Archived: Monteagle Surgery

Updated 1 June 2017

Monteagle Surgery is situated in the town of Yately in Hampshire. The river at the northernmost part of the town forms the border between the counties of Hampshire and Berkshire. Monteagle Surgery is located in an affluent area of the country and is the top decile on the deprivation scale (lower deciles indicate high deprivation). There is a small car park attached to the practice with disabled spaces. Access to the practice is via a wooden non-automatic door. There is a buzzer to call for assistance if required. The reception is located between the main door and another door through to the waiting area. All treatment rooms and clinical rooms are located on the ground floor.

The practice has 5889 patients on its register. The patient population is predominantly White British. There is a slightly higher than national average population of patients registered at the practice between 40 and 60 years of age. There is a lower than average patient population of older adults over the age of 75. The life expectancy of males and females is just under 3 years less than the national average with a life expectancy of 79 years for males and 83 years for females.

The practice is owned solely by one GP and there are three additional salaried GPs. The practice has two male and two female GPs. At the time of the inspection one of the GPs was on maternity leave and cover was being provided by another GP not directly salaried by the practice. This equates to three full time GPs. The practice has three practice nurses and a health care assistant. The clinical team are supported by a managerial team consisting of an acting practice manager, administrator and reception staff. At the time of the inspection the previous practice manager was providing HR and finance support to the practice 1 day a week as well as to oversee the new practice manager through a transition period. The practice also has an in house practice pharmacist and shares a paramedic practitioner with another practice.

The practice is a training practice for foundation doctors and registrars wishing to train as GPs.

The practice is open between 8am and 6.30pm Monday to Friday. The practice telephone lines are open between 8am and 1pm and again at 2pm to 6.30pm. During 1-2pm there is a voice message directing patients to contact numbers for emergency treatment. Appointments are available between 8:30am for nursing appointments (9am for GP appointments) and 11:20am and then from 3:30-5:30pm daily. Extended hours appointments with the nurse are available on a pre-bookable basis from 6:30 to 8pm on Thursday evenings. There are no extended hours appointments with the GPs. The practices website publishes what dates and times each GP is available for appointments.

The practice does not offer out of hours treatment for their patients instead referring patients to the NHS 111 service.

Monteagle Surgery have been operating under this current registration since February 2015. This is the practices first full comprehensive inspection under this registration.

Monteagle Surgery provides services at this location

Tesimond Drive

Yateley

Hampshire

GU466FE

Updated 1 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Monteagle Surgery on 2 May 2017. 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 a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had above average patient satisfaction scores from the GP patient survey. This was echoed by positive views from patients spoken to on the day and from comment cards received.
• Patients we spoke with 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvement are:

• Consider how to capture, document and learn from all low-level complaints.

• Ensure flooring in the treatment room complies with infection control protocols.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 June 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• The percentage of patients with diabetes in whom the last blood pressure reading was within an acceptable range was 80% compared to the clinical commissioning group (CCG) average of 76% and a national average of 78%.

• The practice had a clinic for Chronic Obstructive Pulmonary Disorder patients which was attended by a multidisciplinary team including pulmonary nurses, physiotherapists and GPs. The clinic was successful and the CCG had decided to roll the program out to other practices in the locality.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• All these patients had a named GP and there was a system to recall patients for 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 1 June 2017

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

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.

• Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

• Appointments were available outside of school hours. The practice did not have any furniture, books or toys in the waiting area suitable for babies or young children.

• The practice worked with midwives, health visitors and school nurses to support this population group.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

• The practice provided contraceptive services including the implant and intra-uterine devices for women registered at the practice.

• The practice had links with the local early intervention psychosis team and eating disorder services for young patients who have mental health conditions.

Updated 1 June 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

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

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

• The practice offered 20 minute long appointments as standard for all patients over 75 in order to discuss the complexities associated with their care. Alerts were placed on patients notes to notify reception staff when booking appointments.

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Where older patients had complex needs, the practice shared summary care records with local care services.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

• Older patients were offered same day or telephone appointments.

Updated 1 June 2017

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

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours on Thursday evening.

• Urgent and pre-bookable telephone appointments were available.

• 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 encouraged patients to undertake bowel screening and the practice followed up any patients who had not returned their bowel cancer screening kits.

• Text message reminder services were offered at the practice in an attempt to reduce non-attendance to appointments.

• The practice offered an in-house quit smoking clinic.

Updated 1 June 2017

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

• The practice carried out advance care planning for patients living with dementia.

• 79% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia. Young people at the practice were referred to local mental health services such as early intervention psychosis teams or eating disorder teams. The practice had recently been accredited as a dementia friendly practice.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• The percentage of patients with schizophrenia, schizoaffective disorder or other psychoses whose alcohol consumption was recorded in the preceding 12 months was 100%. This is better than the clinical commissioning group average of 87% and national average of 90%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

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

Updated 1 June 2017

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

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours on Thursday evening.

• Urgent and pre-bookable telephone appointments were available.

• 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 encouraged patients to undertake bowel screening and the practice followed up any patients who had not returned their bowel cancer screening kits.

• Text message reminder services were offered at the practice in an attempt to reduce non-attendance to appointments.

• The practice offered an in-house quit smoking clinic.