Dr Guildford and Partners

Updated 10 March 2016

Dr Tiley and Partners, also known as Prescott Surgery, is located in the rural village of Baschurch in North West Shropshire, approximately seven miles from Shrewsbury. It is part of the NHS Shropshire Clinical Commissioning Group (CCG). The total practice population is around 6,300 patients spread across a wide geographical area. The practice covers the villages of Ruyton XI Towns, Bomere Heath, Yeaton, West Lullingfields and Myddle. It is a rural dispensing GP practice that was built in 1964/5 and extended in 1989/90. The practice has a higher proportion of patients aged 65 years and above compared with the practice average across England. For example, 12% of patients registered are aged 65-74 years compared with the national average of 9%.

The staff team comprises of three GP partners. The senior partner has recently left the practice. One of the other partners has taken up the senior role and has appointed another GP initially as a salaried GP for 12 months before becoming a partner. The clinical practice team also includes three salaried GPs and a GP Trainee making a total of six GPs and a GP Trainee. There are three part-time practice nurses, two phlebotomists, supported by a practice manager, three dispensary staff including a trainee and seven administration/reception staff, making a total of 23 staff. The practice is supported by a care coordinator as an attached staff member who offers a signposting service for frail and vulnerable patients, their family and/or carers.

The practice and dispensary are open Monday to Friday 8.30am to 6pm. The practice does not provide an out-of-hours service to its own patients but has alternative arrangements for patients to be seen when the practice is closed through Shropdoc, the out-of-hours service provider. The practice telephones switch to the out-of-hours service at 6pm each weekday evening and at weekends and bank holidays. GPs at the practice also work as members of Shropdoc. The practice is a teaching practice.

The practice provides a number of clinics, for example long-term condition management including asthma and diabetes. It also offers child immunisations, minor surgery, and travel vaccinations. The practice offers health checks and smoking cessation advice and support. The practice has a General Medical Services (GMS) contract with NHS England. This is a contract for the practice to deliver general medical services to the local community or communities. They also provide some Directed Enhanced Services, for example they are a dispensing practice, offer minor surgery and the childhood vaccination and immunisation scheme for their patients.

Updated 10 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Tiley and Partners on 22 January 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 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.
• Patients said they found it easy to make an appointment with a named GP and that 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 the 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.

We saw an area of outstanding practice:

• GPs performed paediatric venesection (taking of blood samples) for some children to try to reduce the need to attend the local paediatric ward.

The areas where the provider should make improvements are:

• Consider a process to follow up patients that are overdue medication reviews to ensure effective management of repeat prescribing.

• Review the non-audible fire alarm system in place.

• Consider an active carers’ register.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 March 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.

• 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.

• The practice held a regular diabetes clinic every Wednesday, had diabetic foot screening appointments once a month and diabetic eye screening appointments took place every 6 weeks.

Updated 10 March 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.

• The percentage of patients diagnosed with asthma, on the register, who had an asthma review in the last 12 months was 69.49%, which was slightly lower than the national average of 75.35%. The practice had responded and the GPs assured us that this was in the process of being addressed by increasing the knowledge and skills with another member of staff in the team to assist in the monitoring of patients.

• 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 80.58%, which was comparable to the national average of 81.83%.

• 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.

• The GPs performed paediatric venesection (blood taking) for some children to try to reduce the need to attend the local paediatric ward.

Updated 10 March 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.

• Meetings took place monthly to discuss patients on the practice hospital admissions avoidance register, many of whom were older patients, who had been admitted or attended A&E.

• The practice completed 'Avoidance of Unplanned Admissions Plans' these included older patients.

Updated 10 March 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 reflected the needs for this age group.

• The practice provided guaranteed same day appointments available from 11:30am to 12.45pm daily.

• The GPs provided patients the option of a telephone consultation whilst a patient is at work if required.

Updated 10 March 2016

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

• 95.24% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was better than the national average of 84.01%.

• Performance for mental health related indicators were comparable with the national averages. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 80% when compared with the national average of 88.47%.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• The practice had a practice based counsellor.

• A practice based Community Mental Health Trust (CMHT) liaison nurse was to provide appointments at the practice from January 2016.

• 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 10 March 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 with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• 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.