The Saxon Spires Practice

Updated 16 May 2017

The Saxon Spires Practice situated in Guilsborough, Northamptonshire, is a GP practice which provides primary medical care for approximately 14,900. A branch of this practice the Brixworth Surgery is located at Pytchley Court Health Centre, Brixworth. The practice maintains one patient list and patients can access either practice. We did not inspect the Brixworth branch at this time. Together they provide primary medical care to the residents of Guilsborough and Brixworth and surrounding areas.

The Saxon Spires Practice provides primary care services to local communities under a General Medical Services (GMS) contract, which is a nationally agreed contract between general practices and NHS England. The practice population is predominantly white British along with a small ethnic population of Asian and Eastern European origin.

The practice has six GPs partners (three female and three male) and four salaried GP (four female). The practice uses two regular locum doctors (two female). There are three practice nurses, a nurse advisor, two nurse prescribers (all females) and one assistant nurse practitioner (male). The nursing team is supported by three health care assistants (all females). There are two pharmacists attached to the practice. There is a practice manager who is supported by a team of administrative and reception staff. The local NHS trust provides health visiting and community nursing services to patients at this practice.

The practice provides training to doctors studying to become GPs. It also supports undergraduate and postgraduate nurse education and provides mentoring to practice and community nurses during further training such as prescribing qualifications. Being affiliated to Warwick Medical School the practice supports the training of new doctors.

The Saxon Spires Practice is a dispensing practice and has a dispensary at this practice as well as at the Brixworth branch which are open during surgery times. There are nine dispensers supported by a dispensary manager across both sites.

Patient consultations and treatments take place on ground level. There is a car park outside the surgery with adequate disabled parking available.

The practice is open Monday to Friday from 8am to 6.30pm except on Tuesday and Thursday when the practice is open from 7am. The practice offers extended opening on the first Saturday of each month from 8am till 10am. The practice offers a variety of access routes including telephone appointments, on the day appointments and advance pre bookable appointments.

When the practice is closed services are provided by Integrated Care 24 Limited via the 111. service.

Updated 16 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Saxon Spires Practice on 9 August 2016. The overall rating for the practice was Good however a breach of legal requirements was found. After the comprehensive inspection, the practice wrote to us and submitted an action plan outlining the actions they would take to meet legal requirements in relation to:

• Regulation 12 (RA) Regulations 2014, Safe care and treatment.

The full comprehensive report of the inspection on 9 August 2016 can be found by selecting the ‘all reports’ link for The Saxon Spires Practice on our website at www.cqc.org.uk.

This inspection was a desk-based focused follow up inspection carried out on 27 March 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 9 August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as ‘Good’.

From the inspection on 9 August 2016, the practice was told they must:

• Strengthen procedures and confirm that they are carrying out the full range of tests required for each high risk medicine prior to prescribing to patients.
• Ensure good practice guidance and control measures were adopted to make sure adequate supply of oxygen was available for use in an emergency situation.

We also told the practice that they should make improvements to the follows areas:

• To the recording systems relating to safety alerts, and significant events. This was because at the time of the inspection a strategic overview of performance was not available.
• To the way staff were appraised. This was because at the time of the inspection five staff members (out of 40) had yet to be appraised.
• To the way practice specific policies were reviewed. This was because some policy documents we checked were undated.
• To the way patients were encouraged to attend for breast screening when invited. This was because not all patients (though attendance is voluntary) had responded to the invitation to attend.

Our key findings were as follows:

• The practice had made the necessary changes to their procedures for managing high risk medicines.
• The practice had assured a process to ensure adequate supply of oxygen for use in an emergency situation.
• The practice confirmed that the recording systems relating to patient safety alerts had been changed and an overview of all alerts was now available.
• The practice verified that there was a new system in place to ensure staff appraisal and confirmed all staff has had an appraisal in the past 12 months.
• The practice specific policies had been reviewed and dated and they had introduced planned review dates for all policy moving forward.
• Measures were in place to encourage attendance for cancer screening by opportunistically reminding patients when they attended a GP appointment, and by hosting the mobile breast screening van on site.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 November 2016

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

• Clinical staff trained in chronic disease management had lead roles in supporting patients with long term conditions such as diabetes, asthma and chronic obstructive pulmonary disease (COPD).

• Performance for diabetes related indicators was comparable to the national average. For example, the percentage of patients with diabetes, on the register, in whom the last blood glucose reading showed good control in the in the preceding 12 months (01/04/2014 to 31/03/2015), was 79%, compared to the CCG average of 79% and the national average of 78%.

• 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 or at high risk of hospital admission, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care including opportunistic reviews of their care.

• The practice undertook periodic medication reviews when repeat prescribing.

• Patients referred for an appointment within two weeks using the suspected cancer pathway referral process were followed up by a telephone call to review their progress.  

Updated 30 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.
• The practice operated an in-house health visiting team.
• Immunisation rates were comparable to CCG and national averages for all standard childhood immunisations.
• 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 79%, which was comparable to the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice provided access to pupils from nearby schools irrespective of their registration status with the practice.

• A GP offered advice to new parents on childhood illnesses and how to manage them through a meeting held six monthly.

• We saw positive examples of joint working with midwives school nurses and health visitors.
• The practice provided contraceptive advice and services.
• The practice provided a variety of health promotion information leaflets and resources for this population group for example the discreet provision of chlamydia testing kits.

Updated 30 November 2016

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

• Patients aged 75 years and older had a named GP.

• The practice was responsive to the needs of older people.

• The Nurse advisor provided home visits and support to the older and vulnerable patient and provided extensive advice on benefits and other related services.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• The GPs routinely worked with the community nursing service to ensure continuity of care for patients who needed care at home.

• The practice had identified older patients at high risk of admissions to hospital (patients with multiple complex needs, and involving multiple agencies) and worked with local partners such as the community nursing service to coordinate their care.

• The practice supported three care homes and visited the larger of the three homes three times a week for a ward round and twice weekly the other two homes. There was a lead GP who liaised with the care homes.

• The practice provided a home delivery service of medicines to the housebound.

Updated 30 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.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

• The practice offered health checks, travel advice, cervical screening, and contraceptive services for this population group.

• The practice provided extended hours with early morning appointments available two days a week, Saturday morning appointments were available once a month as well telephone appointments when appropriate.

• On line services were available for booking of appointments and ordering of repeat medications.

• The practice offered flexibility in seeing working age people working in the local area who are not registered with the practice. For example teachers at secondary school, employees at a local car factory.

Updated 30 November 2016

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

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• There was a GP with a special interest in the elderly and dementia who provided appropriate support.

• The practice hosted the First for Wellbeing service which is a social enterprise that aimed to provide an effective, integrated service that prevented poor physical and mental health. This enterprise was a partnership between Northamptonshire County Council, Northamptonshire Healthcare NHS Foundation Trust and the University of Northampton.

• Patients could access a wellbeing counsellor, and a mental health primary care liaison worker from the local mental health NHS Trust at the practice.

• The practice provides an in-house counselling service for patients with mental health issues.

• The practice carried out advance care planning for patients with dementia.

• Patients with dementia were offered a review at least yearly usually with their carers.

• 81% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average.

• The practice provides facilities for a consultant psychiatrist from the local NHS Trust to review patients with dementia.

• The practice maintained a register of patients with mental illness and offered them annual health reviews.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations including to direct access counselling and cognitive behavioural therapy.

• The practice had a system in place to follow up patients who had attended A&E 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 30 November 2016

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

• 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.
• There was a GP with a special interest in the care of the elderly and dementia patients who supported patients.
• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
• 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 support groups and voluntary organisations.
• The practice held regular review meetings involving the community nursing team, GPs and the local palliative care nurses for people that require end of life care and those on the palliative care register.
• There was a domiciliary service for the housebound patient. The community care coordinator visited many of these patients to advise and support them on their specific needs.
• The practice identified patients who were also carers and signposted them to appropriate support. The practice had identified 695 patients as carers (5% of the total practice list).