Stockbridge Practice

Updated 18 August 2017

Stockbridge Practice is located at New Street, Stockbridge, Hampshire. SO20 6HG. The practice provides general medical services for the geographical area of the Test Valley; specifically the rural area within 100 square miles around Stockbridge. The main surgery is in New Street, Stockbridge which also has a dispensing pharmacy on site. The branch surgery is situated in School Lane, Broughton. Both practices are accessible for patients with a disability.

The practice has eight GPs, two male and six female. Stockbridge Surgery is a training practice and had a GP registrar at the time of our inspection. The current staff of the practice includes:

4 GP Partners (One male and three female providing 21 sessions-2.625 whole time equivalent WTE)

4 Salaried GPs (One male and three female providing 23 sessions 2.875 WTE)

1 Practice Manager (1 WTE)

2 Practice Nurses (1.98 WTE)

3 Advanced nurse practitioners (1.2 WTE)

1 Health Care Assistant (0.89 WTE)

2 Phlebotomist (0.21 WTE)

6 Pharmacy dispensers (4.27 WTE)

19 Receptionists/Admin/Secretarial (11.13 WTE)

1 Community nurse (0.8 WTE)

The practice has 9075 registered patients and dispenses medicines to 7630 of them. A quarter of the patients are over 65 years of age and there is a significantly higher proportion of people aged over 75 than England average. There are higher levels of socio-economic deprivation than local average and low levels of ethnic diversity. The practice also supports a local nursing home.

Stockbridge Practice is open from Monday to Friday between 8.15am and 6.30pm. Phone lines are open from 8am for urgent calls. Extended hours are provided on Saturdays between 8.30am and 12pm and on alternate Monday and Wednesday evenings between 6.30pm and 7.30pm. When the practice is closed patients can phone the local Out of Hours clinic through NHS 111.

Updated 18 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stockbridge Surgery on 26 July 2016. At this inspection the overall rating for the practice was requires improvement. The full comprehensive report on the 26 July 2016 inspection can be found by selecting the ‘all reports’ link for Stockbridge Surgery on our website at www.cqc.org.uk .

This inspection was an announced focused follow up inspection carried out on 20 July 2017 to confirm that the practice had carried out their action plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection in July 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

At the inspection in July 2016 we found there were areas of practice where the provider needed to make improvements. This included:

• The practice must ensure that clinical waste is managed in line with its policy and protocol. In particular all clinical waste bags and sharps bins must be marked with the postcode of the practice and the date on which the packages were sealed.

• The provider must ensure all appropriate recruitment checks are undertaken and recorded prior to the employment of new staff including obtaining satisfactory evidence of conduct in previous employment.

At the inspection in July 2016 we said the provider should:

• Ensure that they identify and support carers appropriately.

• Encourage and support the formation of the new patient participation group.

• Improve their performance with regards to the management of patients who have diabetes.

• Ensure that all policies and procedures clearly state the date when those were written. It should also be clear when a review date is include whether that is a ‘due date’ or the date when a review was completed. This includes the practice’s written dispensary standard operating procedures.

At this inspection in July 2017 we found:

• All waste was securely stored and labelled in line with the practice policy and national guidance. The waste management policy had been updated.

• A recruitment pack had been introduced which included a mandatory checklist for employment. An inspection of four files demonstrated that this checklist was being used. A welcome pack for staff had been introduced which included the above checklist, job description, contract of employment, training information, induction documentation, information on emergency procedures and contact numbers for the team and local safeguarding teams.

• Changes to the identification of carers had resulted in the numbers of carers increasing from 0.5% of the patient population to 2%.

• A new patient participation group had been formed.

• Significant steps had been taken to improve the service being offered to patients with diabetes.

• Policies and standard operation procedures had been reviewed and amended to make the review dates clearer on the document.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 November 2016

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

• 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.
• GPs and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The practice experienced good engagement and uptake of their diabetes education programme.
• Longer appointments and home visits were available when needed.

Updated 9 November 2016

The practice is rated as good for the care of families, children and young people.

• The practice’s GPs had special interests which included safeguarding children, paediatrics, family planning, obstetrics and gynaecology.
• 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.
• Young patients told us they were treated in way that was appropriate to their age and were recognised as individuals.
• The practice’s uptake for the cervical screening programme was 92%, which was better than the CCG average of 82% and 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.

Updated 9 November 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. For vulnerable and often elderly patients the practice provided service of assessment and support planning, signposting and unplanned hospital admission prevention.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. Patients aged over 75 years had a named GP and a medicines delivery service was available.
• Meetings took place with other health care professionals on a monthly basis when care plans were routinely reviewed and updated for patients with complex needs.

Updated 9 November 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. Evening and weekend clinics were available.
• University and boarding school students were accommodated when required during vacations and home leaves.
• 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.
• E-mail advice and same day telephone advice was available from the patients usual GP or from the duty GP.

Updated 9 November 2016

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

• 94% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had had their care reviewed in a face to face meeting in the last 12 months, which was better than the clinical commissioning group (CCG) average of 89% and the national average of 88%.
• 82% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the CCG average of 84% and to 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.
• The practice made use of the Child and Adolescent Mental Health Services’ consultation line and patients had access to same day appointments.

Updated 9 November 2016

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

• The practice held a register of vulnerable children and adults and had regular meetings to discuss their cases. The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice funded a proactive care team though the Transformation Fund. This included funding nursing and clinician time for preventative work with vulnerable patients, particularly the elderly at risk of hospital admission.
• The practice hosted multi-disciplinary meetings which helped to coordinate the care of some of the most vulnerable patients, and allowed exchange of ideas and information about how to best manage the patients with skills and resources which they may have not been aware of.
• The practice offered longer appointments for patients with a learning disability.
• 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 was 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.