Archived: Drs Lesser, Giblin & Piccaver

Updated 30 December 2016

The practice is situated in the village of Glemsford with a branch site in the village of Hartest. The practice area extends into the outlying villages. The practice offers health care services to approximately 4900 patients and consultation space for GPs and nurses as well as extended attached professionals including phlebotomists, a mental health worker, and a physiotherapist.

The practice holds a General Medical Service (GMS) contract and dispenses medicines to those patients who live in the surrounding villages. We visited the dispensary as part of our inspection. We did not visit the branch site at Hartest.

• There are three (two male and one female) GP partners who holds managerial responsibilities for the practice and three female practice nurses. A pharmacist is employed to lead the management of the medicines services in the practice and is supported by a team of seven dispensary staff.
• A team of nine administration and reception staff support the practice manager, assistant practice manager and business manager.
• The practice is open between 8am and 6.30pm Monday to Friday.
• If the practice is closed, patients are asked to call the NHS111 service or to dial 999 in the event of a life threatening emergency. The practice is part of the GP Plus service and is able to book appointments for patients who wish to be seen in nearby Bury St Edmunds.
• The practice has a lower number of patients aged 0 to 50 years and a higher number of patients aged over 60 years than the practice average across England. The deprivation score is above the England average.
• Male and female life expectancy in this area is 81 years for males and 86 years for females compared with the England average at 82 years for men and 87 years for women.

Updated 30 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Lesser, Giblin & Piccaver known as Glemsford Surgery on 1 November 2016. Overall the practice is rated as good.

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

• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with practice staff and was regularly reviewed.

• The practice had strong and visible clinical, managerial leadership and governance arrangements.

• Practice staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• The practice system to ensure patients taking high risk medicines were monitored was appropriate and effective.

• Patients said they found it easy to get an appointment at a time convenient for them and usually with their GP of choice.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice demonstrated that they used a team approach that assessed patients’ needs and delivered care in line with current evidence based guidance. Practice staff had been trained to provide them with the skills, knowledge, and experience to deliver effective care and treatment.

• The practice strived to maintain and provide additional services to benefit the patients. For example, the practice had campaigned to retain the phlebotomy, mental health worker, and physiotherapy services within the practice ensuring that patients could be seen timely in the practice and did not have to travel.

• The patients had launched a campaign to protect the dispensary within the practice from being compromised by a pharmacy opening up in the village. With the patients’ support the practice opened their own pharmacy, ensuring that all their patients were able to obtain their medicines within the practice. The team undertook deliveries to over 50 households each week.

• The practice did not have an active face to face patient participation group but had used social media and the local Women’s Institute Group to ensure they engaged with and gained feedback from patients.

Areas of outstanding;

• The practice were instrumental in contacting and working with the Roald Dahl’s’ Marvellous Children’s Charity to ensure that a patient was able to have an essential piece of equipment to manage their condition at home. Following a negative response from many health agencies, the GP contacted the charity and secured funding, and the purchase of the equipment. The practice, staff, local school, and village residents have continued to support the charity. For example for Roald Dahl’s 100th birthday celebrations the children aged around 5 years had a trail to follow, the practice allowed space in the waiting room for a sculpture to be positioned. The GPs and practice staff support other various fund raising events.

• The practice worked with charities, third sector, and voluntary agencies to maximise benefits for their patients. They had arranged for food parcels from the food bank to be delivered to those patients in need of them.

The areas where the provider should make improvements are:

Continue to find ways to engage a patient participation group.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 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. Due to long term absence of key staff some appointments had been delayed, the practice undertook a risk assessment and decided to employ an additional qualified nurse to solve the capacity issue.
• Longer appointments and home visits were available, including for long term condition reviews when needed for all patients unable to attend the practice or with a learning disability.
• 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 undertook six monthly medicine reviews to ensure that their medicines and health needs were well managed.
• For patients that required specialist medicines direct from the suppliers, the practice accepted the delivery and ensured appropriate storage and refrigeration until the patient could collect them.
• The dispensary offered a managed repeat prescription service. This enabled patients to collect their regular medicines each month without having to re-order first.

Updated 30 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 above the national average for the 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.

• 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 practice was signed up to the C-Card scheme. The scheme offered free contraceptives to young people.

• The practice offered full contraceptive services including long-acting reversible contraceptives (LARC).

• The practice found that the use of social media was a positive way to engage with the younger population of the practice.

Updated 30 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 people in its population.

• The practice recognised that some of the older patients were carers not only for their spouse/partner but for their parents and were aware that these families were highly vulnerable if any one member became unwell.

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

• Appointments were available at the branch site for those that preferred to be seen there.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including hypertension, dementia, and heart failure were above or in line with the local and national averages.

Updated 30 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. The practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• The practice offered telephone consultations for those patients that wished to seek advice in this way. The GP stayed beyond practice closing time to see patients if there was a clinical need following a telephone call.

• 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 offered early appointments with nurses and GPs. Flu clinics were held on Saturdays enabling patients who were at risk to obtain their immunisation without having to take time off work.

Updated 30 December 2016

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

• The practice had 63 patients diagnosed with dementia on the register. Only 15 of these patients had received a coded annual review. The practice explained to us that they do not always undertake formal reviews annually but assessed and reviewed patients throughout the year. The practice undertook six monthly medicines reviews and addressed the patient and their carer’s needs at this time.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those 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 A&E where they may have been experiencing poor mental health.

• Practice staff had a good understanding of how to support patients with mental health needs and dementia.

• A mental health worker attended the practice regularly; face to face reviews were used in the early days of a patient experiencing poor mental health. We saw that medicines were reviewed frequently for efficacy and safety.

Updated 30 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 transiently homeless 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. The practice worked closely with the Dementia Intensive Support Team.

• Practice 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.

• The practice was proactive in their management of patients who were at the end of their lives. The GPs ensured patients had continuity of care at all times during this difficult time by arranging another named GP to cover in the event of their leave. The GPs rarely used locums and therefore the patients were known to all the GPs in the practice. Patients we spoke with who had suffered a recent bereavement told us they valued this greatly and commented that they never felt isolated or alone.