Tolsey Surgery

Updated 1 December 2016

Letter from the Chief Inspector of General Practice

In May 2016 a comprehensive inspection of Tolsey Surgery was conducted. The practice was rated as requires improvement for safe and good for effective, caring, responsive and well led. Overall the practice was rated as good.

We found that the practice required improvement for the provision of safe services, improvements were needed in the method the practice assessed, managed and mitigated the risks that related to the safe management of medicines.

Tolsey Surgery sent us an action plan that set out the changes they would make to improve these areas.

We carried out an announced focussed inspection of Tolsey Surgery on 10 November 2016 to ensure the practice had made these changes and that the service was meeting regulations. At this inspection we rated the practice as good for providing safe services. The overall rating for the practice remains good. For this reason we have only rated the location for the key question to which this related. This report should be read in conjunction with the full inspection report of 17 May 2016. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Tolsey Surgery on our website at www.cqc.org.uk.

Our key findings at the November 2016 inspection were:

• The practice had ensured effective systems were in place for monitoring patients prior to issuing repeat prescriptions of high risk medicines
• Standard operating procedures for the signing of repeat prescriptions prior to dispensing were being adhered to.
• Standard operating procedures in relation to checks of controlled drugs and the maintenance of an accurate controlled drugs register were being adhered to.
• Systems were in place to ensure effective monitoring of hand written prescription use.
• Fire drills had been carried out.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 July 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. The practice had detailed care plans for patients’ at risk of hospital admission, which could be accessed by out of hour’s services. The plans included, likely reason for deterioration, treatments which had previously exacerbated other problems so were best avoided, contact details for family and carers and a suggested management plan.

• Performance for diabetes related indicators was better than local and national averages. The percentage of patients with diabetes, on the register, in whom the last blood test was within target range in the preceding 12 months (2014 to 2015) was 82% compared to a local average of 84% and a national average of 76%.

• The practice had been accredited with a gold award by Wiltshire Public Health for its achievements in their stop smoking targets.

• 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.

Updated 11 July 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 practice supported a local sexual health initiative for young patients. GPs within the practice would see any young patient, whether they were registered with them or not, who needed on the day advice and treatment. Contraceptive condoms and testing kits for a sexually transmitted infection were placed discreetly but visible for young patients’ to collect from the practice without the need to be seen by a GP or nurse.
• The practice’s uptake for the cervical screening programme was 84%, compared to the local average of 85% 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.

Updated 11 July 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.

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

• A frail elderly clinic was held at the practice weekly. Each clinic started with a team meeting to discuss cases, a GP would then visit or telephone patients and their families in order to plan care that was tailored to meet the needs of the individual and also delivered in a way to ensure flexibility, choice and continuity of care. The clinic also enabled rapid and responsive care to those who had become acutely unwell. Effective collaborative working with the practices care coordinator, community staff and care organisations, had led to improved outcomes for patients. For example, a frail elderly patient who had become acutely unwell was reviewed in the frail elderly clinic by the team. The patient was visited daily, and increased care package was implemented immediately and home physiotherapy was initiated which avoided hospital admission.

• The practice had been proactive identifying older patients who rarely visit the practice who may require support. All patients over the age of 75 had received a questionnaire entitled “Staywell”. The care co-ordinator analysed the forms and following agreement with patients’ those who would benefit from being seen were booked an appointment with the GP or nurse or community teams as appropriate. The practice followed up all patients’ who had not responded with a telephone call. The response rate had been good meaning patients’ who rarely attended the practice had their health assessed.

Updated 11 July 2016

The practice is rated as good for the care of working-age people (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.

• Extended hours appointments are offered between 7.30am and 8am Wednesday and 6.30pm to 7pm Wednesday and Thursday evenings.

• 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.

Updated 11 July 2016

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

• The percentage of patients with a serious mental illness who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (2014 to 2015) was 100% compared to a local average of 93% and 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.

• 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. For example, the practice would telephone patients’ with memory problems to remind them of booked appointments.

Updated 11 July 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 homeless people, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• 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.