Archived: Churchdown Surgery

Updated 12 August 2016

Churchdown Surgery is a GP partnership located in Churchdown which is approximately four miles from Gloucester City centre. The practice premises has four consulting and two treatment rooms on the ground floor and five consulting rooms and one treatment room on the first floor.

The practice provides its services to approximately 13,800 patients under a General Medical Services (GMS) contract. (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 delivers its services from the following address:

24 St John's Avenue,

Churchdown,

Gloucester,

Gloucestershire,

GL3 2DB.

The practice partnership has nine GP partners and two salaried GPs making a total of approximately seven and a half whole time equivalent GPs. There are four male and seven female GPs. The nursing team includes two advanced nurse practitioners, four practice nurses and one diabetes nurse who were all female. The practice also employed two advanced health care assistants, a pharmacist practitioner, a phlebotomist and a health care support staff (the health care supports the health care team with administrative tasks). The practice management and administration team included a practice manager, a reception manager, nine reception staff, four secretaries and six administration staff. The practice is approved for training qualified doctors who wish to become GPs and teaching medical and nursing students.

The practice has a higher than average patient population aged 45 and above. The general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in the least deprivation decile. (An area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score. Not everyone living in a deprived area is deprived and that not all deprived people live in deprived areas). Average male and female life expectancy for the practice is 81 and 85 years, which is above the national average of 79 and 83 years respectively.

The practice is open from 8am to 6.30pm from Monday to Thursday and until 6pm on Fridays. The practice telephone lines were closed between 1pm and 2pm to routine calls. Between those hours and 6pm to 6.30pm on Fridays, telephone calls were diverted to the practice call handling service (Message Link). They refer urgent matters to the practice that have members of staff on standby to respond to issues if needed. Extended hours were offered from Monday to Thursday between 6.30pm to 7pm and 7.30am to 8am on Wednesdays and Fridays.

The practice has opted out of providing out of hours services to its patients. Patients can access the out of hours services provided by South Western Ambulance Service NHS Foundation Trust via the NHS 111 service.

This inspection is part of the CQC comprehensive inspection programme and this is the first inspection of Churchdown Surgery.

Updated 12 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Churchdown Surgery on 13 July 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.
• 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 August 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.

• There was a lead GP and practice nurse for each long-term condition. One of the practice nurses visited housebound diabetic patients to ensure the health of those patients were reviewed and not overlooked.

• The practice achieved 100% of the targets for care of patients with diabetes in 2014/15 which was above the clinical commissioning group average of 95% and above the national average of 89%.

• Longer appointments and home visits were available when needed.

• The practice provided an in-house blood testing service for patients on blood thinning medicines who required regular monitoring.

• 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 12 August 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 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 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 the cervical screening programme was 85% which was comparable to the clinical commissioning group of 84% and the national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• One of the advanced nurse practitioners held a weekly sexual health clinic where young patients could book an appointment or drop in for sexual health advice.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 12 August 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.

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

• The practice employed a district nurse who visited patients at risk of hospital admission. She reviewed and updated care plans for those patients and also reviewed older patients who have been discharged from hospital or attended A&E department. She could also offer and administer flu vaccine to housebound patients.

• The practice held bi-monthly multi-disciplinary meeting to discuss patient on the palliative care register.

• The practice supported two local nursing homes and there was a dedicated GP who carried out fortnightly “ward round”.

• The practice held annual flu vaccine clinic at the local community centre.

• The practice participated in a range of enhanced services including shingles and pneumococcal vaccine service.

Updated 12 August 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. Patients could book appointments with a GP, practice nurses and advance nurse practitioner online.

• 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 offered extended hours from Mondays to Thursdays between 6.30pm and 7pm and between 7.30am and 8am on Wednesdays and Fridays.

Updated 12 August 2016

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

• 77% 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 below the clinical commissioning group (CCG) of 86% and national average of 84%.

• The percentage of patients with severe mental health problems who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months (04/2014 to 03/2015) was 93% which was comparable to the CCG average of 93% and above the national average of 88%.

• There was a lead GP for patients experiencing poor mental health (including patients living with dementia).

• 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 12 August 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 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.

• There was a lead GP for vulnerable patients including those with learning disabilities.

• 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 took part in a local social prescribing initiative whereby patients with non-medical issues, such as debt or loneliness could be referred by a GP to a single hub for assessment as to which alternative service might be of most benefit.