Revel Surgery

Updated 10 March 2017

Revel Surgery is a rural practice in the village of Brinklow. The practice catchment area covers approximately 40 square miles in between the town of Rugby and the City of Coventry. It operates under a General Medical Services (GMS) contract with NHS England. A GMS contract is one type of contract between general practices and NHS England for delivering primary care services to local communities. The practice operates from premises purpose built in 1987 and later extended to accommodate a larger team for growing numbers of patients. The building has accessible facilities for patients with additional needs, such as wheelchair access and disabled parking. Revel Surgery has a patient list size of 6,781 including a small number of patients who live in two local care homes. In addition to the services provided from the premises, the practice provided clinics to students at a local private school, and to service personnel families based at a local MOD barracks. Revel Surgery is a training practice which has qualified junior doctors working under the supervision of its GPs. The practice dispensing service is provided from an integrated pharmacy. Dispensing services are provided to approximately 5,500 patients who lived more than 1.6km from their nearest pharmacy.

Revel Surgery’s patient list has lower than average levels of social deprivation, and a slightly higher than average population aged over 40, and a lower than average population aged 10 to 40. The practice has expanded its contracted obligations to provide enhanced services to patients. An enhanced service is above the contractual requirement of the practice and is commissioned to improve the range of services available to patients. For example, the practice offers minor surgery, risk profiling, case management, and additional services for patients at risk of or following unplanned admissions. It is also a dispensing practice.

The clinical team three male GP Partners, three female salaried GPs, one male salaried GP, four trainee GPs, one senior nurse, one practice nurse and one healthcare assistant. The team is supported by a practice manager, five reception staff and two administrators. Additionally the practice has a dispensary staffed by five dispensers and one counter assistant.

Revel Surgery is open from 8am to 6.30pm from Monday to Friday. The practice closes between 1pm and 2pm during which time the duty GP is on call for patients with urgent needs. Appointments are available from 8.30am to 1pm and 2pm to 6.30pm. Outside of the practice opening hours there are arrangements in place to direct patients to out-of-hours services provided by NHS 111.

Updated 10 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Revel Surgery on 16 August 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• The system used to report and record significant events was clearly understood by staff and met with current requirements. This ensured that incidents were thoroughly investigated and any patients affected received appropriate information and support.
• A number of risk assessments and processes ensured that patients were kept safe and safeguarded from abuse. Pre-employment checks had been made to help ensure staff were safe to work with the patients.
• The dispensary used clear procedures to ensure medicines were handled and dispensed safely.
• Clinicians assessed needs and delivered care in line with relevant and current evidence based guidance and standards, including National Institute for Health and Care Excellence (NICE) best practice guidelines.
• Staff liaised with other healthcare professionals in the management of patients to meet their needs and improve continuity of care.
• Data from the national GP patient survey showed the practice results were significantly higher than local and national averages, indicating a consistently high level of patient satisfaction with all areas of the service. The high return rate of very positive comment cards and the willingness of patients we approached to tell us about their experiences also indicated that they were satisfied with the standard of care the practice offered.
• The GPs were available on call to make home visits to palliative care patients outside of working hours and during the night.
• The practice developed a set of values to support its vision to provide a high quality, responsive, accessible and caring service. Staff worked in a way that supported these values and promoted better outcomes for patients.
• The practice was aware of the requirements of the duty of candour and systems were in place to ensure compliance with this. There was a culture of openness and accountability.
• The practice had a proactive approach to seeking feedback from staff and patients, and we saw evidence that concerns were acted on.
• There was a strong focus on continuous learning and improvement through training and individual development.

We saw one area of outstanding practice:

• The practice offered patients attending acute or chronic appointments a volunteer driver service which had been running for over 20 years. This was initially organised and funded by the local charity in support of the practice, Friends of The Revel Surgery, before separating into a volunteer group. The practice ensured that volunteers had signed a confidentiality agreement, received a DBS check and had the correct level of insurance for their vehicle.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 March 2017

The practice is rated as good for the care of people with long-term conditions.

• GPs gave their mobile telephone numbers to patients nearing their end of life and made home visits to them outside of working hours and during the night, in order to deliver continuity of care.
• The practice had identified that working aged men were less likely to attend for health checks. It had therefore devised an improved system of virtual clinics for patients with high blood pressure to facilitate regular monitoring. There was a blood pressure machine in the waiting room which patients were encouraged to use. Patients initially saw a nurse for checks, the results of which were reviewed by a GP, and monitored on an ongoing basis.
• The practice maintained registers of patients with long-term conditions and used these to monitor their health and ensure they were offered appropriate services.
• The nursing team had lead roles in chronic disease management.
• Performance for diabetes related indicators was similar to or higher than CCG and national averages. For example, 84% of the practices patients with diabetes had a blood glucose level within the target range in the preceding 12 months compared with the CCG and national averages of 78%. 95% of patients with diabetes had a record of a foot examination in the preceding 12 months compared with the CCG average of 91% and national average of 88%.
• The practice ran specialist clinics and offered longer appointments for patients with long term conditions. Review appointments were coordinated for those with multiple long term conditions.
• Clinical staff engaged with healthcare professionals to provide a multidisciplinary package of care.

Updated 10 March 2017

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

• Same day appointments were available for children. Appointments were also available outside of school hours and the premises were suitable for children and babies.
• The practice provided clinics at a local private school for students requiring primary medical services such as vaccinations.
• Childhood immunisation rates for the vaccinations given were comparable to or higher than CCG and national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 84% to 99%, which was comparable to the CCG average of 82% to 99% and five year olds from 97% to 100%, which was comparable to the CCG average of 93% to 98%.
• The practice worked with midwives, health visitors and school nurses to coordinate care. One of the GPs was the practice’s safeguarding lead who engaged with local health visitors. All staff were trained to the appropriate child safeguarding level.
• Clinical staff demonstrated their understanding of Gillick competence and Fraser guidelines, and why these needed to be considered when providing care and treatment to young patients under 16. The Gillick test is used to help assess whether a child has the maturity to make their own decisions and to understand the implications of those decisions. Fraser guidelines related specifically to contraception, sexual health advice and treatment.

Updated 10 March 2017

The practice is rated as good for the care of older people.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice offered patients attending acute or chronic appointments a volunteer driver service which had been running for over 20 years. The practice ensured that volunteers had signed a confidentiality agreement, received a DBS check and had the correct level of insurance for their vehicle.
• There was an on-site pharmacy convenient to older patients who had difficulty travelling elsewhere. The practice also provided phlebotomy (blood taking) appointments to save older patients travelling to hospital.
• The dispensary provided weekly blister packs for older patients where appropriate to assist them in taking medicines regularly.
• There was a medicines delivery service for house bound patients. All staff members who carried out deliveries had received a Disclosure and Barring Service check.

Updated 10 March 2017

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

• Patients could access online services such as repeat prescription ordering and appointment booking. All pre-bookable appointments were available online and the system had a good uptake, with 50% of patients being registered and 25% using it on a regular basis.
• The practice offered a text message appointment reminder service for convenience.
• Telephone consultations were available for patients who did not feel they required a physical consultation or who had difficulty in attending the practice during opening hours.
• A full range of health promotion and screening was available, including NHS health checks for those aged 40 to 74.
• The practice provided outreach clinics twice every week for service personnel families based at a local MOD barracks, many of whom are of Nepalese origin. Clinicians had needed to tailor prescribing for this significant group of patients, as they felt it was important to offer continuity of care and were aware that the same range of medicines may not be available or potentially affordable when the soldiers and their families returned to Nepal.

Updated 10 March 2017

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

• 91% of patients diagnosed with dementia had a face to face care review in the past 12 months, compared with an average 82% in the CCG area 84% nationally.
• Performance for mental health related indicators was also similar to or higher than the CCG and national averages. For instance, 94% of patients with a form of psychoses had a comprehensive, agreed care plan documented in the preceding 12 months, compared to the CCG average of 84% and the national average of 88%. 94% of the same group had also had their alcohol consumption recorded, again higher than the CCG and national averaged which were both 90%.
• The practice liaised with multi-disciplinary teams in the management of patients experiencing poor mental health and we saw that care plans were in place for those with dementia.
• The practice facilitated an Improving Access to Psychological Therapies (IAPT) counsellor to offer appointments on the premises.

Updated 10 March 2017

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

• The practice provided care to patients travelling through the area on narrowboats who had no fixed abode or were away from home. The practice registered these people as temporary patients. There were no homeless patients registered at the time of the inspection, but it was the practice’s policy to register and treat people from this group.
• Longer appointments were offered for patients who required them, including patients with a learning disability. There were ten patients on the practices learning disability register at the time of the inspection.
• The practice worked with other health care professionals in the case management of vulnerable patients.
• Staff members we spoke with during the inspection knew how to recognise signs of abuse in vulnerable adults and children and were aware of their responsibilities. All staff had additionally completed Identification and Referral to Improve Safety (IRIS) training in domestic violence and the practice had made individual arrangements to support patients as necessary.
• The practice’s computer system alerted GPs if a patient was also a carer, and linked their record with that of the person they provided care to if they were also a patient. There was a large board in the patient waiting area dedicated to displaying information for carers. The practice directed patients to Guideposts Warwickshire Carers Support Service and encouraged use of the Carers Emergency Card.