Yetminster Health Centre

Updated 28 November 2016

Yetminster Health Centre was inspected on Tuesday 4 October 2016. This was a comprehensive inspection.

The practice is situated in the rural village of Yetminster, Dorset. The practice provides a general medical service to 4,100 patients covering an area from Sherborne to East Coker, Halstock to East Coker and Minterne Magna to Cattistock. There is also a branch practice in Evershot.

The practices population area is in the eighth decile for deprivation, which is on a scale of one to ten. The lower the decile the more deprived an area is compared to the national average. The practice population ethnic profile is predominantly White British. Over a third of the practice population group are over the age of 60 years with 12% over the age of 75 years. The average male life expectancy for the practice area is 82 years which is higher than the national average of 79 years; female life expectancy is 87 years which is higher than the national average of 83 years.

The practice has an Alternative Provider Medical Services (APMS) contract for a boys school in Sherborne, this made up approximately 15% of their patients. Dedicated surgeries are held six days of the week during term time.

There are four GP partners, two male and two female equating to 2.25 WTE GPs each week. The GPs hold managerial and financial responsibility for running the business. The team are supported by a practice manager, two practice nurses, a healthcare assistant/phlebotomist (Phlebotomists are people trained to take blood samples) and additional administration and reception staff.

The practice also has a dispensary that employs four dispensing staff; they dispense medicines to over 95% of the practice population.

Additional services for patients from visiting NHS professionals included a physiotherapist once a week, a chiropodist, midwife and health visitors.

The practice reception is open between 8am and 6.30pm Monday to Friday. Booked appointments are offered between 8.30am and 6.30pm. The practice offers a range of appointment types including book on the day, telephone consultations and advance appointments. Extended hours are offered on a Tuesday evening until 7pm.

Outside of these times patients are directed to telephone the NHS 111 number for assistance.

The Yetminster Health Centre provides regulated activities from the main site at Church Street Yetminster Sherborne Dorset DT9 6LG and the Evershot Surgery, 13 Fore Street Evershot Dorset DT2 0JR. We did not visit the branch practice at this inspection.

Updated 28 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Yetminster Surgery on 4 October 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.

• The practice hosted physiotherapy, chiropody and complimentary medicines in their treatment suite.

• The practice also has a dispensary that employs four dispensing staff; they dispense medicines to over 95% of the practice population.

• Approximately 15% of the patients were pupils at Sherborne School for Boys and the International College. The practice held surgeries at the school health centre six times a week, including Saturdays. These clinics were open access for the pupils.

• 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 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.

• Nationally reported data from the Quality and Outcomes Framework showed that outcomes for patients were good for patients with long term conditions. For example, 92% of patients diagnosed with chronic obstructive pulmonary disease (COPD) had received an annual health check review within the past 12 months.

• Performance for diabetes related indicators were all comparable or slightly higher than national scores. For example, the patients who had a blood test result within normal limits was 82% compared with a national average of 78%, and 93% of patients had received a foot examination, which compared to the national average score of 88%.

• Longer appointments and home visits were available when needed.

• 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 named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 28 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 were relatively high for all standard childhood immunisations.

• The Health Visitor attended Yetminster Health Centre weekly. The practice scheduled nurse-led immunisation clinics to coincide with the Health Visitor appointments, for patient convenience and to provide more joined-up care.

• Patients were able to receive a contraception service in house, The practice nurses fitted implants, and one partner fits coils.

• 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 percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years was 89%, which was above the CCG average of 81% and the national average of 82%.

• 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 28 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 offered proactive, personalised care to meet the needs of the older people in its population. Data showed that 26.7% of the practices population of approximately 4,100 were aged over 65 years, which was higher than the national average of 17.1%. The practice used a frailty index to identify vulnerable elderly patients, and the healthcare assistant saw patients in the practice as well as visiting them at home.

• All older patients had a named GP for continuity of care but were able to see a GP of their choice.

• Longer appointment times were available to enable older patients with multiple ailments to be discussed in one visit.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Updated 28 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. Extended hours were offered on a Tuesday evening until 7pm.

• 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 had an Alternative Provider Medical Services (APMS) contract for a boys school in Sherborne, these pupils made up approximately 15% of their patients. Dedicated surgeries were held six days of the week during term time and resulted in easier access to health advice and treatment for these patients.

Updated 28 November 2016

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

• 96% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was better than both the clinical commissioning group (CCG) average of 86% and national average of 84%.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in their records in the preceding 12 months was 95%, which was better than the national average of 88%.

• 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 28 November 2016

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

• The practice had established close relationships with their patients which enabled them to identify potential vulnerability and be aware of changes in circumstances, for example, at time of bereavement.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and 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 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.