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Inspection Summary


Overall summary & rating

Good

Updated 9 April 2015

Letter from the Chief Inspector of General Practice

The Culverhay Surgery in Wotton-Under-Edge was inspected on the 9 December 2014. This was a comprehensive inspection.

The Culverhay Surgery in Wotton-Under-Edge Gloucestershire, GL12 7LS provides primary medical services to people living in the town of Wotton-Under-Edge and the surrounding villages. The practice also has two branch surgeries. One in Wickwar, held in the Community Centre, Avon Crescent on Monday afternoons from 12 noon, and a second in Hawkesbury Upton at the Bethesda Chapel, Park Street on Wednesdays from 12:30pm. We did not visit these branches as part of our inspection.

At the time of our inspection there were approximately 6,300 patients registered at the Culverhay Surgery. This is a dispensing practice and provides a dispensing service to approximately 40% of the practice population. A dispensing practice is where GPs are able to prescribe and dispense medicines directly to patients who live in a rural setting which is a set distance from a pharmacy.

Patients using the practice also have access to community staff including district nurses, health visitors, and midwives.

The practice has opted out of providing out of hours services to their own patients and refers them at evenings and weekends, when the practice is closed, an Out of Hours service delivered by another provider.

We rated this practice as Good.

Our key findings were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from incidents were taken advantage of.

  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group.

  • Patients had a variety of ways to make appointments and found the practice to be flexible in meeting their needs. We were told patients could always get an appointment.

  • The practice had good facilities and was well equipped to treat patients and meet their needs. Patients told us the practice was clean and safe.

  • The practice had a clear vision which had quality and safety as its first priority and high standards were promoted and owned by all practice staff with evidence of team working across all roles.

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

Action the provider SHOULD take to improve:

  • All clinical staff should receive training in the Mental Capacity Act (2005). The MCA is a legal framework which supports patients who needs assistance to make important decisions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 9 April 2015

The practice is rated as good for providing safe services. Staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses. Lessons were learned and communicated widely to support improvement. Information about safety was recorded, monitored, appropriately reviewed and addressed. Risks to patients were assessed and well managed. Medicines were stored, managed and dispensed in line with national guidance. There were safeguards in place to identify children and adults in vulnerable circumstances. There was enough staff to keep people safe. Recruitment procedures and checks were completed as required to ensure that staff were suitable and competent. The practice was clean, tidy and hygienic. We found that suitable arrangements were in place that ensured the cleanliness of the practice was maintained to a high standard.

Effective

Good

Updated 9 April 2015

The practice is rated as good for providing effective services. Supporting data obtained both prior to and during the inspection showed the practice had systems in place to make sure the practice was effectively run. The practice had a clinical audit system in place and audits had been completed. Care and treatment was delivered in line with national best practice guidance. The practice worked closely with other services to achieve the best outcome for patients who used the practice. Staff employed at the practice had received appropriate support, training and appraisal. GP appraisals and revalidation of professional qualifications had been completed. The practice had extensive health promotion material available within the practice and on the practice website.

Caring

Good

Updated 9 April 2015

The practice is rated as good for providing caring services. Patients said they were treated with compassion, dignity and respect and they were involved in care and treatment decisions.

Accessible information was provided to help patients understand the care available to them. We also saw that staff treated patients with kindness and respect ensuring confidentiality was maintained.

Responsive

Good

Updated 9 April 2015

The practice is rated as good for providing responsive services. The practice reviewed and understood the needs of their local population. The practice identified and took action to make improvements. Patients reported that they could access the practice when they needed. Patients reported that their care was good. The practice was well equipped to treat patients and meet their needs.

There was an accessible complaints system with evidence demonstrating that the practice responded appropriately and in a timely way to issues raised. There was evidence that learning from complaints was shared with staff.

Well-led

Good

Updated 9 April 2015

The practice is rated as good for being well-led. The practice had a clear vision and strategy to deliver quality care and treatment and they were looking for ways to improve. Staff reported an open culture and said they could communicate with senior staff. The practice had a number of policies and procedures to govern activity and regular governance meetings took place. There were systems in place to monitor and improve quality and identify risks. There were systems to manage the safety and maintenance of the premises and to review the quality of patient care.

The practice had an active patient participation group (PPG) which was involved in the core decision making processes of the practice.

Checks on specific services

Older people

Good

Updated 9 April 2015

The practice is rated as good for providing care to older people. All patients over 75 years had a named GP. Health checks and promotion were offered to this group of patients. There were safeguards in place to identify adults in vulnerable circumstances. The practice worked well with external professionals in delivering care to older patients, including end of life care. Pneumococcal vaccination and shingles vaccinations were provided at the practice for older people on set days as well as during routine appointments. Staff recognised that some patients required additional help when being referred to other agencies and assisted them with this.

People with long term conditions

Good

Updated 9 April 2015

The practice is rated as good for providing care to people with long term conditions. The practice managed the care and treatment for patients with long term conditions in line with best practice and national guidance. Health promotion and health checks were offered in line with national guidelines for specific conditions such as diabetes and asthma. Longer appointments were available for patients if required, such as those with long term conditions. The practice had a carers' register and all carers were offered an appointment for a carers' check with nursing staff. Patients were screened for depression if appropriate. All patients suffering with asthma or chronic obstructive pulmonary disease had a care plan.

Families, children and young people

Good

Updated 9 April 2015

The practice is rated as good for families, children and young people. Staff worked well with the midwife to provide prenatal and postnatal care. Postnatal health checks were provided by a GP. The practice provided baby and child immunisation programmes to ensure babies and children could access a full range of vaccinations and health screening. Information relevant to young patients was displayed and health checks and advice on sexual health for men, women and young people included a full range of contraception services and sexual health screening including chlamydia testing and cervical screening. The practice has an arrangement with another local practice for young people to use its services. The GPs training in safeguarding children from abuse was at the required level.

Working age people (including those recently retired and students)

Good

Updated 9 April 2015

The practice is rated as good for providing care to working age people. The practice provided appointments on the same day. Emergency appointments were available. The practice operated extended opening hours one evening a week. Smoking cessation appointments were available. The practice website invited all patients aged between 40 years to 75 years to arrange to have a health check with a nurse if they wanted. A cervical screening service was available.

People whose circumstances may make them vulnerable

Good

Updated 9 April 2015

The practice is rated as good for people whose circumstances may make them vulnerable. The practice had a vulnerable patient register to identify these patients. Vulnerable patients were reviewed at team meetings. Referral to a counselling service was available. The practice did not provide primary care services for patients who are homeless as none are known, however, staff said they would not turn away a patient if they needed primary care and could not access it. Patients with interpretation requirements were known to the practice and staff knew how to access these services. Patients with learning disabilities were offered a health check every year during which their long term care plans were discussed with the patient and their carer if appropriate. Reception staff were able to identify vulnerable patients and offer longer appointment times where needed and send letters for appointments.

People experiencing poor mental health (including people with dementia)

Good

Updated 9 April 2015

The practice is rated as good for people experiencing poor mental health, including people with dementia. The practice is aware of their aging population group. Staff were aware of the safeguarding principles and GPs and nurses had access to safeguarding policies. The nurses had not received training in the Mental Capacity Act (MCA) 2005 but were aware of the principles and used them when gaining consent. There was signposting and information available to patients. The practice referred patients who needed mental health services and community psychiatric nurses visited the practice. Some support services were provided at the practice, such as Talking Therapies. Patients suffering poor mental health were offered annual health checks as recommended by national guidelines. Longer appointment times were available and volunteers offering transport was used for patients to access the practice.