Bere Regis Surgery

Updated 14 October 2016

The Bere Regis Surgery was inspected on Thursday 18 August 2016. This was a comprehensive inspection.

The practice is situated in the village of Bere Regis in Dorset. The practice provides a general medical service in a rural area to 3.500 patients living within an eight mile radius of the practice.

The practices population is in the eight decile for deprivation, which is on a scale of one to ten. The lower the decile the more deprived an area is compared to the national average. The practice population ethnic profile is predominantly White British with 31% of the practice list aged over 60 years. The average male life expectancy for the practice area is 82 years which is higher than the national average of 79 years; female life expectancy is 86 years which is higher than the national average of 83 years.

There is two GP partners one female and one male with one female salaried GP providing 18 GP sessions each week. The GP partners held managerial and financial responsibility for running the business. The team are supported by a practice manager two practice nurses, a healthcare assistant, a healthcare assistant/phlebotomist (Phlebotomists are people trained to take blood samples) and additional administration and reception staff.

The practice has dispensing facilities for patients who lived more than a mile away from a dispensing chemist. The dispensary is open during surgery times. A delivery driver is available to ensure medicines reach isolate patients promptly.

The practice reception is open between 8am and 6.30pm Monday to Friday. Booked appointments are offered between 8.30am to 1pm and 2pm to 6pm. The practice offers a range of appointment types including book on the day, telephone consultations and advance appointments. Extended hours are offered on a Monday and Thursday evenings and Monday and Wednesday mornings.

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

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

The Bere Regis Surgery provides regulated activities from the main site at Manor Farm Road, Wareham, Dorset BH20 7HB

Updated 14 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bere Regis Surgery on 18 August 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.

We saw one area of outstanding practice:

The practice healthcare assistant (HCA) had identified 383 patients over the age of 75 years that were vulnerable and to date had carried out 170 assessments on the most vulnerable and isolated. These assessments were an evolving process and included identifying need in housing, physical health, mental health and social need and associated risks such as risk of falls or poor nutrition using a nationally recognised tool. The HCA liaised with dentists, opticians, housing departments and the practice GPs where areas of concern were identified.  The practice also worked closely with local organisations to provide social events and lunch clubs. This initiative had reduced the hospital admissions for this age group by 33%.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 October 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.

• Nationally reported data from the Quality and Outcomes Framework showed that outcomes for patients were good for patients with long term conditions. For example, patients diagnosed with hypertension whose last blood pressure reading measured in the preceding 12 months was 150/90mmHg or less was 87% which was better than the national average of 84%.

• 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.

Updated 14 October 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 percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years was 80%, which was comparable to 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.

Updated 14 October 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 healthcare assistant (HCA) had also identified 383 patients over the age of 75 years that were vulnerable and had carried out 170 assessments on the most vulnerable and isolated. These assessments were an evolving process and included identifying need in housing, physical health, mental health and social need and associated risks such as risk of falls or poor nutrition using a nationally recognised tool. The HCA liaised with dentists, opticians, housing departments and the practice GPs where areas of concern were identified.The practice also worked closely with local organisations to provide social events and lunch clubs. This initiative had reduced the hospital admissions for this age group by 33%.

Updated 14 October 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.

Updated 14 October 2016

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

• 90% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was higher than the national average of 84%

• The percentage of patients with schizophrenia, bipolar affective disorder and other

  psychoses who had a comprehensive, agreed care plan documented in the record, in

  the preceding 12 months (01/04/2014 to 31/03/2015) was 100% which was above 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 14 October 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 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.