Archived: St Ann Street Surgery

Updated 19 December 2016

St Ann Street Surgery is located near the centre of Salisbury, in Wiltshire. The practice has a slightly higher than average patient population in the over 45 years age group and lower than average in the 15 to 40 years age group. The practice is part of the Wiltshire Clinical Commissioning Group and serves approximately 8,000 patients across two surgeries, one in the centre of Salisbury and one in Porton, about seven miles from the city centre. Porton surgery offers dispensing services to eligible patients (those who live further than one kilometre from the chemist). 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 (An area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score. It is important to remember that not everyone living in a deprived area is deprived and that not all deprived people live in deprived areas). The practice has a higher than average number of patients (4.1%) who are unemployed compared to the local average of 2.9% but lower than average compared to the national average of 5.4%.

The practice is managed by five GP partners (three female and three male).The practice is supported by three salaried GPs, all female, a nurse practitioner, a practice nurse, one health care assistant, and an administrative team led by the practice manager . The practice has three trained dispensers who dispense medication for patients under the supervision of the doctors and another who was undergoing training. St Ann Street Surgery is a teaching and training practice providing placements for GP registrars and medical students and administrative apprentices.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are available between 8.30am and 12pm every morning and 3.30pm to 5.30pm every afternoon at St Ann’s Surgery. Telephone appointments are also available to book. Extended hours appointments are offered on one Saturday morning every month and from 7.30am to 8am on Mondays and Fridays and from 7.15am to 8am on Tuesdays.  Porton Surgery offers extended hours from 7.30am until 8am on Tuesday mornings. In addition to pre-bookable appointments that could be booked up to six 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 (GMS) contract to deliver health care services.

St Ann Street Surgery is registered to provide services from the following locations:

82 St Ann Street, Salisbury, Wiltshire. SP1 2PT.

and

Porton Surgery, 32 Winterslow Road, Porton. SP4 0LR

This inspection is part of the CQC comprehensive inspection programme and is the first inspection of St Ann Street Surgery.

Updated 19 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Anne Street Surgery on 3 November 2016. Overall the practice is rated as outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. Examples were:
• The practice worked with two other local practices to ensure frail patients over the age of 75 received domiciliary visits from the practice pharmacist and care coordinator to support them in their social care needs and medicines management.
• The practice provided care for patients admitted to the 15 intermediate care beds in the city, which provided an environment that would enable successful rehabilitation at a place close to home.
• The initiation of a community heart failure clinic.
• Feedback from patients about their care was consistently positive.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example the introduction of mental wellbeing courses to support different cohorts of patients towards a healthier life.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• The practice was a teaching and training practice and provided placements for GP registrars, medical students and administrative apprentices from the local college.

We saw several areas of outstanding practice including:

• The practice worked with the local heart failure specialist nurse to improve the care of patients with this condition. A 12 week pilot project was initiated by the practice, that incorporated six local practices and assessed the impact of a primary care community heart failure service. During the pilot, patients were referred to the service for assessment, diagnosis and continuing care. A number of these patients were found to require immediate changes to treatment and hospital admission was avoided in over 80% of these patients. Weekly involvement from a local consultant cardiologist gave the opportunity for complex cases to be discussed. An education programme was also delivered to patients which enabled them to recognise symptoms and improve self-management. The success in terms of patient outcomes of the pilot project had led to the clinical commissioning group extending the project to the whole area. The team had won their category for Clinical Community team of the year in the National GP awards 2016.

• People’s individual needs and preferences were central to the planning and delivery of tailored services. For example, a GP at the practice, who had a special interest in drug and alcohol misuse, recognised that a number of working patients wanted to reduce alcohol intake before it became a major problem, but away from the perceived stigma of the drug and alcohol service. The GP worked with the substance misuse service to deliver one to one counselling appointments at the practice outside of work hours. We saw evidence that the service had made a positive impact for these patients.

• We saw proactive innovative approaches to understanding the needs of different groups of people to ensure care was delivered in a way to meet those needs. For example, the practice initiated three mental wellbeing courses, delivered by Active Plus (a charity that delivers personal development, education and wellbeing programmes to people in need). The objective of the courses was to deliver the programme to patients seeking medical support, but who would be more likely to benefit from positive practical activities, interaction with others and the development of a personal action plan to take them forward. Following positive outcomes further cohorts of patients had been identified, for example, carers and patients who were finding it challenging to return to work following sickness, and courses made available to them. Positive outcomes had enabled the practice to obtain further funding in order to continue this work.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 December 2016

The practice is rated as outstanding 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.
• Hospital admissions for patients living with COPD (a chronic lung condition) had been reduced by a third following improved management of these patients within the practice.
• The initiation of a community heart failure clinic had resulted in improved self-management by these patients and reduced hospital admissions.
• The practice provided care for patients admitted to the 15 intermediate care beds in the city. These beds provided an environment that would enable successful rehabilitation. The practice worked closely with occupational therapists, rehabilitation assistants, nurses, social workers and the patients own GP to ensure the care for patients was consistently optimised.
• 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 19 December 2016

The practice is rated as outstanding 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.
• The practice was a young person friendly practice and delivered the ‘No Worries’ service, a confidential sexual health service for all young people aged 13-24, which offered access to contraception, testing and treatment of sexually transmitted infections, support and information about safer sexual relationships.
• 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 19 December 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Changes to the ways of working in nursing and care homes had improved patient outcomes in terms of consistency of care, the quality of interactions and reduced hospital admissions. Feedback from care home staff was very positive regarding the quality of care provided by the practice.
• The practice worked with two other local practices to ensure frail patients over the age of 75 received domiciliary visits from the practice pharmacist and care coordinator to support them in their social care needs and medicines management.

Updated 19 December 2016

The practice is rated as outstanding 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.
• Extended hours surgeries were offered three mornings a week and one Saturday a month.
• 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.
• A one to one counselling and support service was available outside of working hours for those patients who wished to reduce their alcohol intake before it become a major problem but away from the perceived stigma of the drug and alcohol service.
• Funding was gained from the Department of Work and Pensions for a mental wellbeing course to be delivered to patients who were finding it challenging to return to the work place following illness.

Updated 19 December 2016

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

• 95% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was higher than the local average of 88% and the national average of 84%.
• 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.
• There were proactive innovative approaches to understanding the needs of different groups of people to ensure care was delivered in a way to meet those needs. For example, the practice commissioned three mental wellbeing courses that were delivered by Active Plus (a charity that delivers personal development, education and wellbeing programmes to people in need). The programmes were successful in supporting identified patients towards a healthier life.
• 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 19 December 2016

The practice is rated as outstanding for the care of people who 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 was working with the local area on a Substance Misuse and Mental health project. The objectives of the project was for GP practices in the locality to provide care closer to home and with wider stakeholders, to improve the lives of their patients and reduce the associated burden seen with this cohort of patients. Funding had been made available and a model of care agreed.
• 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.