St Peters Surgery

Updated 22 June 2017

St. Peter’s Surgery is located in a residential area of Woolston, Southampton. The practice is based in a purpose built centre built in 1996. All of the 11 treatment and consulting rooms are located on the ground floor. The first floor is accessible by staff only and is used for management and administrative duties. The waiting area in the practice is large, bright and airy and has a children’s play area and a range of seating including high-backed chairs.

The practice provides services under a NHS General Medical Services contract and is part of NHS Southampton City Clinical Commissioning Group (CCG). The practice has approximately 5,300 patients registered most of whom live within a four mile radius of the practice.

The practice is located in an area considered to be in the fourth most deprived band out of ten for England. The average life expectancy for both males and females is comparable to local and national averages. A total of 65% of patients at the practice are working or are in full-time  education compared to the national average of 60%. The practice population has a similar number of patients with a long-standing health condition compared to the national average. A total of 49% of patients registered at the practice have a long-standing health condition compared to the  national average of 54%.

The practice has two male GP partners as well as employing a regular female locum GP. Together, the GPs provide care equivalent to approximately three full-time GPs. A practice nurse and a health care assistant, both of whom are female, also provide a range of services to  patients such as wound care and long-term condition reviews. Together the nurses are equivalent to approximately 1.5 full time nurses. The clinical team are supported by a practice manager, two administrative staff, six receptionists and a cleaner. The practice is also a training practice for doctors training to be GPs (GP registrars). At the time of our inspection, the practice was  supporting three GP registrars.

The practice is open from 8.30am until 6.30pm Monday to Friday. The practice phone line is open from 8am until 8.30am Monday to Friday for emergency calls. The reception desk closes for lunch at 12.45 and re-opens at 1.45pm. Phone lines for emergency calls, remain open during this time. Morning appointments are available between 8.30am and 12.30pm daily. Afternoon appointments are available from 2pm until 6.30pm daily. Extended hours appointments are offered on Wednesdays and Thursdays from 7am until 8am and on Saturday mornings from 8am until 11am approximately every six weeks. St. Peters Surgery has opted out of providing out-of-hours services to their own patients and refers them to the out of hours service via the NHS 111 service or the Minor Injuries Unit based in Southampton.

We carried out our inspection at the practice’s only location which is situated at:

• 49-55 Portsmouth Road, Woolston, Southampton, SO19 9RL

Updated 22 June 2017

Letter from the Chief Inspector of General Practice

When we visited St Peter’s Surgery on 18 October 2016 to carry out a comprehensive inspection we rated them as good overall. However, we found the practice required improvement for the provision of safe services and said they must:

• Ensure a comprehensive fire risk assessment is completed and actions are taken to improve fire safety.
• Ensure an effective business continuity plan is completed and maintained so emergencies can be effectively managed.

We also said they should;

• Review the processes for the identification and support of patients who may also have caring responsibilities, so that their needs are appropriately met.  
• Review the processes for checking emergency equipment and medicines.  
• Continue to review arrangements for routine appointments to give patients access in a timely way.

This inspection was an announced focused inspection carried out on 31 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified at our previous inspection. This report covers our findings in relation to those requirements. This report should be read in conjunction with the full report of our inspection on 18 October 2016, which can be found on our website at www.cqc.org.uk .

The practice is now rated as good for the provision of safe services. Overall the practice rating remains as good.

Our key findings were as follows:

• The practice sent us a comprehensive fire risk assessment that met the regulatory requirements.
• The practice had a business continuity plan that set out how they would respond to major incidents such as flooding or IT failure to minimise service disruption.
• The practice had an appropriate system to ensure all emergency medicines and equipment was in date and suitable for use.
• The practice had reviewed their arrangements for routine appointments to give patients access in a timely way.  We were told the practice reviewed this regularly and we saw evidence to confirm this.
• The practice had reviewed how they identified and supported patients who may also have caring responsibilities. At our previous inspection in October we saw 15 patients had been identified as carers. On this inspection we saw the practice had identified 35 patients as carers. This equates to 0.7% of the practice list.  However, it is estimated that 10% of patients are carers. Therefore:

One area where the practice should make improvement is:

• To continue to work to identify and supported patients who may also have caring responsibilities.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 December 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.
• Data for patients with diabetes were comparable with national figures. For example, the percentage of patients with diabetes, on the register, who had a flu vaccine in the preceding 1 August to 31 March was 99%, compared to a national average of 94%.
• 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 6 December 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.
• A total of 86% of eligible women attended for a cervical smear in 2014-2015. This is higher than the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice been part of a group of practices to commission a family navigator. Family navigators offer health promotion advice, support and signposting to families where a child or young person’s life impacted by a health issue.

Updated 6 December 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 patients in its population.
• Performance indicators for conditions commonly found in older patients were comparable to national averages. For example, 87% of patients diagnosed with high blood pressure had an acceptable blood pressure reading in the preceding 12 months compared to a national average of 83%.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• Older patients were actively identified and supported by a dedicated team conducting extended assessments to ensure this patient groups’ needs were met.

Updated 6 December 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.
• A text messaging service for reminders to attend appointments and routine reviews was offered to patients.

Updated 6 December 2016

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

• A total of 89% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 months was 100% compared to a national average of 90%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice carried out advance care planning for patients living 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 6 December 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 had 20 patients with a learning disability. The practice had developed appropriate information about health checks for this patient group. At the time of our inspection, 42% of patients had received a health check.
• 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.