Archived: The Shaftesbury Practice

Updated 30 November 2016

The Shaftesbury Practice belongs to The Blackmore Vale Partnership but is currently registered as a separate location. The Shaftesbury Practice was inspected on Tuesday 18 October 2016. This was a comprehensive inspection.

The location we visited during this inspection was The Shaftesbury Practice in Shaftesbury, Dorset. The deprivation decile rating for this area is eight (with one being the most deprived and 10 being the least deprived). This meant that this area was relatively affluent compared to the national average. The 2011 census data showed that 98% of the local population identified themselves as being white British. The Blackmore Vale Partnership provides a primary medical service to 24,000 patients of a diverse socio-economic group. The practice is a teaching practice for medical students and a training practice for GP trainees.

There is a team of 15 GPs. Seven were GPs partners and eight are salaried GPs. Of these, seven are female and eight male. Some work part time and some full time. The whole time equivalent is approximately nine and a half GPs. A new GP partner started in October 2016. The practice manager is also a partner. Partners hold managerial and financial responsibility for running the business. The team are supported by an operations manager, office manager, finance manager, an IT and data quality manager and a nurse team manager. There are six advanced nurse practitioners, six practice nurses, seven health care assistants, and additional administration staff. GPs have a dedicated personal assistant who deals with their administrative tasks.

Patients using the practice also have access to community nurses based in the Marnhull Surgery branch. Health visitors and the school health team are based at the practice. The community mental health team is based in The Shaftesbury Practice. Other health care professionals visit the practice on a regular basis.

The practice is open between the NHS contracted opening hours 8am - 6.30pm Monday to Friday. Appointments are offered anytime within these hours. Extended hours surgeries are offered at the following times, on Mondays and Wednesdays until 7.30pm and on Tuesday and Thursdays until 7pm.

Outside of these times patients are directed to contact the South West Ambulance Service Foundation Trust service out of hour’s service by using the NHS 111 number.

The practice offers a range of appointment types including book on the day, telephone consultations and advance appointments.

The practice has a Personal Medical Services (PMS) contract with NHS England.

The Shaftesbury Practice belongs to The Blackmore Vale Partnership which provides regulated activities from four locations. During our inspection we visited The Shaftesbury Practice (also known as Abbey View Medical Centre), Salisbury Road, Shaftesbury SP7 8DH.

We did not visit the other locations at Sturminster Newton Practice, Old Market Hill, Sturminster Newton, Dorset DT10 1QU or Marnhull Surgery, Church Hill, Marnhull DT10 1PU or Fontmell Magna Surgery, West Street, Fontmell Magna, Shaftesbury SP7 0EF.

Updated 30 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Shaftesbury Practice on 18 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. The practice held monthly all staff meetings where discussion and shared learning on these events took place.
• A wide range of complete cycle clinical audits demonstrated quality improvement. There had been 28 clinical audits in the past two years.
• Risks to patients were assessed and well managed throughout the practice.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff training needs analysis had been undertaken and the results implemented. Staff had the skills, knowledge and experience to deliver effective care and treatment. Management had undertaken a staff training needs analysis and provided appropriate training for staff. There were six advanced nurse practitioners.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. All of the feedback from patients was positive.
• Information about services and how to complain was available and easy to understand. The practice carried out an annual complaint audit, the findings of which influenced shared learning events and 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 which were spacious and 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.

We identified an area of outstanding practice:

The practice employed a community psychiatric nurse (CPN) as a nurse practitioner at the practice for two days a week. This member of staff maintained close links with the local NHS Mental Health Trust through working there three days a week. The CPN supported patients with a wide range of mental health issues both at the practice and during home visits. The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the preceding 12 months was 92% which was comparable with the CCG average of 92% and higher than the national average of 88%. They provided us with examples of individual cases where they had used their mental health expertise to support patients with their medical care and treatment to avoid relapses in their mental health. They also helped to carry out physical health checks for patients receiving anti-psychotic medicines to reduce the risk of these patients gaining unhealthy weight.

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.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The percentage of patients with diabetes, on the register, who had had an influenza immunisation, was 97% which was higher than the national average of 94%.

• 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.

• The practice had recently undertaken a nurse led review of its diabetic care. This had freed up nurse time by reducing the clinical work load for patients who were managing well and were therefore low risk, in order to improve care for housebound high risk diabetic patients.

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. Immunisation rates were relatively high 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 cervical screening rate was 95% which was higher than 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.

• The practice received SCARF (single combined assessment of risk forms) directly from health visitors which enabled GPs to act upon them immediately; for example, by implementing a child patient action plan.

• The practice had a dedicated children’s play area in the waiting room and children’s books and toys.

• The practice had numerous toilet facilities and a baby changing area.

• There were regular breast feeding support sessions held by health visitors and twice weekly midwife clinics at the practice.

• The practice used social media such as their website together with Twitter and Facebook to engage with young people to promote healthy lifestyles and events.

Updated 30 November 2016

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

• The practice offered proactive, holistic and 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 held fortnightly multi-disciplinary team meetings with community nurses, therapists, consultant geriatricians, palliative care nurses and occupational therapists to discuss their most at risk older patients.

• The practice had been awarded the Going for Gold standard for being amongst the first in Dorset to provide Gold Standard Framework (GSF) end of life care. This was in line with current practice and NICE guidance.

• The practice employed a pharmacist and a pharmacy technician in order to reduce poly pharmacy in its large elderly population (polypharmacy is when patients are taking 10 or more medicines), in order to reduce the side effects of multiple medicines being used, reduce waste and support the management of multiple conditions.

• An elderly care psychiatrist attended the practice to see patients depending on patients needs at least once a month. This had helped the practice to identify the onset of conditions such as dementia.

Updated 30 November 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice maintained a social media presence on Facebook, together with a website and a Twitter account in order to provide services aimed at this population group.

• The practice offered extended hours several times a week which were aimed at this population group.

• There were a range of online services available including the ability to book an appointment online or order a prescription.

• 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 reflects the needs for this age group.

• Health promotion material was available through the practice.

Updated 30 November 2016

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

• 90% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was above the national average of 84%.

• The practice employed a community psychiatric nurse (CPN) as a nurse practitioner at the practice. This member of staff maintained close links with the local NHS Mental Health Trust through working there three days a week and with the practice two days a week. The CPN supported patients with a wide range of mental health issues both at the practice and during home visits. They provided us with examples of individual cases where they had used their mental health expertise to support patients with their medical care and treatment. They also helped to carry out physical health checks for patients receiving anti-psychotic medicines to reduce the risk of these patients gaining unhealthy weight and look for metabolic syndrome.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the preceding 12 months was 92% which was comparable with the CCG average of 92% and higher than the national average of 88%.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months was 87% which was slightly lower than the national average of 90%.

• 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 30 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 homeless people, travellers and those with a learning disability.

• The practice had approximately 100 patients registered with a learning disability and had appropriate support systems in place such as easy to read communication leaflets, diagrams and photographs to support these patients.

• 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.