Archived: The Tollerford Practice

Updated 20 September 2016

The Tollerford Practice was inspected on Tuesday 9 August 2016. This was a comprehensive inspection.

The main practice is situated in the rural village of Maiden Newton, Dorset. The practice is rated as being on the fourth least deprived decile which meant it is in a relatively affluent area of the country. Census information showed that 98% of the local population identify themselves as white British. The practice provides a general medical service to 5,800 patients of a diverse age group.

There is a team of three GPs partners and one salaried GP. Three are female and one male. Some work part time and some full time. The whole time equivalent is 3.5. Partners hold managerial and financial responsibility for running the business. The team are supported by a practice manager, one nurse prescriber, four practice nurses, two health care assistants, and additional administration staff.

Patients using the practice also have access to community nurses, mental health teams and health visitors who are based at the practice. Other health care professionals visit the practice on a regular basis.

The practice is open between the NHS contracted opening hours of 8am and 6.30pm Monday to Friday. Appointments are offered anytime within these hours. Extended hours surgeries are offered on Mondays from 6.30pm until 8pm.

Outside of these times patients are directed to contact the 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 General Medical Services (GMS) contract with NHS England.

The practice provides regulated activities from two locations, a main site and a branch site. The main site is located at The Tollerford, Pound Piece, Maiden Newton, Dorset DT2 0DB. The branch site is located at Tunnel Road Surgery, 24 Tunnel Road, Beaminster, Dorset DT8 3AB. During our inspection we visited the main site in Maiden Newton; we did not visit the branch site.

Updated 20 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Tollerford Practice on 9 August 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.
• 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 practice used video conferencing to link staff working at both sites in this rural area to support effective communication between staff.

• The provider was aware of and complied with the requirements of the duty of candour.

We saw areas of outstanding practice:

The practice employed a full time adult care co-ordinator in response to the higher than average older patient population. The adult care co-ordinator proactively sought to reduce unplanned hospital admissions. The role included signposting patients to relevant support services, reviewing care plans, carrying out home visits to facilitate reasonable adaptations and co-ordinated care between nurses, community matrons, social services and hospital clinicians. The positive impact of this work had been a reduction in unplanned hospital admissions by 8.6% since the new role commenced in 2014.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 September 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, in whom the last blood test was 64 mmol/mol or less in the last 12 months was 84% which was better than the national average of 77%.

• 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 received a visit from dementia advisers, a wheelchair user, and a charity for the visually impaired to help improve facilities for vulnerable patients visiting the practice. The practice had acted upon their feedback to improve access. For example, through the use of coloured signage, braille signage, lowering the leaflet racks and reception desk and fitting dementia friendly coloured toilet seats.

Updated 20 September 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 percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years was 89% which was better 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 employed a part time child care co-ordinator who had a positive impact on child safeguarding. For example, when a newly registered child patient arrived at the practice, the co-ordinator wrote to the child’s previous GP to request any information. Also, when a child left the practice the co-ordinator sent a letter to the new GP with relevant information.

• The practice had a website and a webpage specifically aimed at health promotion for younger people.

• GPs from the practice provided a monthly clinic for the local secondary school on sexual health and contraceptive advice.

Updated 20 September 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 was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice employed a full time adult care co-ordinator in response to the higher than average older patient population. The adult care co-ordinator liaised closely with the 166 patients aged over 75 years with a proactive aim to reduce the inconvenience of unplanned hospital admissions for patients. The role included signposting patients to relevant support services, reviewing care plans, carrying out home visits to facilitate reasonable adaptations and co-ordinated care between nurses, community matrons, social services and other health professionals. The positive impact of this work had been to reduce unplanned hospital admissions by 8.6% since starting in 2014. This was accompanied by a reduction in accident and emergency attendances for patients aged over 75 years by 6.7% and their use of out of hour’s services by 5.5%. Prior to the creation of this role, in 2013 there were 95 occasions where the same patients aged over 75 years attended accident and emergency three times. The work of the adult care co-ordinator reduced this to 49 in 2014 and 54 in 2015.

• The practice carried out a monthly meeting with practice GPs and nurses, district nurses, rehabilitation teams, geriatricians, social services, and elderly community mental health teams.

Updated 20 September 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.

• 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.

• The practice had a website, online appointment booking system and electronic prescribing system.

Updated 20 September 2016

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

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  The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months was 91% which was better than the national average of 89%.

• 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 20 September 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 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.