Northlands Surgery

Updated 7 April 2017

Northlands Surgery is located near to the centre of Calne, a market town in rural Wiltshire. The practice has a slightly higher than average patient population in the 40 to 80 years age group and lower than average in the 25 to 40 years age group. The practice is part of the Wiltshire Clinical Commissioning Group and has approximately 11,000 patients. The area the practice serves is urban and semi-rural and has relatively low numbers of patients from different cultural backgrounds. The practice area is in the low to mid-range for deprivation nationally.

The practice is managed by five GP partners (three female and two male) and the practice manager who is a non-clinical partner. The practice is supported by two salaried GPs, (both female), an advanced nurse practitioner, three practice nurses, three health care assistants and an administrative team led by the practice manager. Northlands Surgery is a training practice providing placements for GP registrars and medical students.

The practice is open between 8.30am and 6pm Monday to Friday. The telephone lines are transferred to a call answering service from 8am to 8.30am and at 5.30pm. Appointments are available between 8.40am and 12.25pm every morning and 2.30pm to 5.40pm every afternoon. Telephone appointments are also available to book. Extended hours appointments are offered from 6.30pm to 8pm on Monday and Wednesday evenings. In addition to pre-bookable appointments that could be booked up to four weeks in advance, urgent appointments were available for patients that needed them.

When the practice is closed patients are advised, via the practice website and telephone answer machine that all calls will be directed to the out of hour’s service. Out of hours services are provided by Medvivo.

The practice has a General Medical Services contract to deliver health care services. This contract acts as the basis for arrangements between the NHS England and providers of general medical services in England.

Northlands Surgery is registered to provide services from the following location:

North Street,

Calne,

Wiltshire,

SN11 0HH.

Updated 7 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Northlands Practice on 16 August 2016. The practice was rated as requires improvement for providing Well Led services. The overall rating for the practice was good. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Northlands Practice on our website at www.cqc.org.uk.

This inspection was a focussed inspection which was carried out on 9 March 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 16 August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• The practice had undertaken a staff survey that was confidential and anonymised in order to listen to and understand concerns of staff.
• There had been changes made to the staffing structure to enable improved communication pathways.
• Regular meetings for all staff groups were in place.
• Staff we spoke to acknowledged that the working environment had improved and they now felt supported, valued and respected by the management team.

We have changed the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 October 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.
• The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (01/04/2014 to 31/03/2015) was 96% compared to a local average of 91% and national average of 88%
• 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 3 October 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 had identified themselves as having a higher than average prevalence of childhood obesity. In response the practice had initiated activities to address this. For example, the GPs invited families to attend an open morning on a Saturday for an educational talk, to which 50 people attended.
• 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.

Updated 3 October 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 provided medical services for four care homes and had improved ways of working with these homes in order to reduce hospital admissions. Weekly ward rounds and monthly multidisciplinary care homes locality meetings were initiated. Improved collaborative working with the community nursing team, care home managers and the care homes pharmacist had led to a 40% reduction in hospital admissions over a 12 month period.

• Nationally reported data showed that outcomes for patients with conditions commonly found in older patients were at or above local and national averages. For example The percentage of patients with chronic obstructive pulmonary disease (a chronic lung condition) who had a review undertaken including an assessment of breathlessness using the Medical Research Council breathlessness scale in the preceding 12 months (01/04/2014 to 31/03/2015) was 96% which was higher than the local average of 91% and the national average of 90%.

Updated 3 October 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.
• Extended hours surgeries were available two evenings a week, and occasional Saturday mornings. Telephone consultations were available to improve access for working patients.
• Nurses provided extended hours appointments for reviewing patients with diabetes and performing cervical cytology screening.
• The practice had purchased a machine for processing blood samples which meant working age patients could attend for blood tests even after the last specimen collection for the day to the hospital laboratory.

Updated 3 October 2016

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

• 89% of patients diagnosed with dementia that had their care reviewed in a face to face meeting in the last 12 months, which was better than the local average of 88% and the national average of 84%.
• The percentage of patients with a serious mental illness who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months (2014 to 2015) was 97% compared to a local average of 93% and a national average of 90%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice carried out advance care planning for patients with dementia.
• All staff had received dementia awareness training and a number of staff had become dementia friends.
• 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 3 October 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.