Cerne Abbas Surgery

Updated 14 April 2016

Cerne Abbas Surgery was inspected on Thursday 25 February 2016. This was a comprehensive inspection.

The main practice is situated in the rural village of Cerne Abbas, Dorset. The practice area covered 100 square miles of countryside which contained small villages and hamlets. The practice provides a primary medical service to 4,000 patients of a predominantly older age group.

There was a team of four GPs partners, two female and two male. Some worked part time and some full time. The whole time equivalent was three. Partners hold managerial and financial responsibility for running the business. The team were supported by a practice manager, seven practice nurses, one health care assistant, and additional administration staff.

The practice nursing team based at this dispensing practice in this rural area was an integrated nursing team (INT). The nurses carried out the role of community nurses, district nurses, palliative care, and community matron. Patients using the service also had access to mental health teams and health visitors. Other health care professionals visit the practice on a regular basis; such as a podiatrist and citizen’s advice bureau advisers, a counsellor, physiotherapist and midwife, chiropodist and nail care therapist.

The practice is open between the NHS contracted opening hours 8am to 6:30pm Monday to Friday. Appointments can be offered anytime within these hours. Extended hours surgeries are offered on a Saturday morning 9am to 12 noon.

Outside of these times patients are directed to contact the South West Ambulance Service Trust out of hour’s service by using the NHS 111 number.

The practice offered a range ofappointment types including book on the day, telephone consultations and advance appointments.

The practice had a Personal Medical Services (PMS) contract with NHS England.

The practice provided regulated activities from one location; 51 Long Street, Cerne Abbas, Dorset DT2 7JG. We visited this location during our inspection.

Updated 14 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cerne Abbas Surgery on 25 February 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 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.
• Patients said they found it easy to make an appointment with a named GP and that 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 provider was aware of and complied with the requirements of the Duty of Candour.

We identified areas of outstanding practice:

• The practice participated in the Vanguard Project which involved closer collaborative working with other healthcare providers; South Western Ambulance Service NHS Foundation Trust (SWAST), local hospital, social care and other GP practices. The project included working with retail companies to provide patients with welcome home from hospital food packs; to ensure that bread and milk were available at home on arrival from hospital.
• The practice had an innovative integrated nursing team (INT). The traditional practice nurse role and community nurse role was provided by the INT, who worked as practice nurses and also as community nurses, carrying out home visits across this large rural area with high numbers of older patients with complex conditions. The INT provided a wide range of nursing services seven days a week, 365 days a year from 8:30am to 5pm. Benefits to patients were demonstrated by the 74% of end of life patients who died in their own home which was their preferred place of death. This was higher than the national average of 33%.
• The practice had organised a service called “Giant’s Social” which offered social events and befriending services which helped to reduce patient isolation across this rural area. The practice facilitated regular presentations on health promotions to this group. We spoke with patients who belonged to this group which had over 80 members and heard it had a positive impact on large numbers of patients.

The area where the provider should make improvements is:

Review facilities for patients with hearing loss to ensure effective communication with them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 April 2016

The practice is rated as good for the care of patients 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 who had a review in the last 12 months was 84.7% which was better than the national average of 77.54%.
• 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.

Updated 14 April 2016

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

• 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 patients 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 patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• The cervical screening rate for the practice was 87%, which was better than the national average of 81%.
• 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 the integrated nursing team comprised of multi skilled nurses who worked as both practice nurses and community nurses.

Updated 14 April 2016

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

• 31% of the practice population was aged 65 years or older. The practice had responded to this demand through its development of an integrated nursing team which provided both practice and community nursing.
• The practice integrated nursing team (INT) also carried out home visits to older patients in remote rural villages, who would otherwise find it difficult to access the service.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered GP home visits and urgent appointments for those with enhanced needs.
• The practice had organised a service called “Giant’s Social” which offered social events and befriending services which helped to reduce patient isolation particularly for older patients across this rural area. The practice facilitated regular presentations on health promotions to this group. We spoke with patients who belonged to this group which had over 80 members and had a positive impact on large numbers of patients.

Updated 14 April 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 that reflects the needs for this age group.
• The practice had recorded the smoking or non-smoking status of 95% of its patients, which was higher than the national average of 90%. Of these, 88% had been offered support which was in line with national averages.
• The practice was in the process of introducing a policy on the Armed Forces Covenant in order to ensure that systems in place to identify military veterans and enable their priority access to secondary care in line with the national Armed Forces Covenant. The practice had already begun to identify its military veterans.

Updated 14 April 2016

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

• 100% of patients diagnosed with dementia who had had their care reviewed in a face to face meeting in the last 12 months, which is better than the national average of 84%.
• 91% of patients with schizophrenia, bipolar affective disorder and other psychoses who had an agreed comprehensive care plan. This was better than the national average of 88%.
• 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 14 April 2016

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

• The practice held a register of patients living in vulnerable circumstances including homeless patients, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams 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.