Staunton and Corse Surgery

Updated 1 June 2016

Staunton and Corse Surgery is a rural dispensing practice covering 240 square kilometres and is one of the practices within Gloucestershire Clinical Commissioning Group (CCG). The practice provides general medical services to approximately 6400 registered patients in Staunton and the surrounding villages which cover 14 parishes. Almost one sixth of the practice list are students at Hartpury College. Services to patients are provided under a General Medical Services (GMS) contract with NHS England. (GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract).

Staunton and Corse Surgery provides services from a purpose built building which has been twice extended and modernised to include a nursing suite and a consulting room for a GP Registrar, the practice is wheelchair accessible.

The Practice has two GP partners (both male) and two salaried GPs (both female), which is equivalent to three and a quarter whole time equivalent GPs. The clinical team includes two prescribing nurse practitioners, two practice nurses, a healthcare assistant and a community phlebotomist. The practice manager is supported by a senior receptionist, eight receptionists/administrators, a note summariser and a practice secretary.

Staunton and Corse Surgery is a dispensing practice, the dispensary is managed by two dispensary managers who are supported by three dispensers.

The practice is a training practice for GP trainees with two GPs providing training support. At the time of our inspection a GP trainee was being supported by the practice on her first day.

The practice population has a higher proportion of patients aged between 15 and 18 compared to local and national averages. For example, 18% of practice patients are aged between 15 and 18 compared to both the local clinical commissioning group (CCG) and national averages of 6%. This is due to the practice supporting approximately 1000 students at Hartpury College.

According to national data there pockets of deprivation in Gloucestershire; however the practice is located in an area with minimal deprivation. The prevalence of patients with a long standing health condition is 51% compared to the local CCG average (55%) and national average (54%). Patients living in more deprived areas and with long-standing health conditions tend to have greater need for health services.

The practice is open between 8.30am and 6.30pm on Mondays to Fridays with appointments available from 8.30am to 6pm. Extended hours surgeries were available from 6am to 8am on Tuesdays and Thursdays. The dispensary is open between 8.30am and 6pm. Out Of Hours cover is provided by South Western Ambulance Service NHS Foundation Trust and is accessed via NHS 111.

The practice provided its services from the following address:

Staunton and Corse Surgery

The Surgery

Gloucester Road

Staunton

Gloucestershire

GL19 3RB

Updated 1 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Staunton and Corse Surgery on 3 February 2016. We found that the practice had breached a regulation relating to the safe delivery of services.

The practice required improvement for the provision of safe services to ensure that the risks associated with prescription security had been appropriately assessed. The practice also needed to implement a system to identify, assess and mitigate risks arising from cross infection this included the requirement to complete an infection control risk assessment required by the relevant code of practice. Overall the practice was rated as good.

Following the inspection the provider sent us an action plan detailing how they would improve the prescription security and infection control management systems ensuring they reflect national guidelines.

We carried out a desktop review of Staunton and Corse Surgery on 16 May 2016 to ensure these changes had been implemented and that the service was meeting the regulations previously breached. For this reason we have only rated the location for the key question to which this related. This report should be read in conjunction with the full inspection report from 3 February 2016.

We found the practice had made improvements since our last inspection on 3 February 2016 and they were meeting the regulations that had previously been breached.

Specifically the practice was operating safe systems in relation to prescription security and infection control management. This included:

• The practice reviewed prescription security and had implemented new processes supported by a policy amendment.

• The practice improved infection control management by completing a robust infection control audit.

During our previous inspection we also highlighted areas where the practice should consider improvement and these have been improved as follows:

• The practice has established and operates a robust fire evacuation plan to include named fire marshals.

• All Standard Operating Procedures have been signed.

• The practice has ensured that there is a robust and consistent system in place for the dissemination of learning from prescribing and, or dispensary incidents.

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 19 April 2016

The practice is rated as good for the care of patients with long-term conditions.

• The practice had specialist nurses for diabetes and respiratory disease who provided both chronic and acute management of patients with the conditions of their expertise. Support from a GP was available if needed, and patients at risk of hospital admission were identified as a priority.

• Performance for overall diabetes related indicators was 97% which was above the CCG average of 95% and 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.

Updated 19 April 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.

• 73% of patients with asthma on the register had a review in the last 12 months which was below both the CCG and national averages of 75%. The practice send patients a letter inviting them for a review on their birthday month, also in February and finally call patients who still have not attended.

• The practice QOF Lead also advised that they were planning to discuss collaborative working with local college nurses to try to identify ways of improving compliance from students with asthma, who historically have been difficult to get to attend the surgery.

• Patients told us 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’s uptake for women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years was 83% which was above the national average of 82%.

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

• A weekly clinic for children under the age of five, which was staffed by a GP, Health Visitor or Nursery Nurse and Practice Nurse was available on Mondays.

We saw positive examples of joint working with midwives, health visitors and school nurses through multi-disciplinary meeting minutes.

Updated 19 April 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 and

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

• Weekly meetings took place that included discussions of hospital admissions, hospital discharges and palliative care patients.

• The practice took part in a “Village Agent” system which was run by the local County Council to facilitate access to benefits and services to patients over the age of 55.

Updated 19 April 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 reflects the needs for this age group.

• Clinics available included in house phlebotomy, minor surgery, anticoagulant clinics, spirometry, 24 hour electrocardiogram (ECG) monitoring, international normalised ratio (INR) monitoring and NHS health checks.

• The needs of approximately 1000 patients from a local college were met as the practice worked closely with the college nurses and acted as the first point of contact for students when they were unwell or need health care. The practice had dedicated safeguarding, women’s health and sexual health leads to support all patients including local students.

• The Student Services department at the College have dedicated appointments each day with GPs and Practice Nurses, which are bookable by them. The students are brought to the practice by College transport. Quarterly meetings with between the practice GPs and College nurses are held to discuss any issues.

Updated 19 April 2016

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

• 83% of patients diagnosed with dementia that had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84%.

  Staff had a good understanding of how to support patients with mental health needs and dementia. Performance for mental health related indicators was 100% compared to the CCG average of 97% and national average of 82%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia and an intermediate mental health nurse visited once a week.

• 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 19 April 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.

• 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.

• 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 took part in a local social prescribing initiative whereby patients with non-medical issues, such as debt or loneliness could be referred by a GP to a single hub for assessment as to which alternative service might be of most benefit.