Woodbury Surgery

Updated 29 December 2016

Woodbury Surgery has one registered location providing general medical services at: The Surgery, Fulford Way, Woodbury, Exeter EX5 1NZ

It is a small rural practice with a dispensary caring for approximately 3916 patients in an area covering 250 square miles and is located nine miles from the main hospital. Bus services serving the community are infrequently scheduled. Approximately 3350 patients are able to use the dispensary services because they live too far from another community pharmacy. Information about this is listed on the practice website and patient information leaflet.

The population of the practice is diverse and includes a large retired population, families who have been in farming for generations, young families and working age adults. The local population is predominantly White British with some Eastern European and travellers. There is a broad socioeconomic mix including a number of vulnerable children and adults and some rural poverty in farmed areas. The practice serves patients on a traveller site and has developed close working relationships with families staying there. There is also an influx of temporary residents during the summer months, due to the location being near popular holiday destinations. The deprivation decile rating for this area is 10 (with one being the most deprived and 10 being the least deprived). This meant that this area was affluent compared to the national average.

The practice is managed by three GP partners (one male and two females). If required the practice uses the same GP locums for continuity where ever possible to cover absences such as holiday periods. The nursing team consists of three female nurses: two practice nurses and a healthcare assistant. One nurse is an independent prescriber and is able to treat minor illnesses.

Woodbury Surgery is a teaching practice, with three GP partners approved as GP tutors with the University of Exeter. The practice normally provides placements for medical students in years 2 and 4 of their education.

The practice at Woodbury Surgery is open 8am to 6.30pm Monday to Friday. Phone lines are open from 8.30am to 1pm and 1.30pm to 6pm, with the out of hours service responding to patient phone calls after this time. GP appointments for patients are available every weekday. On Monday mornings the practice runs an open surgery between 9am and 10.30am, which patients can turn up to and wait to be seen by a GP. Extended opening hours are available with early morning and evening appointments by arrangement. These were available on Tuesday mornings and on Monday and Tuesday evenings.

Opening hours of the practice are in line with local agreements with the clinical commissioning group. Patients requiring a GP outside of normal working hours are advised to contact the out of hours service provided by Devon Doctors. The practice closes for four half days a year for staff training and information about this is posted on the website.

The practice has a general medical services (GMS) contract.

The following regulated activities are carried out at the practice: Treatment of disease, disorder or injury; Surgical procedures; Family planning; Diagnostic and screening procedures; Maternity and midwifery services.

Updated 29 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Woodbury Surgery on 20 September 2016. Overall the practice is rated as outstanding.

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. Woodbury Surgery was proactive in identifying frailty and managing vulnerable patients and those with long term health conditions registered at the practice. An intuitive IT system facilitated the early identification of patients who could also be at risk of developing long term conditions enabling early interventions to take place.
• 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.
• There was high patient satisfaction, with all 46 patients confirming 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.

• People’s individual needs and preferences were central to the planning and delivery of tailored services.We saw several examples of this illustrated by: Longer 15 minute appointments as a standard; seeing patients in the setting they were most comfortable with; a flexible and responsive service by clinical staff for housebound patients; bridging gaps bringing services closer to home such as specialist clinics for patients with long term conditions and building a trusting rapport with hard to reach vulnerable groups such as the travelling community. 

• 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 GP partnership provided a total team approach to monitoring the health and well being of patients with innovative new ways of providing care and treatment.
• The leadership, governance and culture at Woodbury Surgery was used to drive and improve the delivery of high-quality person-centred care.
• Learning was celebrated and the practice was proactive in using opportunities to improve services by seeking and acting upon feedback from staff, patients and other stakeholders.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw two areas of outstanding practice:

People’s individual needs were central to planning and the delivery of tailored services. For example, the practice had initiated a complex condition clinic where patients were seen by a GP and other specialists to ensure patients received a comprehensive holistic review that met all health and social care needs. The practice understood the impact of living with chronic and life limiting conditions such as chronic kidney disease. Clinics were held with consultant and specialist nurse input facilitating closer monitoring of these patients.

The practice had invested in a software risk management system, which enabled patient records to be analysed to produce risk profiles and target audit activity and health screening. For example, the system enabled the practice to identify patients and led to timely diagnosis of coeliac disease so that they could receive appropriate support and treatment to manage this condition.

Action the provider should take to improve:

Ensure that pre appointment checks for locum staff are carried out for every new period of cover at the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 December 2016

The practice is rated as outstanding for people with long-term conditions in the Responsive and Well-Led domains; the ratings for these domains mean the population groups are also rated outstanding.

• There was a holistic approach to assessing, planning and delivering care and treatment to people who had long term conditions and early interventions for those who could be at risk of developing them.

• Anticipatory risk management provided timely interventions for patients who could be at risk of developing long term conditions.Examples seen included: the identification of at risk patients and led to timely diagnosis of coeliac disease so that they could receive appropriate support and treatment to manage this condition. The identification of and monitoring of patients who had previously had gestational diabetes for whom there was a known risk that they could go on to develop diabetes in later life.

• Performance for diabetes related indicators was better than the national average. For example, the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 94.5%. (CCG 89.2% and 88.3% national averages).

• There was effective management all patient registers through it’s bespoke software to recall patients for review and had achieved lower exception reporting (Longer appointments and home visits were available when needed.

• Woodbury Surgery facilitated access for patients and had brought several services closer to home, particularly for people living with chronic and life limiting conditions. For example, the practice ran a monthly clinic for patients with chronic renal disease which had specialist consultant and nursing input.

Updated 29 December 2016

The practice is rated as outstanding for families, children and young people in the Responsive and Well-Led domains; the ratings for these domains mean the population groups are also rated outstanding.

• 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 high for all standard childhood immunisations, in particular for children aged five years achieving 100% for these in 2015/16.

• 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 87.5%, which was better than the CCG average of 82.5% 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 29 December 2016

The practice is rated as outstanding for the care of older people in the Responsive and Well-Led domains; the ratings for these domains mean the population groups are also rated outstanding.

• The practice offered proactive, personalised care to meet the needs of the older people in its population. For example, practice nurses had carried out home visits to housebound patients to review their health and give flu vaccine.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. The nursing team provided outreach services for housebound patients, regularly carrying out health and well being reviews of any patients with long term conditions.During the Autumn months, this also included an outreach flu vaccination service for thse patients.

• GPs proactively managed patient risks providing responsive triage to determine the support patients needed when contacting the practice.For example followed up every telephone call to the practice within 30 minutes of the patient phoning to assess their needs.

Updated 29 December 2016

The practice is rated as outstanding for working age people (including those recently retired and students) in the Responsive and Well-Led domains; the ratings for these domains mean the population groups are also rated outstanding.

• 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. For example, an aortic aneurysm screening clinic was being held on the day of the inspection for eligible men aged 65 years.

Updated 29 December 2016

The practice is rated as outstanding for people experiencing poor mental health (including people with dementia) in the Responsive and Well-Led domains; the ratings for these domains mean the population groups are also rated outstanding.

• 90.6% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was better than to the national average of 84%.
• Performance for mental health related indicators was better than the national average. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 93.7%. This was above average compared with the CCG (87.2%) and national averages (88.5%).

• 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 29 December 2016

The practice is rated as outstanding for people whose circumstances may make them vulnerable in the Responsive and Well-Led domains; the ratings for these domains mean the population groups are also rated outstanding.

• Services were tailored to meet the needs of vulnerable people and delivered in a way to ensure flexibility, choice and continuity of care.This was illustrated by:

• Woodbury practice had effective management systems in place to proactively manage patients at risk of unplanned hospital admissions.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. For example, a flexible approach ensured that staff looking after patients, family members and carers were fully involved in assessment and planning of care for patients with complex learning disabilities.

• The practice had developed a trusting rapport with traveller families and understood their culture needs.Six families and their extended families had returned to a temporary site each year to access health reviews for their children and parents and were registered at the practice.

• The practice regularly worked with other health, social and third sector care professionals in the case management of vulnerable patients. For example, the practice worked in partnership with the third sector organisation ‘Neighbourhood Friends’ to provide and develop a range of supporting services for older, vulnerable patients registered at the practice. A prescriptions delivery service was due to start for vulnerable and isolated patients.

• The practice informed and actively supported vulnerable patients needing to access various support groups and voluntary organisations. For example, vulnerable patients were provided a safe haven at the practice whilst escaping domestic abuse.

• 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.