The Downland Practice

Updated 11 February 2016

The Downland Practice is a dispensing practice and offers GP services to the local community in rural West Berkshire including the surrounding 13 villages and hamlets within a 120 square mile radius. The practice is part of Newbury and District Clinical Commissioning Group (CCG). The practice provides general medical services to approximately 11,000 registered patients.

Clinical services are provided from:

• Chieveley Surgery, East Lane, Chieveley, Newbury, Berkshire, RG20 8UY.

• Compton Surgery, High Street, Compton, Newbury, Berkshire, RG20 6NJ

The practice has core opening hours from 7.30am to 7.00pm Monday to Friday to enable patients to contact the practice. The branch surgery in Compton is open every weekday morning between 8.00am and 12.00 noon.

The patient population has increased by approximately 17% in the last four years. The practice population has a significantly higher proportion of patients aged 5-14 and 40-54 compared to the national average. The practice also provides GP services to a local independent, specialist school for pupils with autism, moderate to severe learning difficulties and complex needs (approximately 68 patients).

According to national data there is minimal deprivation within the locality.

The practice comprises of seven GP partners (four male, three female) who are supported by two female salaried GPs and one female GP Registrar. The practice is a training practice for GP Registrars. GP Registrars are qualified doctors who undertake additional training to gain experience and higher qualifications in general practice and family medicine.

The all-female nursing team consists of five practice nurses and one health care assistant with a mix of skills and experience. In addition, the practice is supported by one midwife who runs clinics on the practice premises. The practice also works closely with health visitors and district nurses.

A practice manager, an assistant practice manager, a dispensary/reception manager and a team of reception, administrative and 10 dispensary staff undertake the day to day management and running of the practice. The practice is engaged with the apprentice programme and has one apprentice who undertakes administration and reception duties.

The practice opted out of providing the out-of-hours service. This service is provided by the out-of-hours service accessed via the NHS 111 service. Advice on how to access the out-of-hours service is clearly displayed on the practice website and over the telephone when the surgery is closed.

Updated 11 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of The Downland Practice on 16 December 2015. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).

• The practice had an effective governance system in place, was well organised and actively sought to learn from performance data, incidents and feedback.

We saw two areas of outstanding practice including:

• The Downland Practice had responded to the needs of the wider community and was providing an ultrasound scanning service. The practice uses a high quality scanner and offers scans for the abdomen including liver, gall bladder, abdominal aorta, pelvis and pregnancy assessment. This resulted in patients receiving scans at a more convenient location than travelling to hospital, often a shorter waiting time and one expectant mother told us the early pregnancy scans provided reassurance and continuity of care. The practice performs approximately 300 ultrasound scans each year and was regularly audited to demonstrate quality improvement as part of the clinical audit programme within the practice. Recent notable diagnoses following ultrasound scans include three cases of testicular cancer, a life threatening critical abdominal aortic aneurysm and 13 pregnant women have avoided hospital admission following first trimester pregnancy scans.

• The Downland Practice provides GP services to a local independent, specialist school for pupils with autism, moderate to severe learning difficulties and complex needs. There was specific designated GP point of contacts for the school (approximately 68 patients). Contact details of the designated GP were shared with the relevant staff and patients families, enabling continuity of care and quick access to the right staff at the practice. The designated GP had 16 years’ experience of working with patients with autism and could demonstrate regular and up-to-date autism specific training and undertook monthly ‘Looked After Children’ Health Reviews and updates from the Royal College of General Practitioners.

However, there was an area of practice where the provider needs to make improvements.

Importantly the provider should:

• Continue to review and monitor the performance and outcomes for patients with diabetes and COPD.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 11 February 2016

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

• The GPs and nurse team had the knowledge, skills and competency to respond to the needs of patients with long term conditions such as diabetes and COPD (Chronic obstructive pulmonary disease is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease).

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check that their health and medicine needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• Patients with end of life care needs and their families were well supported by the practice. One of the GPs facilitated an end of life community session at a local church.

Historic quality data demonstrated the monitoring of patients with long term conditions, for example dementia, was similar to the national average. However, data demonstrated the monitoring of patients with diabetes was lower than the local CCG and national average. For example:

Performance for diabetes related indicators was lower (75.6%) than both the CCG (86.2%) and national average (89.2%). This was discussed during the inspection and all the key members of the practice team had a comprehensive understanding of the performance of the practice and we saw a detailed strategy in place to improve diabetic patient outcomes.

Updated 11 February 2016

The practice is rated as outstanding 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.

• 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 performance for the cervical screening programme was 84%, which was higher when compared to the CCG average (77.4%) and the national average (81.8%).

• We saw good examples of joint working with midwives and health visitors. Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice provides an ultrasound scanning service offering scans for the abdomen including liver, gall bladder, abdominal aorta, pelvis and pregnancy assessment. Recent notable diagnoses following ultrasound scans included 13 pregnant women who avoided hospital admission following first trimester pregnancy scans. One expectant mother told us the early pregnancy scans provided reassurance and continuity of care.

Immunisation rates for standard childhood immunisations (12 months, 24 months and five years) given in 2014/15 were higher when compared with the CCG average. For example:

• 94.9% of patients aged 12 months had received PCV vaccination, the CCG average was 92.2% (PCV is a pneumococcal vaccine).

Updated 11 February 2016

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

• The practice provided person centred care to meet the needs of the older patients in its population and had a range of enhanced services, for example in dementia, end of life care and reducing admissions to hospital.

• It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

• The practice systematically identified older patients and coordinated the multi-disciplinary team (MDT) for the planning and delivery of palliative care for people approaching the end of life.

• One of the practice GPs attends and facilitates an interactive ‘end-of-life’ session at a local church within the community. The GP which led this session worked within the five priorities for ‘end-of-life’ care.

• This rural practice provided a service which delivered prescription products and medicines to vulnerable, isolated and housebound patients.

• Unplanned hospital admissions and re-admissions for this group were regularly reviewed and improvements made.

Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. For example:

• 81.2% of patients aged 65 and over had received a seasonal flu vaccination. This is higher when compared to the national average (73.2%).

• 90.9% of patients with atrial fibrillation are currently treated with anti-coagulation therapy. This is higher when compared to the national average (85.3%).

• 100% of patients aged 75 or over with a record of a fragility fracture (on or after 1 April 2014) and a diagnosis of osteoporosis, are currently treated with an appropriate bone-sparing agent. This was higher than the national average (92.9%).

Updated 11 February 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 Downland Practice was open between 7.30am and 7.00pm Monday to Friday. Routine appointments are between 7.30am and 6.40pm Monday to Friday with the exception of Thursdays. On Thursdays routine appointments ranged from 8.00am and 7.00pm. The branch surgery in Compton was open 8.00am to 12noon each weekday morning.

• The dispensary at both the Downland Practice and branch surgery in Compton were open at the same times as the surgery.

• 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. One patient we spoke with praised email correspondence from the GPs and commented this pragmatic approach, for someone with a full time job was very much appreciated.

• Health promotion advice including up to date health promotion material was available through the practice and on the practice website.

Updated 11 February 2016

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

The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

Staff had a good understanding of how to support people with mental health needs and dementia.

The practice had carried out advance care planning including regular face-to-face care review for patients with dementia. For example:

89.3% of patients diagnosed with dementia had a face-to-face review; this was higher when compared with the CCG average (85.5%) and the national average (84%). 

Updated 11 February 2016

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

• The practice held a register of vulnerable patients including those with a learning disability. We saw the practice had carried out annual health checks for people with a learning disability and these patients had a personalised care plan in place.

• The Downland Practice provides GP services to a local independent, specialist school for pupils with autism, moderate to severe learning difficulties and complex needs. There was specific designated GP point of contact for the school (approximately 68 patients). Contact details of the designated GP were shared with the relevant staff and patients families, enabling continuity of care and quick access to the right staff at the practice.

• We saw longer appointments were available for patients that needed them.

• It had told 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.