Price's Mill Surgery

Updated 5 July 2016

Price’s Mill Surgery is a GP partnership located in the town of Nailsworth in Stroud. The practice’s premises is purpose built and has eight consulting rooms and one treatment room on the ground floor and another five treatment rooms on the first floor. The practice is wheelchair accessible and has a lift.

The practice provides its services to approximately 8,900 patients under a General Medical Services (GMS) contract. (A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract). The practice delivers its services from the following address:

Newmarket Road

Nailsworth

Stroud

Gloucestershire

GL6 0DQ

The practice partnership has seven GP partners making a total compliment of approximately five whole time equivalent GPs. There are three male and four female GPs. The nursing staff include one nurse practitioner and three practice nurses who were all female. The practice also employed two health care assistants and a phlebotomist. The practice management and administration team included a business manager, an operations manager, six administration staff and 11 reception staff. The practice is approved for teaching medical students and training qualified doctors who wish to become GPs. To date, the practice has only had foundation trainee doctors and at the time of our inspection, they were supporting two foundation doctors.

The general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in the least deprivation decile. (An area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score. Not everyone living in a deprived area is deprived and that not all deprived people live in deprived areas). Average male and female life expectancy for the practice is 80 and 84 years, which is above the national average of 79 and 83 years respectively.

The practice is open from 8am to 6.30pm Monday to Friday. Appointments with a GP are from 8.30am to 5.30pm, and 8.10am-8.30am to 5.30pm-6pm with a nurse Monday to Friday. Extended hours are available from 6.30pm to 7pm Monday to Friday, and 9am to 12.30pm on the first and third Saturdays of the month.

The practice has opted out of providing out of hours services to its patients. Patients can access the out of hours services provided by South Western Ambulance Service NHS Foundation Trust via the NHS 111 service.

This inspection is part of the CQC comprehensive inspection programme and is the first inspection of Price’s Mill Surgery.

Updated 5 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Price’s Mill Surgery on 24 May 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.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and 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 areas where the provider should improvement are:

• Ensure all GPs have undertaken cardio-pulmonary and resuscitation training.

• Ensure the systems for recording consent are reviewed and improved.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 July 2016

The practice is rated as good for the care of patients 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.

• The practice achieved 100% of the targets for care of patients with diabetes in 2014/15 which was above the clinical commissioning group average of 95% and above the 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.

• The practice signed up to a winter resilience programme between January and March to provide patients more access to GP and nursing services during the winter season especially those diagnosed with chronic obstructive pulmonary disease.

• The practice hosted diabetic retinal screening annually.

• The practice had a GP and nurse who were qualified in initiating insulin for diabetic patients.

Updated 5 July 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.

• Patients told us that 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 the cervical screening programme was 81% which was comparable to the clinical commissioning group of 84% and the national average of 82%.

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

• The practice held monthly meetings with health visitors and midwives to review children on the child protection and children in need register.

Updated 5 July 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 had a range of enhanced services, for example in influenza, pneumococcal and shingles immunisations.

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

• The practice supported three care homes and provided weekly visits to patients living in the homes.

• The practice offered a blood testing service either at home or at the practice for patients on blood thinning medicines.

Updated 5 July 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 that reflects the needs for this age group.

• The practice offered extended hours every evening from Monday to Friday and every other Saturday.

• One of the GPs was trained in occupational medicine and this resulted in the practice having an increased awareness of employment related health issues for this population group.

Updated 5 July 2016

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

• 75% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months (04/2014 to 03/2015), which was below the clinical commissioning group of 86% and national average of 84%.

• The percentage of patients with severe mental health problems who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months (04/2014 to 03/2015) was 91% which was comparable to the CCG average of 93% and above the national average of 88%.

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

• The practice carried out advance care planning for patients living with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice hosted monthly clinics ran by the consultant psychiatrist and community mental health nurse.

• The practice supported a local alcohol rehabilitation unit.

• 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.

• The practice hosted weekly Artlift sessions, which was a clinical commissioning group funded course where patients could undertake art sessions as a different form of therapy for eight weeks with an experienced artist.

Updated 5 July 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 travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• There was a lead GP for patients with learning disabilities. The practice realised that many patients with a learning disability were not attending an annual health check and therefore, offered all those patients a home visit where they could have a health check in their own home and a written health action plan.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. Safeguarding meetings were held every month between clinicians at the practice and community based staff.

• 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.