Stour Surgery

Updated 16 December 2016

Stour surgery is located in Christchurch Dorset and has an NHS England general medical services (GMS) contract to provide health services to approximately 9950 patients. The practice is open between 8.30am and 6pm on Tuesday, Thursdays and Fridays and until 8pm on Mondays to Fridays. In addition, open surgeries were available each morning and pre-bookable appointments could be booked up to four weeks in advance. Telephone triage and telephone appointments are also available. Urgent appointments are also available for patients that needed them.

The practice has opted out of providing out-of-hours services to their own patients and refers them to an out of hours provider via the NHS 111 service. This information is displayed on the outside of the practice and on their website.

Data from public health England showed that the mix of patient’s gender (male/female) is almost 50% each. 11% of patients were above the age of 75 which is higher than the England average of 7.8%. 3.7% of the patients are aged over 85 years old which is higher than the England average of 2.3%. There was no data on ethnicity however staff said they thought the majority of practice patients are white British. The practice informed us that 8160 of the 9950 patients are recorded with English as their first language, 24 Mandarin, 17 Polish, 10 Russian and a number of various European Languages. The practice added that the Summer months sees an increase in foreign language school students so had translation facilities available. The deprivation score for the practice area is recorded as eight on a scale of one to ten. One being more deprived and ten being less deprived.

The practice is a teaching practice for doctors who wanted to become GPs with good feedback from trainees and the local NHS health education team. One of the GPs had been identified as a suitable trainer for GP trainees who had experienced difficulties with the training programme. Three partners are currently trainers and there are usually two or three trainees based at the practice. Four of the GPs working at the practice had previously been trainees at Stour surgery. In addition the practice provided a learning environment to paramedics and student nurses.

The practice has an established team of seven GPs (three male and four female). Four of these GPs are partners who hold managerial and financial responsibility for running the business. The GP partners are supported by two GP registrars and a salaried GP who together provide just under four whole time equivalent. The GPs are supported by a practice manager, assistant practice manager, finance manager, five practice nurses, three outreach nurses, two health care assistants and additional administration and reception staff.

This report relates to the regulatory activities being carried out at:

49 Barrack Road

Christchurch

Dorset

BH23 1PA

Updated 16 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stour Surgery on Tuesday 25 October 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. Staff had access to formularies and guidelines by incorporating them onto the patient computer system.

• Patients had access to the Parkinson’s disease specialist nurse who visited the practice.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Feedback from friends and family tests and national surveys was also positive.
• The practice held regular multi-disciplinary team (MDT) meetings to discuss vulnerable patients. In addition cluster group meetings were run by the SCOT (Stour Community Outreach Team) and SOS (Stour Outreach Sister) teams to discuss patients on these schemes.
• The practice had identified over 4% of patients who were carers and offered them social support and signposted them to other services.

• The practice encouraged its patients to attend national screening programmes for bowel and breast cancer screening.

• 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.
• We looked at the friends and family patient feedback between July and September 2016. These showed that of the 300 patients who had responded, 286 would be extremely likely or likely to recommend the practice to others.
• 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.

• Text reminders were used to remind patients of their appointment. Patients could use text messages to cancel appointments in an attempt to reduce any ‘did not attend-DNA’ appointments.

• 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 practice was a teaching practice for doctors who wanted to become GPs with good feedback from trainees and the local NHS health education team.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw two areas of outstanding practice:

• The practice employed a SCOT nurse and Stour Outreach Sister (SOS) who worked with vulnerable, mainly elderly patients or patients with long term conditions to reduce hospital admissions and improve their quality of life. This model of care was appreciated by local care homes and had been adopted locally and had contributed to a reduced number of emergency hospital admissions. For example, Stour surgery had the second lowest number of emergency admissions for the year and the lowest on a rate per 1000 patients across a rolling year, which saved the CCG just under £27,000. The data also showed a continual downward trend in emergency admissions.

• The practice had set up a befriending project called Christchurch angels. The scheme, involving volunteers initially aimed to improve the health and wellbeing of people who live in the locality and had won an award in 2013. The scheme was very successful and was now run by another agency elsewhere in the town but was still supported by the practice. Since the scheme started at the end of September 2013, Stour had referred 70 patients which was the highest source of referral the scheme had received.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 December 2016

The practice is rated as good for the care of people 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.
• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes for long term conditions were above average compared to the national average.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review based around the patients birthday 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.
• A leg ulcer clinic assessment and treatment centre service was available.
• Patients had access to the Parkinson’s disease specialist nurse who visited the practice to discuss effective symptom control and meet any patients with complex needs.
• The GPs followed evidence based cardia care process for patients with heart conditions.
• Staff had access to prescribing formularies and guidelines from NICE and used this information to deliver care and treatment that met patients’ needs. This was done by incorporating the guidelines onto the patient computer system which prompted staff to carry out all investigations and screening for the common long term conditions.
• The SOS nurse performed home visits including to patients with long term conditions. This resulted with prompt secondary referral, access to medicines and early intervention and treatment.
• The practice maintained effective links with the Dorset Adult integrated respiratory service and heart failure nurse.
• GPs and nurses encouraged patients to have access to pulmonary and cardiac rehabilitation services.

Updated 16 December 2016

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

• 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.
• The GPs routinely saw pregnant women during their pregnancy and parents could access post-natal and six week checks at the ‘one stop’ vaccine appointments.
• A full range of contraceptive services were available.
• 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.
• Sexual health clinics were held each week and women’s health clinics were held twice a week.

Updated 16 December 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. All patients had a named GP but could see whichever GP they chose.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice employed a SCOT nurse and Stour Outreach Sister (SOS) who worked with vulnerable, mainly elderly patients or patients with long term conditions to reduce hospital admissions and improve the quality of life. This service included home visits by the SOS team and proactive care management of patients in care homes, including end of life care planning.
• The practice had initially set up and hosted ‘Christchurch angels.’ This was a befriending service for isolated elderly patients in the town. The service was now run by another agency but the practice regularly referred patients and had referred 70 patients since the scheme began.

Updated 16 December 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice was open until 8pm on Mondays and Wednesdays and offered a ‘Stour Access System’ of GP telephone triage with named patient lists.
• There was a nurse led daily minor illness walk-in clinic which ran every morning from 8.30am to 10.30am. This clinic was supported by the duty GP should patients need prescriptions or further treatment.

• 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.
• Text reminders were used to remind patients of their appointment. Text messages could be used to cancel appointments in an attempt to reduce any ‘did not attend-DNA’ appointments.
• The practice had started to introduce systems in place to identify military veterans and ensured their priority access to secondary care in line with the national Armed Forces Covenant 2014.

Updated 16 December 2016

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

• The practice had a dedicated mental health lead who communicated any best practice changes in the care of patients mental health.
• 79% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is slightly lower than 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 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.

Updated 16 December 2016

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

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
• The practice offered longer appointments for patients who needed more time.
• 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.
• The practice had identified 4.13% of the practice list as carers and facilitated a carers group who met monthly for social or educational sessions.