Archived: Newland Medical Practice

Updated 9 August 2016

Newland Medical Practice is situated in the market town of Sherborne, Dorset. There were approximately 6200 patients registered at the practice. The practice list contained a higher than average elderly population and a higher than average population with long term conditions.

Although the practice was in the third least deprived decile for socio-economic groups, the patient list was a diverse socio-economic group, including pockets of deprivation and a rural population with poor local transport. 96% of patients described themselves in the 2011 census as white British.

The practice is purpose built and shares the site with another separately registered GP practice. There is parking at the practice and ground floor consulting rooms.

There are five GP partners and one salaried GP (three female and three male GPs), four nurses and two health care assistants. There is a practice manager and a personal assistant to the practice manager. The GPs between them cover 18 clinical sessions per week (a session is a half-day). As a dispensing practice there are four dispensary staff. The team is supported by receptionists and administrators.

The practice is a training practice for GP registrars and a teaching practice for medical students, student nurses and paramedics.

The practice is open between 8am and 6.30pm Monday to Friday. On Mondays appointments are available until 7.15pm. Patient consultations start at 8.30am.

When the practice is closed patients are directed to the Dorset Emergency Care Service, accessed via the national NHS 111 telephone service for health advice.

We previously inspected the practice on 23 October 2013 and found the practice was meeting all the standards that we inspected. We have re-inspected the practice under our new inspection regime and to award a rating to the practice.

All regulated activities are carried out from the following location:

Newland Medical Practice

Grove Medical Centre

Wootton Grove

Sherborne

Dorset

DT9 4DL

We visited this location during our inspection.

Newland Medical Practice holds a general medical services contract with NHS Dorset Clinical Commissioning Group (CCG).

Updated 9 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Newland Medical Practice on 9 June 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.
• Appointments were for a minimum of 15 minutes recognising increasing complexity of care needed for many patients.
• 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 sought feedback from staff and patients, which it acted on.
• The practice was piloting specialist paramedic training in conjunction with the South West Ambulance Service. The paramedic held clinics at the practice and the GP partners told us this had been received positively by patients.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

• One of the GPs provided a weekly session to two local residential independent schools, where many of the students were living away from home for the first time. The sessions held at the schools rather than at the practice were less disturbing to the students’ study and took place in an environment students felt safe in. The students were able to see same GP or practice nurse to build up a trust with them and the practice held team meetings with the schools, with input from school staff pastoral care, the schools’ matrons and teachers.

The area where the provider should make improvement is:

• Review the adequacy of the current fire alarm testing regime in terms of safety to patients, staff and visitors to the premises.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Updated 9 August 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.
• Results for diabetes care management were in line with local and above national averages. For example, the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 95% (compared with the clinical commissioning group (CCG) average of 91% and the national average of 88%).
• Practice nurses ran a monthly clinic in conjunction with a visiting specialist diabetic nurse and a ‘calorie counting’ course for patients with diabetes who wanted to lose weight.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and structured reviews either six monthly or annually 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 August 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.
• Results for cervical screening data (women aged 25-64 with a record of a cervical screening test performed in the preceding 5 years) was 83%. This was similar to the clinical commissioning group (CCG) average of 84% and 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.

• Children and babies were seen on a same day basis. The practice had an emergency surgery twice a day.
• The health visitor was based at the practice. There were monthly meetings with a GP, health visitor, practice nurse and practice manager to review families and children who had additional or complex needs.

• One of the GPs provided a weekly session to two local residential independent schools, where many of the students were living away from home for the first time.

Updated 9 August 2016

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

• The practice offered 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.
• Monthly Gold Standards Framework (a set of standards to uphold when delivering best care for patients with palliative care needs) meetings were held at the practice involving a palliative care nurse community matron and a community district nurse.
• One of the GP partners had a specific expertise in palliative care and worked one day a week in a local hospice.
• There were allocated weekly clinical session where one of the GPs and a health care assistant reviewed patients registered at the practice living in care homes in their care home. 
• Patients over the age of 75 were actively invited for health checks.
• Older patients were actively called for pneumococcal and shingles vaccinations.

Updated 9 August 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 offered online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• Patients had e-mail access for advice via the reception e-mail address.
• Travel vaccination requests could be made electronically.
• There were extended opening hours for appointments on a Monday evening.
• On request patients could make appointments with the nurses prior to normal opening hours, for the benefit of patients commuting to work.
• All clinical staff offered telephone consultations. This included phone calls before morning surgery and after evening surgery if required.
• Cervical smear testing and contraceptive appointments were offered flexibly to fit in with the patients’ commitments.

Updated 9 August 2016

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

• 91% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was better than the local clinical commissioning group (CCG) average of 85% and the national average of 84%.
• Other mental health indicators were similarly above local CCG and national averages. For example, 100% of patients with severe mental illness had an agreed care plan that was kept under review. This compared with a 92% average for the CCG and 88% nationally.
• 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 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.
• The practice was signed up to the iSPACE programme to develop the practice environment in becoming more dementia friendly.
• A community alcohol and drug advisory service (CADAS) worker held monthly clinics at the practice (or more frequently if needed).
• A ‘steps to wellbeing’ counsellor held a weekly clinic at the practice. This provided services for adults suffering with depression or anxiety disorders.

Updated 9 August 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.