St Martin's Gate Surgery

Updated 6 February 2017

St Martin’s Gate Surgery consists of two premises within the South Worcestershire Clinical Commissioning Group (CCG), providing GP services to patients within Worcester and surrounding areas.

The main location surgery is a purpose-built GP practice located to the east of Worcester. In addition to the main surgery the practice also provides GP services at a branch surgery located to the south of Worcester, approximately three miles from the main location.

Both premises are served by the local bus network and there is accessible parking. Both buildings and facilities are fully accessible to wheelchair users, are fully computerised and linked through their IT and telephone systems. We visited the main location surgery as part of this inspection.

The practice and branch surgery provide primary medical services to approximately 12,300 patients in the Worcester and surrounding areas. The practice population is approximately 85% White British, with Black and Minority Ethnic groups making up the remaining 15%. The practice area includes a mixture of urban and rural areas and some areas of high deprivation.

The clinical staff team consists of three male and one female GP partners, one male and one female salaried GPs, a clinical pharmacist, five practice nurses (two being Advanced Nurse Practitioners), and two healthcare assistants. Additionally there is one regular locum GP.

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

The clinical team is supported by a practice manager, two office managers, and a team of 18 administrative and reception staff including one apprentice.

There are no staff who work solely at the branch surgery premises.

The main location and telephone lines are open from 8am to 6.30pm on weekdays. Appointments are available between these times. Extended hours appointments are available on Monday or Tuesday evenings until 8.00pm, and from 8am until 12pm on Saturday mornings approximately once a quarter.

The branch surgery is open for GP appointments from 9am until 12pm on weekdays.

When the practice is closed services are provided by Worcestershire Out of Hours service. This operates at the Worcestershire Royal Hospital at weekends, and between the hours of 6.30pm and 8am on weekdays. 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 6 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of St Martin’s Gate Surgery on 1 December 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 February 2017

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

• The practice held registers of those patients with long-term conditions and operated a system whereby patient reviews where carried out during patients’ birthday months.

• 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 was in line with CCG and national averages. For example, 95% of patients with diabetes received 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 14% compared with the CCG average of 19% 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.

• 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 6 February 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.

• Performance for cervical screening indicators were 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 80% compared with CCG and national averages of 83% and 82% respectively.

• 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.

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

Updated 6 February 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.

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

• Practice staff worked closely with other healthcare professionals to deliver care to older people, for example community nursing staff.

• Enhanced checks for patients aged 75 and above were available.

• The practice directed older people to appropriate support services and this was supported by a dedicated care navigator role.

Updated 6 February 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 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. Patient engagement with online services was high.

• Appointments were offered to accommodate those unable to attend during normal working hours. For example, extended hours appointments were available on Monday or Tuesday evenings until 8.00pm.

Updated 6 February 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 95% compared with CCG and national averages of 89% and 90% respectively. The practice’s exception reporting rate for this indicator was 8% compared with the CCG and national averages of 10%.

• Patients experiencing poor mental health (including those with dementia) had a care plan in place, and were invited to see a GP for a comprehensive review at least once a year. Patients who did not make appointments or attend booked appointments were contacted again.

• The practice carried out dementia screening for those identified with memory problems, and had access to early intervention dementia team clinics which took place in the practice building.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• 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 6 February 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held registers of patients living in vulnerable circumstances.

• 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 patients registered as having a learning disability and had offered health checks for all of these patients. The practice used information to support care planning and offered longer appointments for patients with a learning disability.

• The practice provided care and treatment for patients who were residents at a learning disability care home locally.

• The practice provided 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.