Vale of the Red Horse Health Care Centres Also known as Kineton Surgery

Updated 28 April 2017

Vale of the Red Horse Health Care Centres consists of two premises within the South Warwickshire Clinical Commissioning Group (CCG), providing GP services to patients within the South Warwickshire area.

The main surgery is a converted school building located in the village of Kineton, South Warwickshire. This premises is served by the local bus network and there is accessible parking. The building and facilities are fully accessible to wheelchair users.

In addition to the main surgery the practice also provides GP services at a purpose built branch surgery in the nearby village of Tysoe. There is accessible parking and this building and facilities are also fully accessible to wheelchair users.

Both premises provide a dispensary on site to issue prescribed medicines to patients. Both premises are fully computerised and linked through their IT and telephone systems. We visited the main location and branch surgery as part of this inspection.

The practice and branch surgery provide primary medical services to approximately 4,850 patients within a 110-square mile area of rural countryside with villages and some urban developments. The practice population is currently growing at a rate of 2% per year, and is likely to increase further over the next two years due to large scale housing developments locally.

The practice population is approximately 98% White British. Patients aged under 18 years and between 40 and 69 years are overrepresented compared with regional and national averages. The practice area is generally of low deprivation, with small concentrated areas of higher deprivation in some of the villages.

The clinical staff team consists of one male and one female GP partners, one male and three female salaried GPs, a clinical pharmacist, a nursing manager, two practice nurses, a healthcare assistant, a dispensing manager and six dispensing staff.

The practice conducts GP training with qualified doctors who are undergoing a period of further training in order to become GPs. There is currently one trainee GP at the practice.

The clinical team is supported by a practice manager, an assistant practice manager, an accounts administrator and a team of nine administrative and reception staff.

All staff are required to work at both practice premises.

The main location and telephone lines are open from 8am to 1pm and 2pm to 6.30pm on weekdays (8.30pm on Tuesdays). Appointments are available between 8.45am until 1pm and 2pm until 6pm on weekdays. Extended hours appointments are available on alternate Monday and Thursday evenings until 7.45pm. The practice also offers additional appointments on Tuesday evenings from 6pm until 8.30pm, which are over and above extended hours appointments.

The branch surgery is open for GP and nurse appointments and dispensary services from 9am until 1pm on weekdays.

When the practice is closed services are provided by Care UK Warwickshire out of hours service. Patients are directed to this service by a recorded answerphone message, and there is information concerning out of hours arrangements on the practice website.

Updated 28 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Vale of the Red Horse Health Care Centres on 22 November 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• People were protected by a strong, comprehensive safety system and a focus on openness, transparency and learning when things went wrong. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Opportunities for learning from internal and external incidents were maximised.

• Risks to patients were comprehensively assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff were sufficiently trained and had the appropriate knowledge and experience to effectively deliver care and treatment.

• Patient outcomes were in line with or above local and national averages.

• Patients said they were treated with compassion, dignity and respect and that they were suitably involved in their care and decisions about their treatment.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• 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.

• 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.

We saw areas of outstanding practice including:

• The practice had identified five previously unknown carers aged under 18 years following an event at a local school and had placed these on the carers’ register. This enabled these young carers to access additional support and guidance from the practice, including signposting to local support services. Practice staff had engaged with and sought feedback from this group in respect of provision for carers, and had used the feedback to make improvements. This included designing specific correspondence for young carers.

• The practice had recognised they had higher than average numbers of teenage patients and provided additional services for this group, including weekly young persons' clinics specifically for those aged 16 to 19 years. The practice had engaged with a local school to visit and discuss aspects of health care, for example sexual health. This included question and answer sessions with groups of students.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 April 2017

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. We saw that nursing staff utilised, reviewed and kept up to date care plans for patients with long term conditions.

• Performance for diabetes related indicators above Clinical Commissioning Group (CCG) and national averages. For example, 99% of patients with diabetes had received an influenza immunisation in the last 12 months compared with CCG and national averages of 97% and 94% respectively. The practice’s exception reporting rate for this indicator was 15% compared with the CCG average of 14% and the national average of 18%.

• Longer appointments and home visits were available when needed.

• All patients with long-term conditions had a named GP clinical lead and were allocated to a specialist nurse.

• Structured annual reviews were provided to check 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 28 April 2017

The practice is rated as good for the care of families, children and young people.

• There were systems 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 Accident and Emergency (A and E) attendances. Immunisation rates were 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. We saw evidence to confirm this including care planning.

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

• The practice provided combined parent and baby clinics carrying out post-natal and early child development checks.

• The practice had recognised they had higher than average numbers of teenage patients and offered weekly young persons' clinics specifically for those aged 16 to 19 years between 3.30pm and 5.30pm every Tuesday. Staff told us they saw approximately eight to 12 young people per week as part of this service.

• The practice had engaged with a local school to visit and discuss aspects of health care, for example sexual health. This included question and answer sessions with students, and presentations designed to help students make informed choices about their healthcare. Staff told us they had spoken with up to two hundred students within the last 12 months.

• The practice engaged with children locally to provide health advice, for example sessions with groups of Beavers, Brownies and primary school children to consider basic life support and how to deal with choking.

• The practice had identified five previously unknown carers aged under 18 years following an event at a local school and had placed these on the carers’ register. Practice staff had sought feedback from this group into carers’ provision and had used this feedback to make improvements, for example designing specific correspondence for young carers to help identify and engage with this group.

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

Updated 28 April 2017

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population. This included individual care plans for patients aged over 75 including those in care home settings.

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

• Enhanced checks for patients aged 75 and above were available, including a 30-minute appointment with the practice nurse for any new patients.

• The Clinical Commissioning Group (CCG) provided a phlebotomy (blood taking) service in patients’ homes.

• The practice provided an ‘emergency bypass’ telephone number to all patients deemed to be at risk such as older people at risk of hospital admission. When this number was called it rang on separate telephones around the practice and staff knew to answer these calls as soon as possible.

• There was a bell outside the main practice premises for patients who required support to enter the building. Staff would assist these patients when necessary, and had received the appropriate training to do so.

• The practice had a policy to telephone older patients to remind them of their appointment details, on the day of their appointment.

• The practice directed older people to appropriate support services.

Updated 28 April 2017

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 had carried out ongoing analysis of the needs of the population group and had considered and responded to specific challenges.

• The practice was proactive in offering online services. Patients were able to book appointments, order repeat prescriptions and send and receive secure messages online. The practice provided evidence of high levels of patient use of online resources, including the use of the practice’s social networking pages on Facebook and Twitter.

• The practice recognised that working-age patients (those aged between 40 and 65) were overrepresented compared with regional and national averages. Extended hours appointments were available on alternate Monday and Thursday evenings until 7.45pm to help meet the needs of this group. The practice also offered additional appointments on Tuesday evenings from 6pm until 8.30pm which were over and above extended hours appointments. This included providing reception and medicine dispensing services at these times.

• The practice held weekend health awareness sessions at the local village hall and information sessions at a local school.

• The practice offered monthly women’s health clinics which took place in the evening which included cervical screening, contraception and breast examinations. Staff told us these sessions were regularly well-attended.

• Performance for cervical screening indicators was in line with CCG and national averages. For example the percentage of women aged 25-64 receiving a cervical screening test in the last five years was 86% compared with CCG and national averages of 83% and 82% respectively.

Updated 28 April 2017

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

• Performance for mental health related indicators was above CCG and national averages. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the 12 months was 100% (all patients) compared with CCG and national averages of 94% and 90% respectively. The practice’s exception reporting rate for this indicator was 10% compared with the CCG average of 9% and the national average of 10%.

• 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 a policy to telephone those with memory loss to remind them of their appointment details, on the day of their appointment.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 28 April 2017

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, for example homeless people and those with a learning disability. All patients on this register were assessed at least every quarter by a GP partner.

• We saw evidence that circumstances were considered in care planning and treatment for vulnerable patients and the practice regularly worked with other health care professionals to deliver care and treatment.

• The practice had a dedicated list of 24 patients registered as having a learning disability and had offered health checks for all of these patients. 20 of these checks had been completed in the last 12 months. The practice used information to support care planning and offered longer appointments for patients with a learning disability.

• The practice provided extensive help and support for patients who were carers.

• 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.