Dr Philip West Also known as Boundaries Surgery

Updated 7 June 2017

Dr Philip West, known locally as Boundaries surgery, is located in a small village on the outskirts of the town of Alton in Hampshire. The practice provides services under a NHS General Medical Services contract and is part of the NHS North Hampshire Clinical Commissioning Group (CCG). The practice is a dispensing practice and dispenses to approximately a third of its patients.

The practice has proximately 3700 registered patients. The practice population has an above average elderly population. 25% of patients are aged over 65 compared to the CCG and national average of 17%. The practice population is predominantly White British but there are a small percentage of patients registered at the practice from Romania and the Philippines. The practice is located in an area of low deprivation in comparison the national average for England.

Dr West is the GP lead and provider for the practice. There are also two salaried GPs. This equates to approximately two full time GPS. There is a mix of female and male GPs working at the practice. The GPs are supported by four practice nurses who work part time and equate to an equivalent of 1.5 full time nurses. The clinical team are supported by a management team including a practice manager, secretarial, dispensing and administration staff. The practice also employs a domestic supervisor.

The practice reception and phone lines are open between 8am and 6.30pm Monday to Friday. Extended hours appointments are offered on a pre-bookable basis from 6.30pm to7.30pm every Wednesday and from 7.30am to 8.30am every Friday. Morning appointments with a GP are available between 8.30am and 11.30am daily (with the exception of Friday when appointments start at 7.40). Afternoon appointments with a GP are available from 3pm until 6pm daily (Wednesday evenings appointments are available until 7pm). The practice offers an open surgery from 10am to 10.45am daily where patients can walk in and wait to be seen without the need of an appointment.

Dr Philip West has opted out of providing out of-hours services to their own patients and patients are requested to contact the hour of hours GP via the NHS 111 service. The practice offers online facilities for booking of appointments and for requesting repeat prescriptions.

The practice operates from one location which is situated at

Boundaries Surgery

17 Winchester Road

Alton, Hampshire

GU34 5HG

Updated 7 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Philip West on 17 May 2016. The overall rating for the practice was good. The practice was rated as requires improvement for safe for shortfalls around safeguarding training, infection control audits and recruitment. The full comprehensive report on the May 2016 inspection can be found by selecting the ‘all reports’ link for Dr Philip West on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 11 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 17 May 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice had addressed the shortfalls and therefore has now been rated as good for providing safe services. The overall rating for the practice remains as good.

Our key findings were as follows:

• The practice had located induction training records for staff which included safeguarding adult training. Safeguarding adult training had been added to the practice’s training matrix, with dates of completion for each staff member. The practice was monitoring training and had identified staff who required refresher training within the next 12 months.

• All staff had completed safeguarding children training to the appropriate level for their role.

• The practice had undertaken a new infection control audit in February 2017. The practice had identified any areas where they required improvement and deemed no further action was required.

• The practice had not had any new employees since our May 2016 inspection. The practice had improved its recruitment processes.

• Health and safety risk assessments such as for legionella and heating supply had been completed with no further actions required.

• Expiry dates of medicines within the dispensary, vaccine fridges and stock rooms were monitored and medicines were in date.

• Contact details for translation services had been obtained to be used when required.

• Policies, such as the safeguarding adult and children policies had been updated to contain practice specific information such as the name of the safeguarding lead. The business continuity plan had also been updated to reflect the most up to date staffing list and contact details.

• Meeting minutes evidenced that outcomes of significant events and complaints were discussed and reflected upon to ensure lessons were learned.

  There are areas where the practice should make improvements:

• Consider having a written document to evidence that cleaning checks had been completed for treatment and consulting rooms.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 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.
• 85% of patients recorded with a diagnosis of asthma had a review of their asthma care within the preceding 12 months in comparison to the CCG and national averages of 75%.
• Longer appointments and home visits were available when needed.
• Patients were offered a double length appointment if they were on six or more different types of medicines.
• 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 17 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.
• 82% of patients aged 25-64 had a record of attending cervical screening within the past 5 years (Clinical Commissioning Group average 81%, national average 82%).
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice offered a daily walk in clinic which the practice reported was popular with families with young children who require same day treatment. The practice had also implemented doctor led telephone triage.
• We saw positive examples of joint working with midwives and health visitors.

Updated 17 August 2016

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

• The practice has a larger than average representation of over 65 year olds (25% compared to the national average of 17%).
• The practice offered proactive, personalised care to meet the needs of the older people in its population for example, visiting patients who are unable to attend the practice for urgent or routine care.
• The practice offered an open surgery from 10am to 10.45am daily whereby patients can turn up on the day and wait to see a GP without the need for an appointment. The practice told us this service is popular with the older patients at the practice.

Updated 17 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 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.
• Extended hours appointments and telephone triage were available for the working age patient population.
• The practice offered an online booking system for appointments.

Updated 17 August 2016

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

• 78% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is less than the national average of 84%.
• 94% of patients at the practice who had a diagnosis of schizophrenia, bipolar affective disorder or other psychoses had an agreed care plan in place (CCG 94%, national 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.
• A dementia support worker visited the practice on a monthly basis to help complete respite care planning for relatives of patients with dementia.

Updated 17 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. Housebound patients and patients in care homes were automatically coded as vulnerable on the practices electronic patient records system, regardless of circumstances.
• The practice offered longer appointments for patients with a learning disability. An evidence based health questionnaire designed for learning disabled patients was completed alongside the patient at review of care appointments.
• 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 gave some examples of how to recognise signs of abuse in 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.