Archived: Blakeney Surgery

Updated 26 October 2016

Blakeney Surgery is a rural family GP practice located in purpose built premises within the Forest of Dean, approximately 15 miles from the city of Gloucester. The practice is wheelchair accessible with automatic doors.

The practice provides general medical services to approximately 3,400 patients. Services to patients are provided under a General Medical Services (GMS) contract with NHS England. (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 has three GP partners and one salaried GP (two female and two male) which is equivalent to three whole time equivalent GPs. The clinical team include four practice nurses and two health care assistants (all female). The practice management team supporting the GPs comprises of a practice manager, five administrators and five receptionists.

Blakeney Surgery is a dispensing practice. The dispensary manager is supported by five dispensers who dispense to approximately 2,350 patients which equates to 70% of the practice population.

The practice had a lower than average patient population aged under 18 years of age. For example, 16.5% of practice patients are under 18 years of age compared to the local clinical commissioning group (CCG) average of 20% and the national average of 21%.

The general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in the forth most deprivation decile. The prevalence of patients with a long standing health condition is 63% compared to the local CCG average of 55% and the national average of 54%. Patients living in more deprived areas and with long-standing health conditions tend to have greater need for health services. (An area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score. It is important to remember that 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 79 and 83 years, which is the same as the national averages of 79 and 83 years respectively.

The practice is open between 8am and 6.30pm on Monday to Friday. Between 1pm and 2pm every weekday telephone calls are diverted to the practice call handling service (Message Link). They refer urgent matters to the practice that have members of staff on standby to respond to issues if needed. Appointments are available between 8.30am and 6pm. Extended surgery hours are offered on Monday and Tuesday evenings each week between 6.30pm and 7pm.

Out Of Hours cover is provided by South Western Ambulance Service NHS Foundation Trust and can be accessed via NHS 111.

The practice provided its services from the following address:

Blakeney Surgery

Mill End

Blakeney

Gloucestershire

GL15 4ED

This is the third inspection of Blakeney Surgery.

Updated 26 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Blakeney Surgery on 20 September 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 October 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.

• Performance in 2014/15 for overall diabetes related indicators was 100% which was above the clinical commissioning group (CCG) average of 95% and 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.

• Telehealth care monitoring was utilised at the practice to assist in diagnosis and monitoring patients with long term conditions. It can be used to measure and monitor temperatures, blood pressure and other vital signs parameters.

Updated 26 October 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 women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years was 91% which was above both the CCG average of 84% 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, multi-disciplinary meetings attended by community staff were held fortnightly.

• A full range of in-house family planning including contraceptive implants, coils, and other forms of contraception were available in the practice.

Updated 26 October 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.

• Weekly meetings took place that included discussions of hospital admissions, hospital discharges and palliative care patients.

• The practice visited a local care home on a fortnightly basis to see patients and carry out annual reviews, medication reviews and end of life planning. A dedicated partner was allocated to ensure continuity of care.

Updated 26 October 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.

• Extended hours appointments were available on Monday and Tuesday evenings for working age patients to attend outside of working hours.

• The practice offered telephone consultations for all patients which was useful for working patients.

Updated 26 October 2016

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

• 97% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months (2014/15), which was above both the CCG average of 86% and the national average of 84%.

• Overall performance for mental health related indicators in 2014/15 was 100% compared to the CCG average of 97% and national average of 82%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. Fortnightly multi-disciplinary meetings were held which included attendance of the community psychiatric nurse.

• 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 26 October 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 those with a learning disability. The practice supported five learning disability homes and 5% of the practice population had a learning disability.

• The practice offered longer appointments for patients with a learning disability and 100% of these patients on their register had received an annual health check and written care plans in 2014/15.

• Practice nurses provided weight management training for staff at the learning disability homes.

• 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.