Bredon Hill Surgery

Updated 27 April 2016

Bredon Hill Surgery is registered with the Care Quality Commission (CQC) as a partnership provider. The practice holds a General Medical Services (GMS) contract with NHS England. The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities. At the time of our inspection Bredon Hill Surgery was providing care for approximately 5,455 patients.

Bredon Hill Surgery is located in purpose-built premises. It is a dispensing practice, which dispenses to approximately 95% of the practice population. There is currently a branch surgery at Beckford Village Hall, registered separately with the CQC, although the patient list is included in the patient list at the Bredon Hill Surgery. The practice has submitted a formal application to South Worcestershire Clinical Commissioning Group (CCG) to close the branch surgery and the consultation phase has just ended. We did not visit the branch surgery during the inspection.

The practice area is one of lower than average deprivation. The practice has a larger population of older people compared with the county average.

There are three GP partners two male and one female. In addition there is a salaried GP (female). The GPs are supported by three practice nurses and two health care assistants. Non-clinical staff includes a practice manager, senior dispenser, reception, administrative and dispensing staff.

The practice opens from 8.30am to 6.30pm Monday to Friday with a range of pre-bookable and book on the day appointments during these hours. The telephones are answered from 8am to 6.30pm. The dispensary is open from 8.30am to 6.30pm Monday to Friday with a lunch break between 1pm and 2pm.

The practice does not provide an out of hours (OOH) service. When the practice is closed, patients are directed to the NHS 111 service or instructed to dial 999 in an emergency.

Updated 27 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bredon Hill Surgery on 18 February 2016. Overall the practice is rated as good.

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 with the exception of fire safety arrangements, which needed reviewing.

• 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.

The area where the provider should make improvement is:

• Review fire safety arrangements to ensure that they are suitable to protect people from the risk of fire and carry out regular fire drills.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 April 2016

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.
• Diabetes care had improved significantly since a GP and practice nurse had undertaken specialised training. Clinics were held every two months for more complicated cases and the system for annual reviews was much more robust.
• The Quality and Outcome Framework (QOF) data for 2014/15 showed variable data for some long term conditions, for example diabetes and osteoporosis. However, recent data from the practice’s clinical computer system proved that effective action had been taken to address the underlying issues, because this trend had reversed for 2015/16 and the practice was on target to achieve better results.
• 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 nursing team provided lifestyle support (smoking cessation, weight loss) and the NHS Health Checks.
• Data from the QOF achievement for 2014/15 showed that the percentage of patients with hypertension (high blood pressure) having regular blood pressure tests was 82%, which was in line with the local and the national averages.
• Data showed that 64% of patients with asthma had had their care reviewed in the last 12 months, which was 11% below the national average. However, the clinical prevalence for the asthma indicators was 6%, which was in line with the CCG and the national averages.
• Members of the practice clinical team had undertaken additional training in long term care. For example, a GP and a nurse had specialised in diabetes care.
• The dispensary provided a home delivery service for patients who were housebound.

Updated 27 April 2016

The practice is rated as good 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 accident and emergency (A&E) attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• The practice had a policy whereby a GP would phone the parent or guardian of a child who did not attend for a GP appointment.
• 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.
• Cervical screening uptake was 86%, which was in line with the local and the national averages.
• Appointments were available outside of school hours and the premises were suitable for children and babies. Children under the age of five were given priority appointments.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 27 April 2016

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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice held a register for patients who required palliative care. Home visits and same day appointments were provided for these patients, who often had multiple conditions.
• Regular multi-disciplinary meetings were held during which treatment for patients on the palliative care register was discussed.
• The practice participated in the admissions avoidance service, which identified patients who were at risk of inappropriate hospital admission. The emergency admission rate for over 75 years for 2014/15 was 172 per 1000 patients, which was lower than the Clinical Commissioning Group (CCG) average of 246 per 1000 patients.

Updated 27 April 2016

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 was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
• Bookable telephone consultations were offered to provide more flexibility.
• The practice participated in the extended hours pilot, set up with funds from the Prime Minister’s Challenge Fund, at Evesham Community Hospital (open from 6.30pm to 9pm on weekdays).
• NHS Health Checks were offered by the nursing team, who gave advice on smoking cessation, weight loss and exercise.
• A range of contraceptive services were available at the practice (including coils and implants).
• Online booking enabled patients to book routine appointments with a GP at a time which was convenient to them.
• Repeat prescriptions could be requested online, instead of having to ring the practice, thus saving time for patients.

Updated 27 April 2016

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

• 89% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was in line with local and national averages.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• A Community Mental Health Team (Gateway) worker reviewed patients at the practice in a weekly clinic.
• Patients could self-refer to courses for anxiety, stress management, improving self-confidence and sleep management.
• 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 experienced poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 27 April 2016

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 including those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• We received very positive feedback from the residential care home manager with whom we spoke.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Four staff members had received dementia friendly training.
• Staff had received training and 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 a policy whereby the usual GP would follow up on any member of a vulnerable family who did not attend an appointment.
• Information about domestic abuse and sexual violence was displayed in the reception area.