Giffords Partnership Also known as Giffords Surgery

Updated 9 December 2016

Giffords Partnership is a GP practice in Melksham, Wiltshire. It is one of the practices within the Wiltshire Clinical Commissioning Group and has approximately 14,100 patients.

The area the practice serves has relatively low numbers of people from different cultural backgrounds and is in the low to medium range for deprivation nationally, (although it is important to remember that not everyone living in a deprived area is deprived and that not all deprived people live in deprived areas). The practice has a slightly higher than average patient population over 50 years old.

The practice provides a number of services and clinics for its patients including childhood immunisations, family planning, minor surgery and offers a range of health, lifestyle management and advice for conditions including; asthma, diabetes, heart disease and high blood pressure.

There are two full-time and three part-time GP partners and two salaried GPs making a working time equivalent of six GPs.  Two GPs are male and five female. They are supported by three nurse practitioners, three practice nurses, four health care assistants and an administrative and dispensing team of 18 staff led by the practice manager.

The practice is a teaching and training practice. (A teaching practice accepts provisionally registered doctors undertaking foundation training, while a training practice accepts qualified doctors training to become GPs who are known as registrars.) At the time of our inspection they had one registrar working with them.

The practice is open between 8am and 6.30pm Monday to Friday, except Monday and Tuesday when they open until 7.30pm. GP appointments are available between 8.30am and 12.30pm every morning and 2pm to 5.30pm every weekday. Extended hours appointments are offered from 6.30pm to 7.30pm on Monday and Tuesday.

The practice operates an on-the-day triage appointment system where patients who phone the surgery receive a return call from a GP or nurse who discusses the patient’s issues and an appointment later that day is arranged, where appropriate. Some extended hours appointments can be booked on-line.

When the practice is closed patients are advised, via the practice’s website that all calls will be directed to the out of hours service. Out of hours services are provided by Medvivo, accessed via NHS 111.

The practice has a General Medical services contract to deliver health care services. This contract acts as the basis for arrangements between NHS England and providers of general medical services in England.

The practice provides services from the following site:

 Giffords Partnership, Giffords Surgery, Spa Road, Melksham, Wiltshire, SN12 7EA.

Updated 9 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Giffords Partnership on 1 November 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.
• The practice had recently introduced a new triage system for appointments which meant patients could not usually make appointments in advance. Most patients we spoke to said it was a good system and an improvement on the previous arrangements.
• 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:

• The practice had good facilities for the blind and partially sighted. Signage throughout the building was very clear and included a braille translation. The practice leaflet was available in a braille format and the practice was able to arrange the translation of any other of its documents into braille within 24 hours.

The areas where the provider should make improvement are:

• Ensure all staff interview notes and references are recorded and retained.
• Ensure all staff have regular appraisals.
• Ensure that all lessons learnt from significant events incidents are shared with appropriate staff.
• Review their appointment system to ensure it does not disadvantage working patients and other who may need to book appointments in advance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 December 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.
• 98% of patients with diabetes on the register had an influenza immunisation in the period 8/2014 to 3/2015, compared to the CCG average of 96% and national average of 94%.
• Longer appointments and home visits were available when needed.
• All patients with long-term conditions 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. 

Updated 9 December 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.
• 91% of women on the register aged 25 to 64 had a cervical screening tests performed in the preceding five years compared to the clinical commissioning group average of 85% and national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice encouraged feedback from children and young people by using a feedback form specifically designed for them.

Updated 9 December 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 staff made routine visits to local nursing, care and residential homes to see patients.
• The practice had worked with the clinical commissioning group (CCG) and two other local practices under a programme called Transforming Care for Older People (TCOP) to establish a service to improve care for older people. One of the aims of this service was to reduce unplanned admissions and we saw data that showed the practice had achieved a 41% reduction  in unplanned admissions of patients over 75 years of age living in a care home.
• The practice worked with two other local services to provide a leg ulcer clinic and falls clinic.

Updated 9 December 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.
• They had a virtual patients participation group which made it easier for this group of patients to give feedback to the practice.
• Telephone consultations were available during working hours.
• Travel health and vaccination appointments were available.

Updated 9 December 2016

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

• The quality outcome framework data for mental health showed the practice was performing below the national average.
• 74% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, compared to the CCG average of 88% and national average of 84%.
• 85% of patients on the register with a psychosis had a comprehensive care plan agreed in the preceding 12 months compared to the CCG average of 93% and national average of 88%.
• 51% of patients with a psychosis on the register had their alcohol consumption recorded in the preceding 12 months, compared to the CCG average of 93% and national average of 90%.​
• 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 9 December 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.
• The practice had good facilities for the blind and partially sighted, including; clear signage with braille translation and the practice leaflet was available in a braille format.