Thorneloe Lodge Surgery

Updated 23 December 2016

Thorneloe Lodge Surgery is located on Barbourne Road in the city of Worcester, with a car park and bus stop just outside the practice building. The practice serves a practice population of approximately 10,600 patients in Worcester and considers patients from outside their area wishing to register with them.

The practice area is one of lower than average deprivation (1% unemployed compared with local and national levels of 4% and 5% respectively), with a slightly larger population of patients who are in paid work or full time education (64% compared with the county average of 60% and national average of 62%). The practice provides services to students at the local university.

There are four GP partners (three male and a female) and three female salaried GPs, giving patients a gender choice of GP they could see. The GPs are supported by a practice manager, an assistant practice manager, a project manager, a reception manager, administrative coordinators, a nurse manager, three practice nurses, three healthcare assistants, medical secretaries, administration and reception staff.

The practice has a General Medical Services (GMS) contract with NHS England. The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities. The practice also provides minor surgery.

Opening times are Monday to Friday from 8am to 6.30pm and also 8am until 12pm on Saturdays, with appointments available between these times. The practice also provides extended hours appointments until 8.30pm one night per week.

The practice does not provide an out-of-hours service but has alternative arrangements in place for patients to be seen when the practice is closed. For example, if patients call the practice when it is closed, an answerphone message gives the telephone number they should ring depending on the circumstances. Information on the out-of-hours service (provided by Care UK) is available on the practice’s website and in the patient practice leaflet.

Home visits are available for patients who are housebound or too ill to attend the practice for appointments. There is also an online service which allows patients to order repeat prescriptions, book and cancel appointments and make changes to personal details.

The practice treats patients of all ages and provides a range of medical services. This includes disease management such as asthma, diabetes and heart disease. Other appointments are available for maternity care and immunisations including travel advice and vaccinations.

Thorneloe Lodge Surgery is a leading research practice within the South Worcestershire Clinical Commissioning Group. It has a research ready accreditation and engages with the University of Warwick and the University of Nottingham. It is also a Member of National Institute of Health Research (NIHR) and has research ready accreditation

Updated 23 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Thorneloe Lodge Surgery on 15 September 2016. The overall rating for this service is good.

Our key findings across all the areas we inspected were as follows:

• Processes and procedures were in place to keep patients safe. This included a system for reporting and recording significant events, keeping these under review and sharing learning where this occurred.
• Risks to patients were assessed and well managed.
• The practice was aware of and provided services according to the needs of their patient population. This included transient patients such as students studying at the local university.
• Staff received regular training and skill updates to ensure they had the appropriate skills, knowledge and experience to deliver effective care and treatment.
• Regular meetings and discussions were held with staff and multi-disciplinary teams to ensure patients received the best care and treatment in a coordinated way.
• Patients told us they were treated with dignity and respect and that they were fully involved in decisions about their care and treatment.
• Information about services and how to complain was available and easy to understand. Patients told us that they knew how to complain if they needed to.
• The practice had an active Patient Participation Group (PPG). The PPG were proactive in representing patients and assisting the practice in making improvements to the services provided.
• There was a clear leadership structure and staff told us they felt supported by management. The practice proactively sought feedback from patients, which it acted on.

There was however, an area where the provider should make improvements:

• Continue with action to increase the number of health checks carried out for eligible patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 December 2016

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

• All patients diagnosed with a long term condition had a named GP and a structured annual review to check that their health and medicine needs were being met.
• GPs and practice nurses had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Nursing staff had received appropriate training in chronic disease management, such as asthma and diabetes.
• Longer appointments and home visits were available when needed.
• The practice worked with relevant health and care professionals for patients with the most complex needs, to deliver a multidisciplinary package of care.
• Information leaflets about specific long term conditions were available to patients in the waiting room. Links to support agencies were available on the practice website, such as Diabetes UK for diabetes and the British Heart Foundation for coronary heart disease.

Updated 23 December 2016

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

• Same day appointments were offered to all children under the age of five.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Weekly health visitor clinics were held at the practice.
• Childhood immunisation rates for the vaccinations given were comparable to local and national averages.
• 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 uptake for the cervical screening programme was 88% which was comparable to the local average of 83% and above the national average of 82%, although exception reporting was higher than average. For example, 14% compared with local and national levels of 7% and 6% respectively.
• The practice also offered a number of online services including requesting repeat medicines and booking appointments.

Updated 23 December 2016

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

• The practice offered personalised care to meet the needs of the older people in its population. It was responsive to the needs of older patients, and offered home visits and rapid access appointments for those with enhanced needs.
• The practice offered a range of enhanced services, for example, in dementia and end of life care.
• Nationally reported data showed that outcomes for patients were good for conditions commonly found in older patients.
• The practice provided care for patients at two local care homes. GPs visited weekly and also responded to urgent heath care needs when required.
• A direct line was provided to access GPs for patients living in local care homes.

Updated 23 December 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 services that reflected the needs of this age group.
• The practice nurses had oversight for the management of a number of clinical areas, including immunisations, cervical cytology and some long term conditions.
• Patients were able to access telephone appointments which were available to them without time off work needing to taken. Appointments could also be booked and cancelled online.
• NHS Health Checks were offered by the nursing team.
• Flu clinics were scheduled on Saturday mornings, which provided flexibility for patients who could not attend during the week.
• Health promotion advice was offered such as smoking cessation and nutrition. There was accessible health promotion material available at the practice and on its website.

Updated 23 December 2016

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

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. It carried out advanced care planning and annual health checks for patients with dementia and poor mental health.
• Staff had completed Dementia Friendly awareness training.
• Staff understood how to support patients with mental health needs and dementia.
• The practice had advised patients experiencing poor mental health how to access various support groups and voluntary organisations.
• There was a system in place to follow up patients who had attended A&E where they may have been experiencing poor mental health.
• The proportion of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was 76% which was below the local average of 85% and below the national averages of 83%. The practice exception rate was 0% which was below the CCG average of 5% and below the national average of 7%.
• Patients had access to local counselling services provided by the NHS and local organisations. They facilitated shared care clinics provided by support workers from the local drugs and alcohol service.

Updated 23 December 2016

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

• Staff had been trained to recognise signs of abuse in vulnerable adults and children and the action they should take if they had concerns. There were lead members of staff for safeguarding, and GPs were trained to an appropriate level in safeguarding adults and children.
• Clinical staff regularly worked with multidisciplinary teams in the case management of vulnerable patients. Alerts were placed on these patients’ records so that staff knew they might need to be prioritised and offered additional attention such as longer appointments.
• The practice informed patients about how to access various support groups and voluntary organisations.
• The practice held a register of patients living in vulnerable circumstances including those patients with a learning disability.
• Longer appointments were available for patients with a learning disability. The practice had carried out annual health checks for 55% of the patients on their register (27).