Rendcomb Surgery

Updated 11 February 2016

Rendcomb Surgery is a GP practice providing primary medical services under a General Medical Services (GMS) contract to approximately 4000 patients. (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 services from a purpose built building which is approximately 25 years old. There are adequate parking facilities at the practice and it is wheelchair accessible.

Rendcomb Surgery provides services from the following registered location:

Rendcomb

Cirencester

Gloucestershire

GL7 7EY

The practice had three GP partners which was equivalent to two and a half whole time equivalent and two partners are female. The practice team included two practice nurses (both female), one health care assistant, four dispensers and a practice manager. The administrative team included one senior administrator and six reception staff. The practice is also a teaching practice supporting medical students from the University of Bristol between year three and year five.

The practice is open 8.30am to 6.30pm on Mondays and Thursdays and 8.30am to 5pm on Tuesdays, Wednesdays and Fridays. Patients are diverted to the duty doctor between 8am and 8.30am; 5pm and 6.30pm on days where the practice closes at 5pm. Appointments are available from 8.30am and 12.30pm every morning and 3pm to 5pm every afternoon. Extended hours are available on Monday evenings between 6.30pm and 7.45pm.

The practice has opted out of providing out of hours service to its patients. Patients are redirected to the out of hours service via the NHS 111 service.

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

Updated 11 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rendcomb Surgery on 10 December 2015. Overall the practice is rated as good. This includes all patient groups.

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 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.
• Patients said they found it easy to make an appointment with a named GP and that 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 11 February 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. For example, one of the practice nurses had completed a diploma in diabetes.

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

• 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.

• The practice operated a formal recall system where patients are sent a letter on the month of their birthday encouraging them to attend one appointment where all the patient’s long term conditions can be reviewed.

Updated 11 February 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.

• 71% of patients with asthma on the register had a review in the last 12 months which was lower than the national average of 75%.

• 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 percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years was 87% which was above the national average of 82%

• 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.

• The practice sent letters to young patients around their 16th birthday to inform them of the services that were available to them.

• The practice acted as medical officer for a local boarding school. They worked closely with the school nurses and attended termly meetings with the school to discuss patients they were concerned about.

Updated 11 February 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.

• A GP would visit two of the local villages twice a month to drop off medicines and answer any queries that patients may have. The GPs also used this opportunity to visit vulnerable elderly patients in the village.

• The practice worked with the Village and Community Agents and there was a Friendship Club for older people which was run in the local village hall where patients could meet and socialise. Village and Community Agents worked with the over 50s in Gloucestershire to provide easy access to a range of information that would enable them to make informed choices about their present and future needs.

Updated 11 February 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.

• The practice offered a phlebotomy service which patients could access on the day of their appointment. Patients could also pick up their medicines from the dispensary if they were issued with a prescription following their appointment.

Updated 11 February 2016

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

• 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 100% which was above the national average of 88%.

• The practice liaised with the community mental health team and provided a room for consultations once a week so that patients could be seen at the practice.

• 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 11 February 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 patients, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability. At the time of our inspection, the practice had three patients registered with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• The practice computer system alerted staff if a patient was identified as vulnerable and an appointment was offered as soon as possible.

• 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 had systems in place to identify patients who were likely to have unplanned hospital admissions and every patient identified had a care plan in place.