Chipping Surgery

Updated 10 November 2016

Chipping Surgery is a small rural dispensing practice which provides primary care services to residents in the town of Wotton Under Edge and surrounding villages. All patient services are located on the ground floor of the building. The practice also has three consulting rooms on the lower ground floor and there is level access to these.

The practice provides its services to approximately 8,500 patients under a General Medical Services (GMS) contract. (A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract). The practice delivers its services from the following location:

Symn Lane,

Wotton Under Edge,

Gloucestershire,

GL12 7BD.

The practice has four GP partners and two salaried GPs making a total of approximately five whole time equivalent GPs. There are two male and four female GPs. The clinical team includes three practice nurses and two health care assistants, all of which are female. The practice management and administration team consist of a practice manager, an accounts clerk, a senior medical secretary, one medical secretary, a senior medical receptionist, a reception manager, a medical record summariser and five receptionists.

The practice is approved for teaching medical students and training qualified doctors who wish to become GPs.

The practice had a dispensary offering pharmaceutical services to those patients on its practice list who live more than one mile (1.6km) from their nearest pharmacy premises. The practice dispenses medicines for approximately 5,500 patients and was signed up to the Dispensing Services Quality Scheme, which rewards practices for providing high quality services to patients from their dispensary. The practice also employed a dispensary manager and three dispensers.

The practice population demographic shows there is a lower than average patient population aged between 20 to 39 years and higher than average patient population aged between 45 to 69 years and above compared with local and national averages. The general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in the least deprivation decile. (An area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score. It is important to remember that not everyone living in a deprived area is deprived and that not all deprived people live in deprived areas). Average male and female life expectancy for the practice is 79 and 83 years, which is in line with the national average of 79 and 83 years respectively.

The practice is open from 8.30am to 6.30pm on Mondays, Tuesdays, Thursdays and Fridays. The practice closes at 5pm on Wednesdays. Extended hours are available from 6.30pm to 7pm on Mondays and 7.30am to 8.30am from Tuesdays to Fridays. When the practice is closed between 8am and 8.30am on Mondays and 5pm to 6.30pm on Wednesdays, calls are diverted to a call handling service (Message Link), which diverts any urgent calls to a designated member of staff at the practice.

The practice has opted out of providing out of hours services to its patients. Patients can access the out of hour’s services provided by South Western Ambulance Service NHS Foundation Trust via the NHS 111 service.

Updated 10 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Chipping Surgery on 29 September 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 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.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• 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 good facilities and was well equipped to treat patients and meet their needs.

• The practice was participating in a research programme for the early identification of patients at risk of stroke. There was a monitor in the waiting area where patient could place their hands on the machine and this would inform them if they were at risk or not. If patients were at risk, they would be referred for further treatment.

• There was a clear leadership structure and staff felt supported by 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.

The areas where the provider should make improvement are:

• Review the location and provision of emergency medicines.

• Ensure that a legionella risks assessment (a report by a competent person giving details as to how to reduce the risk of the legionella bacterium spreading through water and other systems in the work place) is carried out.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 November 2016

The practice is rated as good for the care of patients 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 percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (04/2014 to 03/2015) was 93% which was above the clinical commissioning group of 90% and national average of 88%.

• 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 supported some patients who had home monitoring through Telehealth (a system where information about the patient’s condition is monitored remotely and the information sent to a clinician at the practice without the need for the patient to attend the practice).

Updated 10 November 2016

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

• 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 patients 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 patients 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 86% which was comparable to the clinical commissioning group average of 84% and national average of 82%.

• The practice held weekly “walk in” sexual health clinics.

• 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 10 November 2016

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

• The practice offered proactive, personalised care to meet the needs of the older patients in its population and had a range of enhanced services, for example, in avoidance of admission to hospital and end of life care.

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

• Patients on the hospital admission avoidance register were put though to their named GP immediately if they called for an urgent appointment.

• The practice arranged for home delivery of medicines. There were local medicines collection points in outlying villages for patients who found it difficult to attend the surgery to collect their medicines.

Updated 10 November 2016

The practice is rated as good for the care of working-age patients (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 extended opening hours on Mondays from 6.30pm to 7.30pm and from 7.30am to 8am from Tuesdays to Fridays.

• The practice participated in a Gloucestershire scheme called ‘Choice Plus’, which provided additional GP appointments for patients with acute on the day problems at various locations in the county.

Updated 10 November 2016

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

• 91% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months (04/2014 to 03/2015), which was above the clinical commissioning group (CCG) average of 86% and the national average of 84%.

• The percentage of patients with severe mental health problems who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months (04/2014 to 03/2015) was 100% compared to the CCG average of 93% and 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.

Updated 10 November 2016

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

• The practice held a register of patients living in vulnerable circumstances including homeless people 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 through social prescribing.

• 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.