The Prince of Wales Surgery

Updated 19 September 2016

Prince of Wales Surgery was inspected on Tuesday 21 June 2016. This was a comprehensive inspection.

The practice is situated in Poundbury, which is part of the Duchy of Cornwall estate in Dorchester, Dorset. The area scores eight on the deprivation decile, with one being the most deprived and ten being the least deprived, showing that Dorchester is an affluent area compared to the national average. Census information shows that 97% of the population identify their ethnicity as being white British.

The practice provides a primary medical service to 5,865 patients of a diverse age group. The practice is a training practice for doctors who are training to become GPs and for medical students. There was one GP registrar at the practice.

There was a team of four GPs partners, one female and three male. The practice also employed a locum GP (female). Some GPs worked part time and some full time. The whole time equivalent was 3.12. Partners hold managerial and financial responsibility for running the business. The team were supported by a practice manager, a nurse prescriber, two practice nurses, three health care assistants, and additional administration staff.

Patients using the practice also had access to district nurses and health visitors who are based at the practice. Podiatrists and physiotherapists were also based at the practice. A muscular skeletal service is also based at the practice, together with epidurals and physiotherapy. There was also a warfarin clinic for patients with atrial fibrillation. An MS nurse visits once a month (multiple sclerosis) as well as a nurse who specialises in diabetes. Other health care professionals visit the practice on a regular basis.

The practice is open between the NHS contracted opening hours 8am and 6.30pm Monday to Friday. Appointments can be offered anytime within these hours. Extended hours surgeries are offered at the following times; every Tuesday 7.30am till 7.30pm. These had been decided upon following a patient consultation.

Outside of these times patients are directed to contact the Dorset out of hour’s service by using the NHS 111 number.

The practice offered a range of appointment types including book on the day, telephone consultations and advance appointments.

The practice had a Personal Medical Services (PMS) contract with NHS England.

The practice provided regulated activities from the Prince of Wales Surgery, 2 Frederick Treves House, St John Way, Dorchester, Dorset DT1 2FD. We visited this location during our inspection.

Updated 19 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Prince of Wales Surgery on 21 June 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.
• 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 improvements are:

Ensure that patients with the long term condition of diabetes are provided with a written copy of their own care plan. When this was brought to the attention of the practice manager, a new protocol was introduced.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 September 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.

• The percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) is 5 mmol/l or less was 85% which was better than the national average of 80%.

• 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 had introduced a proactive call and recall system for nurse appointments dedicated to those patients with a diagnosis of hypertension, heart disease, respiratory disease, learning disabilities, or cervical smears. This system also covered the administration of vaccines, therapeutic injections, and drug monitoring blood tests.

• The practice provided shared care with a diabetic specialist nurse working with the practice nurse at a monthly clinic.

• The practice had diabetes trained practice nurses and a diabetes trained GP.

• The practice offered in-house spirometry.

• The practice had a cancer patient list colour coded by prognosis which was updated monthly. Cancer survival patient reviews were held with the practice nurses.

• The practice provided an ostomy review service. An ostomy is a surgical procedure that creates an opening on the abdominal wall for waste products to move out of the body. This helped patients avoid unnecessary hospital appointments for their ostomy reviews.

Updated 19 September 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.

• The practice cervical screening programme had achieved 82% which was higher than the clinical commissioning group (CCG) average of 77% and in line with the national average of 82%.

• 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 offered in-house access to health visitors, who were based at the same location as the practice.

• The practice had a child safeguarding lead GP and a lead child safeguarding administrator.

• The practice maintained an up to date list of vulnerable and looked after children. The practice also maintained a list of patients who had previously been on the at risk children list but had attained their 17th birthday, to ensure continuity of care.

• The practice provided priority appointments for vulnerable children and children with serious long term conditions and telephone consultations for teenagers who wished to speak discreetly with a GP or nurse.

• The practice offered contraceptive services including emergency contraception and long term contraceptive implants.

Updated 19 September 2016

The practice is rated as outstanding 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.

• The practice offered 15 minute appointments instead of 10 minute appointments. These extended appointments were offered from 8.30am until 12.30pm daily and all day on a Tuesday from 7.30am to 7.30pm. The practice recognised that older patient and those with multiple complex conditions required more time and this made visiting the practice less stressful for them.

• Each GP had protected time for one session a month to review patients aged over 75 years, with their time back filled with a locum. The vulnerable patients lead GP (which included patients aged over 75 years) held a management session monthly. The practice had an established process in place which resulted in regular updates of patient lists, protocols, searches, medication safety actions, and liaison with other health professionals.

• The practice had an allocated GP for local nursing and residential care homes to ensure continuity of care. The practice worked with these homes to promote adherence to the Dorset prescribing formulary, to develop a weight management form and a urine sample form which the practice has shared with other practices in the local clinical commissioning group.

• The practice had an emergency access phone hotline that residential care homes or NHS organisations could use to contact the practice, bypassing the switchboard for emergencies only.

• Patients at the practice had in house access to the district nursing team, who were based in the same location as the practice.

Updated 19 September 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.

• The practice offered early morning and late evening surgeries and lunchtime telephone appointments.

• The nurse practitioner provided surgeries for minor illnesses.

• The practice provided a range of online services including booking and cancelling of appointments, prescription ordering, access to medical records, change of address or personal details.

• Electronic transfer of prescriptions for flexible collection and repeat dispensing was available.

• NHS Health checks for patients aged over 40 were provided.

• The practice provided signposting to local support services relevant to working age patients such as Live Well Dorset for flexible access to smoking cessation, exercise and weight management.

Updated 19 September 2016

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

• 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 100% which was better than the 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 19 September 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 homeless people, travellers and those with a learning disability.

• The practice had provided the time and resources for their nurse practitioner to develop a system which identified and supported homeless patients. The system devised helped homeless patients to secure timely appointments at the practice, including an urgent appointment system if appropriate

• 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.

• The vulnerable patients lead GP (which included patients aged over 75 years) held a management session monthly to update patient lists, protocols, perform searches, perform medication safety actions, and liaise with other health professionals.

• A nurse practitioner at the practice had achieved a Royal College of General Practitioners (RCGP) award for nurse of the year 2015. The practice had provided the time and resources for their nurse practitioner to develop a system which identified and supported homeless patients. The system devised helped homeless patients to secure timely appointments at the practice, including an urgent appointment system if appropriate.