Acorn Practice

Updated 12 January 2018

Acorn Practice www.acornpractice.co.uk provides primary medical services to approximately 4,000 patients living in Dursley and the surrounding area. The provider is registered to deliver services from May Lane Surgery, Dursley, Gloucestershire GL11 4JN. Dursley is situated 12 miles south of Gloucester and 25 miles north of Bristol.

Data from Public Health England show that the age distribution of the practice population is similar to the national picture. The practice was situated in an area with lower deprivation with a deprivation score of 13% compared to a clinical commissioning group average of 15% and the national average of 22%.

The practice shares the premises with another practice. Nursing and administrative staff are employed and shared by both practices and the practice manager has responsibility for both practices.

Updated 12 January 2018

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection 26/08/2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Acorn Practice on 14 November 2017 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice employed a care coordinator and made use of social prescribing to provide effective support to frail elderly patients. Social prescribing is a way of linking patients in primary care with sources of support within the community. It provides GPs with a non-medical referral option that can operate alongside existing treatments to improve health and well-being.
• The practice fully engaged with programmes developed in the local area to support patient’s health and wellbeing in a number of different ways. For example, an art group for cancer survivors.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• Services were tailored to meet the needs of individual patients and delivered in a way that ensured flexibility and choice. For example, the practice worked collaboratively with local practices to set up a travel clinic which was accessible to the entire locality and also delivered a sexual health clinic at the practice for the locality.
• There was a focus on continuous learning and improvement at all levels of the organisation.

We saw two areas of outstanding practice:

• A GP had undertaken additional training in drug and alcohol misuse in order to better support patients where there was a need. The GP had also become a mentor for others wishing to gain certification for working in substance misuse . The practice ran a substance misuse service for patients registered with them and the adjoining practice. It was the only practice in Gloucestershire to offer this service to patients.The practice worked effectively with specialist workers who also consulted with patients at the practice. Routine screening and vaccination was offered and the practice worked collaboratively with the local pharmacists.
• Due to the rurality of Dursley, access to family planning clinics was difficult for local residents. A GP from the practice worked with a nurse practitioner employed by the other practice in the building, to deliver a sexual health clinic for the whole locality including patients registered at other practices.

The area where the provider should make improvements:

• The practice should ensure that actions are taken to improve patient feedback.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 December 2015

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. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication 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 10 December 2015

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

We saw good examples of joint working with midwives, health visitors and school nurses. The nurse practitioner visited a local school weekly to provide appointments for children.

Updated 10 December 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. The practice was responsive to the needs of older patients and offered home visits and rapid access appointments for those with enhanced needs.

Updated 10 December 2015

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 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.

Updated 10 December 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). We saw 93% of patients experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. They carried out advance care planning for patients with dementia.

The primary mental healthcare team held weekly appointments at the practice. We saw that the practice had a good relationship with these organisations; shared learning and discussed patient care. The primary mental healthcare team held twice weekly appointments at the practice. We saw that the practice had a good relationship with these organisations; shared learning and discussed patient care.

The practice used innovative and proactive methods to improve patient outcomes and working with other local providers to share best practice. For example an arts in health project

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. They had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

Updated 10 December 2015

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. They had carried out annual health checks for patients with a learning disability and 95% of these patients had received a follow-up. 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 people. For example, an in-house drug worker and Turning Point attended the practice to support patients with substance misuse. We saw that one GP would provide joint patient consultations when required and provided drug misuse instalment prescriptions for controlled drugs to patients including those not registered at the practice; patients at risk of abusing or overdosing medicines.

The practice had told 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.