Archived: Caerleon Surgery

Updated 24 May 2016

Caerleon Surgery is located in a deprived area of Wolverhampton and provides Primary Medical Services (PMS) to a population of approximately 3,275 patients. The practice has a higher proportion of patients between the ages of 60 and 85+ years compared with the practice average across England. There is a higher practice value for income deprivation affecting children and older people in comparison to the practice average across England.

The practice team consists of two GPs (one male and one female). The male GP took over ownership of the practice in February 2014. The other GP is a salaried GP. The practice used GP locums to support the clinicians and meet the needs of patients in times of absence. The clinical practice team also includes a practice nurse. The clinical practice staff was supported by a practice manager and office supervisor and five administration/ receptionists support staff. In total there are nine staff employed either full or part time hours to meet the needs of patients.

The practice is open from 8am to 7.30pm on Monday, 8am to 6.30pm, Tuesday and Friday, 7am to 6.30pm Wednesday and 8am to 4pm on Thursday. Extended surgery hours are from 6.30pm to 7.30pm on Mondays and 7am to 8am on Wednesday mornings. A separate appointment schedule is available for appointments with the practice nurse. The practice does not provide an out of hours service to its patients but has alternative arrangements for patients to be seen when the practice is closed. Patients are directed to the out of hours service, NHS111, Primecare and the local Walk-in centre.

The practice has a contract to provide Primary Medical Services (PMS) for patients. This is a contract for the practice to deliver primary medical services to the local community. They provide Directed Enhanced Services, such as the childhood vaccination and immunisation scheme and minor surgery. The practice provides a number of clinics for example long-term condition management including asthma, diabetes and high blood pressure.

Updated 24 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Caerleon Surgery on Thursday 18 February 2016. Overall the practice is rated as requires improvement.

• There was an open and transparent approach to safety and a system was in place for reporting significant events. However, the recording of significant events were insufficiently detailed to show lessons learned, action to be taken and ongoing monitoring.
• Clinical staff had the skills, knowledge and experience to deliver effective care and treatment. However administration and reception staff had not received training related to keeping patients safe, this included chaperoning, health and safety and infection control.
• Risks to patients were assessed, however a full legionella risk assessment had not been completed.
• Robust systems were not in place to ensure that appropriate pre-employment checks were carried out for all staff.
• 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 proactively sought feedback from staff and patients, which it acted on.
• There was a clear leadership structure and staff felt supported by the management team. The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider must make improvements are:

• Ensure that staff who undertake the role of a chaperone have a Disclosure and Barring Service (DBS) check or an appropriate risk assessment carried out to demonstrate why a DBS check is not in place.
• Ensure that all staff receive appropriate support, training, development and appraisals to enable them to carry out the duties they are employed to do.
• Ensure that all necessary employment checks are made for all staff. This should include a full employment history, DBS check and health history.
• Implement robust governance arrangements to ensure appropriate systems are in place for assessing and monitoring the quality of services provided. This should include completed clinical audit cycles and the maintenance of accurate records to demonstrate ongoing improvements.

The areas where the provider should make improvement are:

• Ensure that a full risk assessment for legionella is carried out.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 May 2016

The practice is rated as requires improvement for the care of people with long-term conditions. The practice is rated as requires improvement for the domains of safe and well led and rated as good in effective, caring and responsive. The concerns that led to these ratings apply to everybody using this practice including this population group. The practice performance in some areas related to the management of patients with long term conditions was lower than the national average. For example, the Quality and Outcomes Framework data showed that performance for diabetes assessment and care was 76% compared to the national average of 89%. The practice had taken action to identify the causes and it planned to be involved in a local Clinical Commissioning Group (CCG) initiative to improve the care and treatment of patients with diabetes. The practice had looked at the reasons for its performance with the support of the CCG and had reviewed the staff skill mix to support the care of patients with long term conditions.

Updated 24 May 2016

The practice is rated as requires improvement for the care of families, children and young people. The practice is rated as requires improvement for the domains of safe and well led and rated as good in effective, caring and responsive. The concerns that led to these ratings apply to everybody using this practice including this population group. 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. 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. 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. The practice’s uptake for the cervical screening programme was 80%, which was comparable to the national average of 82%.

Updated 24 May 2016

The practice is rated as requires improvement for the care of older people. The practice is rated as requires improvement for the domains of safe and well led and rated as good in effective, caring and responsive. The concerns that led to these ratings apply to everybody using this practice including this population group. The practice offered proactive, personalised care to meet the needs of the older people in its population. The practice offered home visits and urgent appointments for those older patients with enhanced needs. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice had a proactive working relationship with four care homes. There was effective communication between the practice and care home staff and visits to the homes were made when requested. Weekly ward rounds were made to patients in care homes.

Updated 24 May 2016

The practice is rated as requires improvement for the care of working-age people (including those recently retired and students). The practice is rated as requires improvement for the domains of safe and well led and rated as good in effective, caring and responsive. The concerns that led to these ratings apply to everybody using this practice including this population group. 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. Patients were supported to access local healthy lifestyle programmes.

Updated 24 May 2016

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). The practice is rated as requires improvement for the domains of safe and well led and rated as good in effective, caring and responsive. The concerns that led to these ratings apply to everybody using this practice including this population group. The QOF data showed that 76% of patients on the practice register who experienced poor mental health had a comprehensive agreed care plan in the preceding 12 months (2014/15). This was lower than the national average of 88%. The practice confirmed that there had been improvements in this area (88%) for the QOF year 2015/16. The percentage of patients diagnosed with dementia whose care had been reviewed in a face to face review in the preceding 12 months was 76%, which was also lower than the national average of 84%. The practice regularly worked with multi-disciplinary teams in the case management of people who experienced poor mental health, including those with dementia. It carried out advance care planning for patients with dementia. Staff had a good understanding of how to support people with mental health needs and dementia.

Updated 24 May 2016

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. The practice is rated as requires improvement for the domains of safe and well led and rated as good in effective, caring and responsive. The concerns that led to these ratings apply to everybody using this practice including this population group. The practice held a register of patients with a learning disability and carried out annual health checks for these patients. An easy read (pictorial) letter was sent to patients with a learning disability inviting them to attend the practice for their annual health check.

Staff had been trained 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. The practice was not aware of any patients living in vulnerable circumstances including homeless people or travellers. The practice was aware of the need to allow people with no fixed address to register or be seen at the practice. It had told vulnerable patients about how to access various support groups and voluntary organisations.