflected in the demographics of the practice population; 42% of the patients are 60 years of age or older, and 26% of the patients are 70 years of age or older. The practice population is predominately white, with the majority being born in the UK. However, over the last 5 years the ethnic diversity has increased with more patients coming from Eastern Europe. The local population falls into the least deprived decile though there are some pockets of deprivation in the area.

Both Wistaria and Milford practices are open from Monday to Friday between 8am and 6.30pm. Extended hours appointments are available outside our usual opening hours on early weekday mornings and late evenings. Patients could book appointments up to three months in advance and urgent appointments are also available for people that needed them. When the practice is closed patients can phone the local Out of Hours clinic through NHS 111 outside surgery hours.

Wistaria & Milford Surgeries is also a training practice for GP registrars/trainees and students. The practice had three GP trainees at the time of our inspection and one of the GPs is a program director in Bournemouth.

Updated 14 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wistaria & Milford Surgeries on 17th August 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.
• 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.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• 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.
• The practice was aware of challenges and future concerns and worked towards sustainability and collaboration across local practices. A systematic approach was taken to working with other organisations to improve care outcomes.
• There were high levels of staff satisfaction with a good staff retention rate. Staff were proud of the organisation as a place to work and speak highly of the culture.
• The practice participated in national and local audits and research. There was also a strong focus on continuous learning and improvement at all levels within the practice.

We saw one area of outstanding practice:

• The lead practice nurses had designed a teaching package for non-clinical staff to be able to assist in chaperoning.The training was very thorough ensuring the staff understood their roles and responsibilities in performing the role and also included practical demonstrations of equipment and what the staff should expect to observe in the examinations they may be asked to chaperone. The training also allowed those members of staff who were unsure of the chaperoning role to be fully informed and they can make an informed decision to take on the role or decline it. This meant patients had a trained member of staff who understood and wanted to do the role.

The areas where the provider should make improvement are:

• The practice should make efforts to improve the care and support of patients for healthy lifestyles and long term conditions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 October 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.
• Performance for diabetes related indicators was better than the national average.
• All patients with asthma, chronic obstructive pulmonary disease (COPD), hypertension, ischaemic heart disease (IHD), and diabetes had a named GP and were invited annually for a clinical review with an experienced nurse. Following the review, an agreed action plan was given to the patient with general information about what they can do to manage their condition and also some targets for example for blood pressure or cholesterol. Where appropriate patients were given a print out with their results and targets.
• The practice nurse leading on respiratory disease for the practice was very motivated and knowledgeable in her specialism. She told us about examples of good outcomes with regards to the quality of life of her patients and was leading on research work for the practice in conjunction with Southampton General Hospital.
• 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.
• Longer appointments and home visits were available when needed.
• The local medicines management team had supported the practice to monitor the usage of medicines and ensured that relevant guidance were adhered to.
• There was a call/recall system for patients whose medicines for their long term condition required monitoring and to ensure these patients had their bloods tests and booked review appointments.
• Self-management plans were offered to patients with long term conditions who wished to have them.

Updated 14 October 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. Regular meetings took place with the health visiting team and school nurses where children of concern or children on protection/in need plans were discussed.
• Immunisation rates were relatively high for all standard childhood immunisations.
• The practice’s uptake for the cervical screening programme was 80%, which was comparable to the CCG average of 82% and the national average of 82%. The practice also participated in the chlamydia screening enhanced service.
• Two GPs held the Diploma in Child health. Appointments were available outside of school hours and the premises were suitable for children and babies. Any unwell child would be seen without an appointment.
• The practice had four GPs with advanced training in sexual health and who fitted implants or intrauterine contraceptive devices in the practice’s dedicated minor operations room. All GPs were able to give contraceptive advice.
• The practice provided pre-conceptual care and shared ante-natal and post-natal care with the midwifery and health visiting teams. Six to eight week baby checks were provided as well. Patients could choose to see their GP or midwife for all or some of their routine ante-natal care. Midwives had been able to contact the patient’s GP directly to access information or advice. Patients with complications in pregnancy were also seen by GPs either when patients were unable to access their midwife or for convenience. Monthly meetings also took place with the health visiting and midwifery team to ensure effective child immunisation, cross check birth details and sharing information regarding the new babies’ care and development checks.

Updated 14 October 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 practice participated in the “Avoiding Unplanned Admissions” enhanced service and at least 2% of patients aged over 18 have care plans in place.
• Twice monthly minuted practice ward meetings took place with a multidisciplinary team that included adult services, community Geriatrician, district nurse team, Older Persons Mental health Team, Community Independence Team, GPs, practice nurses and the Care Navigator.
• The practice worked with the local Care navigator who assisted patients in remaining independent in their own home by providing support, advice on accessing services and liaised with social and community services.
• High quality end of life care was a priority for the practice and had a lead GP for this. Monthly palliative care meetings were held with the clinical nurse specialist from the local hospice and a member of the district nursing team allowing for close collaboration in managing patients who were nearing the end of their life or those living with a life limiting disease.
• A named GP supported local nursing homes and visited weekly to provide routine reviews of patient’s condition, medicines and wishes in event of illness and advanced care planning. The GP also worked with the nursing homes to provide care plans for all their residents.

Updated 14 October 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.
• The practice offered appointments that can be booked in advance or on the day, by phone, in person or on-line. There were a variety of appointments types including e-consultation, telephone consultation and face to face. Extended hours appointments were offered for patients who were unable to attend the surgery during usual opening hours. The practice was also flexible about seeing patients outside our usual working hours and adding extra urgent appointments when needed.
• 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 at the local hospital offered further extended appointments for the practice’s patients and had access to the patient records providing safe continuing care.
• Travel advice and immunisations were offered to patients.
• The practice’s website signposted to alternative services as well as health advice and patient information leaflets.

Updated 14 October 2016

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

• 89% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had had their care reviewed in a face to face meeting in the last 12 months, which was better than the CCG average of 89% and the national average of 88%.
• 83% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the CCG average of 84% and to 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 provided ‘i-talk’ and the community mental health team with a room at the practice for consultations when needed.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia. Annual health checks for patients on the mental health register were offered.
• There was a dementia lead GP who worked with all the GPs to enable more accurate and earlier diagnosis. The practice carried out advance care planning for patients with dementia.
• The practice organised an afternoon for the practice staff to focus on dementia. This included a visit from a dementia advisor to increase further ideas of becoming a dementia friendly practice.

Updated 14 October 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. There were alerts on the computer system to highlight children who may be at risk either in care, on a child in need or on a child protection plan. The practice had a safeguarding lead and staff had practice based safeguarding training.
• 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.
• Alerts were on notes for patients who may require longer appointments and any patient could ask for a longer appointment if needed. Annual health checks for adults with learning disabilities in addition to a full range of primary care services were offered.
• 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.
• The practice offered chaperones for all intimate examinations and had posters encouraging patients to ask if they feel they would like a chaperone. Chaperone Training had taken place for all members of staff who may be required to offer this service.
• The practice had and active and supportive ‘Friends of the surgery’ who offered a befriending service. The befrienders were screened, trained, and matched with a patient who had given consent for the referral which was usually done by their GP.