Archived: Lydney Practice

Updated 18 May 2016

The Lydney Practice is a long established family orientated GP practice located in Lydney town centre, Gloucestershire. The practice is situated with a single storey purpose built health centre building and is wheelchair accessible with automatic doors to the practice.

The practice is approved for training qualified doctors who wish to become GPs and provides general medical services to approximately 7,020 patients. Services to patients are provided under a General Medical Services (GMS) contract with NHS England. (A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract).

The Practice has five GP partners (two female and three male) which is equivalent to four and a half whole time equivalent GPs. The clinical team includes three practice nurses (all female), two health care assistants and two phlebotomists. The practice manager is supported by an operations manager, a senior receptionist and a team of ten receptionists/secretaries.

Lydney practice is a dispensing practice with a dispensary managed by a dispensary manager supported by two dispensers. The practice dispenses to approximately 21% of the registered patient base.

The practice population has a higher proportion of patients aged between 65 and 74 compared to local and national averages. For example, 22% of practice patients are aged between 65 and 74 compared to the local clinical commissioning group (CCG) average of 20% and the national average of 17%.

The practice is located in an area with low social deprivation. The prevalence of patients with a long standing health condition is 55% compared to the local CCG average (55%) and national average (54%). People living in more deprived areas and with long-standing health conditions tend to have greater need for health services.

The practice is open between 8.30am and 6.30pm on Monday to Friday. Between 8am and 8.30am every weekday telephone calls are picked up by the reception team and a duty doctor was on site to treat any medical emergencies. Appointments are available between 8.30am and 12.30pm every morning and 2.30pm to 5.45pm every afternoon. Extended surgery hours are also offered on at least two evenings each week between 6.30pm and 7.15pm.

Out of hours cover is provided by South Western Ambulance Service NHS Foundation Trust and can be accessed via NHS 111.

The practice provided its services from the following address:

Lydney Practice

The Health Centre

Albert Street

Lydney

Gloucestershire

GL15 5NQ

This was the first inspection of Lydney Practice.

Updated 18 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lydney Practice on 13 April 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. However, there were two minor risks the practice had not fully considered which related to access to the dispensary and COSHH records held in the practice.
• 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.

We saw one area of outstanding practice:

• A practice GP had implemented a new protocol for monitoring high risk medicines and devised a booklet for patients’ personal usage. This ensured that all patients were aware when their next blood check was due and also gave the practice and secondary care services a means to monitor blood results more closely to avoid repeated tests.

The areas where the provider should make improvement are:

• Implement a robust risk assessment for assessing and monitoring risks with staff members having access to the dispensary.

• Undertake thorough COSHH analysis and complete a robust COSHH risk assessment utilising safety data sheets for all cleaning products held.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 May 2016

The practice is rated as good for the care of patients 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 overall diabetes related indicators was 98% which was above the clinical commissioning group average of 95% and national average of 89%.

• 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.

• Multidisciplinary meetings were held monthly with community based staff.

Updated 18 May 2016

The practice is rated as good for the care of families, children and young patients.

• 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 patients 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 patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The practice’s uptake for women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years was 83% which was above 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 through minutes of monthly primary health care team meetings.

Updated 18 May 2016

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

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

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

• The practice worked closely with the community nursing team who were based in the same building, supporting and caring for patients at the end of life.

• Weekly meetings took place that included discussions of hospital admissions, hospital discharges and palliative care patients.

Updated 18 May 2016

The practice is rated as good for the care of working-age patients (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 reflects the needs for this age group.

• Extended hours evening appointments were available for working age patients to attend outside of working hours.

• Services available included in house spirometry, phlebotomy, electrocardiogram, International Normalised Ratio monitoring for patients taking warfarin and NHS health checks.

Updated 18 May 2016

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

• 75% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is lower than the national average of 84%.

• Performance for mental health related indicators was 100% compared to the CCG average of 97% and national average of 82%.

• 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.

• Annual dementia reviews are carried out on patients who have been diagnosed or are at risk of dementia and the practice maintains a register to monitor these patients.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia and a community psychiatric nurse visited the practice once a week.

Updated 18 May 2016

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

• 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 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.

• The practice took part in a local social prescribing initiative.