Wolston Surgery

Updated 27 April 2017

Wolston Surgery is a located in Wolston village in the borough of Rugby. The rural practice catchment area also spans the villages of Brinklow, Bretford, Church Lawford, Stretton-on-Dunsmore, Princethorpe, Rython-on-Dunsmore, Brandon and Binley Woods. It operates under a General Medical Services (GMS) contract with NHS England. This is the contract between general practices and NHS England which agrees the delivery of primary care services to local communities. The Wolston Surgery premises have accessible facilities including a hearing loop, wheelchair access and disabled parking. The practice has a patient list size of 4,375 including 22 patients who live in a local care home. The practice has a dispensary on site which provides convenient services to patients living over a mile from their nearest chemist. Wolston Surgery is a training practice which has qualified junior doctors working under the supervision of the GPs.

Wolston Surgery’s patient list has significantly lower than average levels of social deprivation, and a slightly higher than average population aged between 65 and 80. There are lower than average numbers of patients aged under 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 instance Wolston Surgery offers minor surgery, work to analyse and reduce unplanned admissions, a number of immunisation programs and facilitating timely diagnosis and support for people with dementia.

Wolston Surgery has a clinical team of one male and two female GP partners, one regular female GP locum, one female trainee GP, one female practice nurse and one female healthcare assistant. The team is supported by a practice manager and four reception and dispensary staff.

The practice opens at 8.30am and closes for lunch at 12.30pm from Monday to Friday. The practice re-opens from 3pm until 4pm on Mondays, and from 4.45pm until 6pm on Tuesday and Thursdays. Appointments are available at a variety of times, and while the practice is closed outside of these times the telephone lines remain open between 8am and 6.30pm and a duty GP is available for urgent patient requests during this time. Before 8am and after 6.30pm there are arrangements in place to direct patients to out-of-hours services provided by NHS 111.

Updated 27 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wolston Surgery on 28 November 2016. Overall the practice is rated as good.

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

• There was a clear process for reporting and recording significant events. This was in line with requirements and staff were involved with the investigation of and learning from these events.
• The premises and equipment used were safe and standards of cleanliness and hygiene were maintained.
• Stringent procedures ensured that medicines were handled and dispensed safely.
• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were in line with or higher than Clinical Commissioning Group (CCG) and national averages.
• Staff had online access to up to date guidelines from NICE and attended local training days which reinforced this. We checked a sample of recent NICE updates and saw that action had been taken, for example by conducting clinical audits.
• There was evidence that the practice had improved the quality of care and treatment it provided through clinical audit, although the number of audits completed was low.
• Staff learning and development was managed through a system of induction and appraisal. Staff had completed role specific training and competency assessments.
• There was a commitment to collaborating with healthcare professionals from external services to understand and meet patients’ needs.
• Data from the National GP Patient Survey (July 2016) showed the practice results for patient satisfaction were significantly higher than local and national averages.
• Staff members were kind and helpful to patients and treated them with dignity and respect.
• There was an effective system for handling patient complaints and concerns. Information was available to help patients understand the complaints system. Appropriate action was taken to resolve matters and learning was discussed at two monthly practice meetings.
• The practice offered a twice weekly transport service for patients who lived in Ryton-on-Dunsmore where there was limited access to public transport.
• Staff told us they felt confident raising issues and making suggestions, and that the practice manager and GP partners were approachable and friendly. Staff said they felt appreciated in their roles. There were frequent minuted staff meetings where information was exchanged.
• There was a candid and accountable culture that supported dealing with problems openly.
• The practice was aware of the requirements of the duty of candour.
• The practice encouraged feedback from patients, the public and staff and used this to improve services.

The area where the provider should make improvements is:

• Review the use of clinical auditing to monitor the quality of patient care.
• Continue to monitor the revised system for receiving and disseminating MHRA alerts.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 April 2017

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

• The practice maintained registers of patients with long-term conditions. These were used to identify patients for review and to recommend appropriate support services.
• Clinical staff had lead roles in chronic disease management.
• The practice’s clinical performance for the management of long term conditions was in line with or higher than local and national averages. For example, 94% of patients with atrial fibrillation (an irregular heart rhythm) who had a high risk score were treated with anti-coagulation therapy (blood thinning medicines), higher than the CCG average of 83% and the national average of 87%. 85% of the practices patients with diabetes had a blood glucose level within the target range in the preceding 12 months compared with the CCG average of 79% and the national average of 78%.
• The clinical team worked with healthcare professionals to provide a multidisciplinary package of care to patients whose care spanned several services.

Updated 27 April 2017

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

• Children and patients whose medical problems needed immediate attention could access appointments on the same day. The premises were suitable for children and babies.
• Childhood immunisation rates for the vaccinations given were higher than the national targets. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 94% to 100%, which was higher than the target of 90%. The practice’s overall score was 9.9 out of 10, compared to the national average score of 9.1.
• The practice’s uptake for the cervical screening programme was 89%, which was higher than the CCG average of 81% and the national average which was 82%.
• The practice worked with other local health professionals to coordinate care. One of the GPs was the practice’s lead for safeguarding and held weekly meetings with the local health visitor, who was also invited to attend monthly clinical meetings at the practice.
• We discussed Gillick competence and Fraser guidelines with clinical staff and were satisfied with their understanding and usage of these 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 relate specifically to contraception and sexual health advice and treatment.

Updated 27 April 2017

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

• Home visits were available for older patients who had difficulty attending the practice.
• The practice dispensary provided a convenient service to patients living over a mile from their nearest chemist. There was a twice weekly medicine delivery service provided by the practice and a daily delivery service provided by a local pharmacy which collected prescriptions from the dispensary. 
• The practice had older patients who were resident in one local care home. We spoke with the manager who told us that patients received consistent care from a named GP and regular visits. They said the practice was good at responding to requests and engaging with care home staff to understand patients’ needs.
• The practice maintained a register of those older people at risk of hospital admission and carried out care planning and reviews to help reduce this risk.

Updated 27 April 2017

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

• Telephone consultations were available for patients who did not feel they required a face-to-face consultation and clinical staff were able to liaise with patients by email if this was their preference.
• The practice offered people who worked during the practice opening hours appointments first thing in the morning or at the end of the day.
• Text messaging appointment reminders and online appointment booking and repeat prescription requests were available to patients.
• Patients were able to access to health assessments and checks including NHS health checks for patients aged 40–74 and new patient health checks. 

Updated 27 April 2017

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 was also similar to or higher than the CCG and national averages. For instance, 93% of patients with dementia had attended a face to face care plan review in the preceding 12 months, compared to the CCG average of 81% and the national average of 84%.
• 100% of patients with mental health issues had their alcohol consumption recorded within the previous 12 months, again higher than the CCG and national averages which were both 89%.
• Patients were able to access counselling sessions on the practice premises through Improving Access to Psychological Therapies (IAPT).
• The practice maintained a mental health register which it used to monitor patients and offer relevant information and services. Patients with dementia had care plans.
• The practice liaised with multi-disciplinary teams in the management of patients experiencing poor mental health.
• Information about how to access various support groups and voluntary organisations was available to patients experiencing poor mental health.

Updated 27 April 2017

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

• There was a nearby community of travellers for whom the practice provided care, and these patients’ records were coded to alert staff to their circumstances. The practice made special arrangements to cater to these patients such as allowing flexibility with appointments and taking extra time to explain conditions and treatments to those who struggled with reading. Clinical staff worked with the local health visitor where appropriate to tailor care. There were no homeless patients registered at the time of the inspection, but the practice told us they would register and treat people from this group in the same way.
• Clinical staff had completed Identification and Referral to Improve Safety (IRIS) training in domestic violence and the practice had made specific arrangements to support patients. All staff had up to date training in safeguarding children and vulnerable adults to the required level.
• Longer appointments were offered for patients who required them, including patients with a learning disability.
• The practice worked with multidisciplinary health care professionals in the case management of vulnerable patients.
• The practice maintained a carers’ register and the computer system alerted clinical staff if a patient was a carer. There were carers’ information folders in the patient waiting area which provided information about local support services for carers and clinical staff directed carers to this information during consultations. Registration forms and information for carers were also displayed on the walls. The practice offered carers an annual health check and flu vaccination to support their wellbeing.