Wareham Surgery

Updated 10 March 2016

Wareham Surgery was inspected on Wednesday 3 February 2016. This was a comprehensive inspection.

The practice is situated in the town of Wareham, Dorset. The practice provides a general medical service to approximately 8000 patients of a diverse age group. The practice is a teaching practice for medical students.

There is a team of six GPs partners, four male and two female and one salaried GP. Some GPs work part time and some full time. The whole time equivalent was five, they were supported by a practice manager, three practice nurses, two health care assistants, and additional administration staff.

Patients using the practice also have access to community nurses, mental health teams and health visitors. Other health care professionals visit the practice on a regular basis.

Outside of these times patients are directed to contact the South West Ambulance Service Trust out of hour’s service by using the NHS 111 number.

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

The practice has a General Medical Services (GMS) contract with NHS England.

The practice provides regulated activities from its primary location at Streche Road, Wareham, Dorset, BH20 4PG.

Updated 10 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wareham Surgery on 3 February 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 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.
• Patients said they found it easy to make an appointment with a named GP and that 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.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider should

Review procedures for checking medicines remain in date in GPs bags.

We also saw an area of outstanding practice :

The practice had developed a system which used medical alerts received into the practice effectively to keep patients safe. Once an alert was received a search was undertaken on the clinical system to identify any patients that may be affected by it. For example, an alert was received about the importance of storing blood testing strips appropriately as some issues had arisen with the quality of testing due to them being stored incorrectly. A letter was generated by the computer system which was then sent to each patient affected to advise them of what actions to take.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 March 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. Long term conditions were managed by the practice nursing team. The nurses had expertise in diabetes management and managed insulin conversions for the patients. The practice had a regular clinic run jointly with a diabetic community nurse specialist. Another practice nurse was undertaking an asthma Diploma and planned to be undertaking a nurse prescribing course later on in the year.

• 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 care professionals to deliver a multidisciplinary package of care.

Updated 10 March 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.

• 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.

• Safeguarding was discussed at significant events meetings within the other professionals form the community. The practice had a protocol that identified all patients who attended under the age of 18 and information was collected about who was accompanying the young person and whether they had capacity to consent as outlined in the Gillick competence framework, in addition to details of how to contact and inform the young patient if necessary after any tests.

Missed hospital appointments for children were followed up with a letter from the GP asking for a reason for the non-attendance. If no response was received further attempts at contact were made and these cases were discussed at the Significant Event Analysis (SEA) meeting. Safeguarding codes were added to patient’s notes by the safeguarding lead for vulnerable adults and children from police domestic incident reports as they were received.

Updated 10 March 2016

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

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

• Patients over the age of 75 were offered a health check that included a routine blood screen, an ECG (a portable electrocardiogram machine was used in the case of home visits) dementia assessment, blood pressure check, weight, malnutrition scoring and general health promotion advice. This was undertaken by a health care assistant (HCA). This appointment was then followed up by a consultation with the named GP who reviewed the results and addressed any issues raised as well as undertaking a full medicines review. Patients’ preferred place of care and end of life choices are also discussed and recorded.

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

• Monthly meetings were held where patients at risk of unplanned admission were discussed and plans made for good coordinated care. These plans were agreed with the patient. If there had been an admission of a patient on this list the aim was to visit them within three working days to review their care.

• There was one care home in the practice area. One GP managed all the patients within the home, staff at the home communicated directly with that GP, to provide proactive and personalized care. The GP also regularly visited to ensure that all chronic disease management was up to date and that these patients were not disadvantaged by not being able to attend the practice.

• The practice had good relationships with the Community Matron. The close contact was very beneficial in supporting the frail and vulnerable and avoiding admissions as well as improving the care of these individuals. Additionally strong links had been forged with the Community Rehabilitation Team who communicated directly with GPs via the computer system to enable prompt responses to any queries or concerns.

• The practice facilitated a weekly surgery for Social Services who provided support and advice to patients who could either self-present or be referred.

• A representative of Dorset Partnership for Older People (POPP) attended the practice once a month on different days to offer advice and support for older patients in the waiting room.

Updated 10 March 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.

• There was an online appointment and prescription service and the practice responded to requests to direct the electronic prescriptions to the nominated pharmacy of the patient’s choice.

• Extended hours appointments after 6:30pm were available up to one month in advance for all GPs. This need was identified by patient questionnaire.

• NHS Health Checks were offered to patients aged 40-74 which provided a routine check including BP, weight, BMI check, cholesterol check, lifestyle monitoring, exercise levels, smoking and alcohol intake.

• The practice had a HealthZone room in the practice where patients could, privately and without appointment, attend and check their blood pressure, weight and height and choose relevant health information. Results submitted by patients were recorded on their medical record and followed up by GPs or nurses at their next routine appointment.

Updated 10 March 2016

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

• The practice carried out advance care planning for patients with dementia. For example, 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 (01/04/2014 to 31/03/2015) was 100% compared to the national average of 88.47%.

• 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 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 March 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 patients, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams 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.

• There was a traveller’s site within the practice area. The practice were responsive to this group of patients by always providing an appointment on the day or a home visit, if required.

• The practice kept a register of patients at risk of domestic violence and this was reviewed at the regular significant event meeting. There was a protocol in place on the clinical system that alerted the GP or nurse to the issue of domestic violence when the patient attended for a consultation.