Archived: Three Swans Surgery

Updated 5 September 2016

The Three Swans Surgery is situated in the City of Salisbury, close to the city centre, with good public transport links nearby. The practice population is approximately 8,640 patients mainly from the urban city of Salisbury with some patients from the surrounding villages. The practice population demographics are similar to the national average across the range of ages, and does support one area of social deprivation.

The practice is located in a purpose built building which opened in 1992; the practice uses a building next door for administrative functions. The practice premises are over three floors; all the clinical rooms are located across the two lower floors with a lift between these floors for access.

The practice is a training and teaching practice and a primary care research practice.

The practice team consists of seven GP partners and two salaried GPs (five female and four male). The practice currently supports one Registrar (Registrars are qualified doctors who undertake additional training to gain experience and higher qualifications in general practice and family medicine), and medical students from local universities.

The practice is supported by a nursing team of six staff, (all female) one nurse prescriber, two practice nurses and three health care assistants. The practice has a practice manager and a business manager and a team of reception and administration staff.

The practice was open between 8am and 6.30pm Monday to Friday. Appointments run from 8.30am to 12.30pm and 14.45pm to 5.50pm daily. Extended hours appointments are offered until 7pm Mondays and from 7.30 am on Fridays. The practice also offers appointments from 8.30am to 10.45am every other Saturday. In addition to pre-bookable appointments that could be booked up to six weeks in advance, urgent appointments are also available for patients that needed them.

The practice holds a General Medical Services contract to provide primary care services.

The practices regulated activities are provided from:

Three Swans Surgery

Rollestone Street

Salisbury

Wiltshire

SP1 1DX

The practice has opted out of providing out of hours services to their patients. The out of hours service is provided by Wiltshire Medical Services and is accessed by calling NHS 111. Advice on how to access the out of hours service is contained in the practice leaflet, on the patient website and on a recorded message when the practice was closed.

Updated 5 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Three Swans Surgery on 7 July 2016. Overall the practice is rated as good.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

• The practice was proactive and passionate about sharing and utilising opportunities for learning.

• 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. Feedback from patients about their care was consistently positive.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example the GPs worked proactively with the other health care professionals to ensure care plans were in place to support patients in local care homes with complex needs and had seen a 36% decrease in hospital admissions over the last two years.

• 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 a clear vision to deliver high quality care and promote good outcomes and continuous improvement for patients. The practice placed a strong emphasis on working together as a team and all staff reported a supportive open team culture which valued learning and feedback.

• The practice actively reviewed complaints and had learning from complaints or any significant events as a weekly standing agenda item to ensure learning was cascaded promptly.
• The practice was continually seeking feedback and opportunities to improve the care, access and experience for the patients
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• 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 5 September 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 held an annual one stop diabetic clinic alongside the retinal screening team. Each patient received their results and a management plan for the year written by one of the GPs with an interest in diabetes.

• Performance for diabetes related indicators were higher than the local and national averages.

• The percentage of patients with diabetes, on the register, in whom the blood test was in the target range in the preceding 12 months (2014/15), was 84% which was higher than the CCG average of 82% and the national average of 78%.

• The percentage of patients with diabetes, on the register, who had influenza immunisation in the preceding 1 August to 31 March (01/04/2014 to 31/03/2015) was 100% which was higher than the CCG average of 96% and the national average of 94%.

• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was in the target range was 84% which was higher than the CCG average of 79% and the national average of 78%.

• 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 5 September 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’s uptake for the cervical screening programme was 83% which was lower than the CCG average of 85% and higher than the national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The lead GP worked proactively with the health visitors to identify families that may need support or any families of concern. The health visitors confirmed they had very good regular communication and support from the GPs and worked effectively together. Safeguarding meeting were held weekly

Updated 5 September 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.

• The GPs supported patients in local care homes and undertook weekly or twice weekly visits. The GPs also delivered educational sessions for care home staff.

• The GPs worked proactively with the other health care professional to ensure care plans were in place to support these patients with complex needs and had seen a 36% decrease in hospital admissions over the last two years.

• The practice were actively engaged in the ‘Transforming Care of Older People’ project with the local clinical commissioning group (CCG), an innovative and successful service where a care coordinator and pharmacist followed up at risk patients at home after discharge or after falls . Through managing medicines and social needs potential problems were identified before they occurred and support or adjustments to care and/or treatments implemented

Updated 5 September 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.

• 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.

• The practice offered a number of telephone and extended hours appointments for those who could not access the practice in normal working hours.

• The practice offered vaccinations and health screening on Saturdays for those who could not access the practice in normal working hours.

Updated 5 September 2016

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

• Performance for mental health related indicators were generally all above the local and national averages.

• The percentage of patients with a serious mental health problem who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 93% which was in line with the CCG average of 93% and higher than the national average of 88%.

• The percentage of patients with a serious mental health problem whose alcohol consumption has been recorded in the preceding 12 months was 97% which was higher than the CCG average of 93% and the national average of 90%.

• The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was 90% which was higher than the CCG average of 88% and 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 5 September 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 and any complex health or care needs.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice worked closely with a homeless hostel with high incidence of drug and alcohol misuse to ensure easy access to services. They offered domiciliary flu jabs each year and annually audit their use of the GPs services. This led to a plan to improve services for the homeless.

• Ex-military personnel had been identified as higher risk and all patients in this group have their notes clearly flagged to ensure consideration is given to liaising with SAFFA (a military charity) at times of difficulty.

• The practice had three GPs who could support shared care for patients with drug or alcohol problems. We saw examples of the GPs taking person centred care to patients in times of difficulty to ensure effective treatment was completed.

• 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.