Archived: Drybrook Surgery Also known as Drs Good, Townsend & King

Updated 21 July 2016

Drybrook Surgery is a long established family orientated GP practice located in Drybrook, Gloucestershire which is a rural area in the Forest of Dean. The practice is situated in a two storey purpose built health centre building and is wheelchair accessible.

The practice provides general medical services to approximately 4,400 patients. Services to patients are provided under a General Medical Services (GMS) contract with NHS England. (A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract).

The Practice has three GP partners (one female and two male) which is equivalent to two and three quarters full time equivalent GPs. The clinical team includes three practice nurses and one healthcare assistant (all female). The practice manager is supported by an office manager and a team of five administrators / receptionists.

Drybrook Surgery is a dispensing practice with a team of three dispensers working in the dispensary on a rotational basis. The practice dispenses to approximately 34% of the registered patient base.

The practice population has a higher proportion of patients aged over 65 compared to local and national averages. For example, 24% of practice patients are aged over 65 compared to the local clinical commissioning group (CCG) average of 20% and the national average of 17%.

The practice is located in an area with low social deprivation and is placed in the third least deprived decile by public health England. The prevalence of patients with a long standing health condition is 57% compared to the local CCG average of 55% and the national average of 54%. People living in more deprived areas and with long-standing health conditions tend to have greater need for health services.

The practice is open between 8.30am and 6pm on Monday to Friday. Between 8am - 8.30am and 6pm – 6.30pm every weekday telephone calls are picked up by the reception team and a duty doctor is on site to treat any medical emergencies. Appointments are available between 8.30am and 1pm every morning and 2.45pm to 6pm every afternoon.

Out of hours cover is provided by South Western Ambulance Service NHS Foundation Trust and can be accessed via NHS 111.

The practice provided its services from the following address:

The Surgery

Drybrook

Gloucestershire

GL17 9JE

This was the first inspection of Drybrook Surgery. We noted that the practice were not registered for family planning. The provider informed us that they did not realise they had to register for family planning. The provider advised that they would apply to CQC for this registration.

Updated 21 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drybrook Surgery on 28 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. However on the day of our inspection we found several out of date controlled medicines from 2013 onwards which had not been disposed of.
• 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 provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Ensure there is a robust and consistent system in place for disposing of out of date controlled medicines.

• Ensure fire drills are undertaken regularly in line with fire risk assessment guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 July 2016

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

• The practice had specialist nurses for diabetes and respiratory disease who provided both chronic and acute management of these patients within their area of expertise. Support from a GP was available if needed, and patients at risk of hospital admission were identified as a priority.

• Performance for overall diabetes related indicators in 2014/15 was 89% which was below the clinical commissioning group average of 95% and comparable to the national average of 89%.

• 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 21 July 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 practice’s uptake for women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years in 2014/15 was 81% which was comparable to both the clinical commissioning group 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. A midwife visited the on a weekly basis and attended monthly multidisciplinary meetings.

Updated 21 July 2016

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

• The practice offered proactive, personalised care to meet the needs of the older patients in its population and had a range of enhanced services, for example in dispensing, dementia, influenza and pneumococcal immunisations.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• The practice identified that they had a higher than average elderly population and in response employed an avoiding admissions administrator and nurse who worked collaboratively to identify patients who were at risk of hospital admission or socially isolated and arranged nurse reviews and liaised with other professionals to ensure older patients’ health and social needs were being met.

Updated 21 July 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.

• Daily telephone consultations were available and one of the GPs is contactable via email for patients who cannot attend the practice due to work commitments.

• Clinics available included counselling, mother and baby clinics, minor surgery and NHS health checks.

Updated 21 July 2016

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

• 82% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months (04/2014 to 03/2015), which was slightly below both the clinical commissioning group average (CCG) of 86% and the national average of 84%.

• Performance for mental health related indicators was 78% which was below both the CCG average of 97% and national average of 82%.

• 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 21 July 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 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 easy read practice leaflets for patients with visual impairments and were in the process of approving easy read practice leaflets for patients with learning disabilities.

• The practice displayed information for carers in the waiting room, on their website, on the health education screen and offered carers health checks.