Archived: Portesham Surgery

Updated 12 October 2016

Drs Baird, Fowler and Beale, also known as Portesham Surgery, is located at The Surgery, Malthouse Meadow, Portesham, Dorset, DT3 4NS.

The practice is based in a rural community and serves patients living around the Bride Valley in West Dorset. The practice provides services under a General Medical Services contract and is part of NHS Dorset Clinical Commissioning Group. The practice has approximately 3000 registered patients. The practice population has a higher proportion of older patients compared to the average for England with a total of 33% being over 65 years of age compared to the national average of 17%. The practice population also has a higher number of patients with a long-standing health condition compared to the national average. A total of 70% of patients registered at the practice have a long-standing health condition compared to the national average of 54%.

The practice has one male GP partner and one female GP partner, who together provide care equivalent to two full time GPs over 12 sessions per week. The GPs are supported by two practice nurses, who together are equivalent to 1.2 full time nurses. The practice has one part-time health care assistant. The clinical team are supported by a management team including secretarial and administrative staff.

The practice is open between 8.30am and 6.30pm Monday to Friday. Extended hours appointments are offered every Tuesday and Thursday between 6.30pm and 7.15pm. Appointments with a GP are available between 9am and 11.30am and again from 4pm to 5pm daily. In addition, an afternoon duty GP does home visits, phone calls and deals with hospital letters. The practice have opted out of providing out-of-hours services to their own patients and refers them to the Dorset Urgent Care service or local Minor Injuries Units via the NHS 111 service.

The practice offers a range of additional services to patients including antenatal care, midwifery, chiropody and toenail cutting, specialist diabetes clinics, counselling, specialist dietary advice, minor surgery, physiotherapy and cryotherapy. The practice offers online facilities for booking of appointments and for requesting prescriptions.

The practice has an in-house dispensary which caters for patients who need medication, appliances and dressings and who live more than one mile from their nearest pharmacy.

We previously inspected Drs Baird, Fowler and Beale on 9 February 2016. Following this inspection, the practice was given an overall rating of good. The practice was rated as requires improvement for providing effective services. This was because not all role specific competency and training for staff was up to date and not all staff had received an appraisal.

A copy of the report detailing our findings can be found at www.cqc.org.uk.

Updated 12 October 2016

Letter from the Chief Inspector of General Practice

We carried out a focused desktop inspection of Drs Baird, Fowler and Beale on 6 September 2016 to assess whether the practice had made the improvements in providing effective care and services.

We had previously carried out an announced comprehensive inspection at Drs Baird, Fowler and Beale on 9 February 2016 when we rated the practice as good overall. However, the practice was rated as requires improvement for providing effective services. This was because not all role specific competency and training for staff was up to date and not all staff had received an appraisal.

We asked the provider to send a report of the improvements they would make to comply with the regulation they were not meeting at that time. The practice is now able to demonstrate that they are meeting the regulations. The practice is now rated as good for providing effective care and the overall rating remains as good.

This report should be read in conjunction with the full inspection report dated 31 March 2016.

Our key finding across the area we inspected was as follows:

• Staff training considered mandatory by the practice occurred at regular intervals.
• There was an effective system in place to ensure training was monitored and staff had the skills they needed to perform their roles safely and effectively.
• There was an effective system in place to monitor staff development through regular appraisals, meetings and discussion.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 31 March 2016

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators was similar to the national average. For example, the percentage of patients with diabetes at the practice who had an acceptable HbA1c level (a test to measure average blood sugar levels over a three month period) in the previous 12 months was 79% compared to a national average of 78%.

• The percentage of patients with COPD (a chronic lung condition) who had a review undertaken, including an assessment of breathlessness in the previous 12 months was 97% compared to a national average of 90%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check that 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 31 March 2016

• 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. Immunisation rates were relatively 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, and we saw evidence to confirm this.

• The practice’s uptake for the cervical screening programme was 80%, which was comparable to the CCG average of 77% and the national average of 74%.

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

• The practice had developed a health information leaflet specifically aimed at teenagers.

• We saw good examples of joint working with midwives, health visitors and school nurses. For example, the practice nurse had discussed with the health visitor different approaches to encourage attendance for parents who did not bring their children for immunisations.

Updated 31 March 2016

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

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

• Nationally reported data showed that outcomes for patients for conditions commonly found in older patients were similar to national averages. For example, 100% of patients with atrial fibrillation (an irregular heart beat) were treated with appropriate medicines compared to the national average of 98%.

• The percentage of patients aged 65 or over who received a seasonal flu vaccine was better than the CCG and national averages.

Updated 31 March 2016

• 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 ran a smoking cessation clinic to support patients who wanted to stop.

Updated 31 March 2016

• 88% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months.

• The percentage of patients with serious mental health conditions who had a comprehensive, agreed care plan documented in the previous 12 months was 100% compared to a national average of 88%.

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

• It 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.

• It 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 made arrangements for staff to collect patients with memory problems from their own homes so they could attend the practice on a regular basis.

Updated 31 March 2016

• The practice held a register of patients living in vulnerable circumstances including homeless patients, travellers and those with a learning disability.

• It offered longer appointments for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.

• It had told vulnerable patients about how to access various support groups and voluntary organisations.

• The practice held a ‘mock clinic’ to help support patients with learning disabilities become familiar with attending GP practices. This was also available to patients who were not registered at the practice.

• All 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.