Jubilee Field Surgery

Updated 3 July 2017

Jubilee Field Surgery is situated in the village of Yatton Kennel located near Chippenham, a market town in Wiltshire. The practice has a slightly higher than average patient population in the above 40 years age group and lower than average in the 20 to 40 years age group. The practice is part of the Wiltshire Clinical Commissioning Group and has approximately 4,500 patients.

Jubilee Fields Surgery offers dispensing services to eligible patients (those who live further than one kilometre from the pharmacy). The area the practice serves is semi-rural and has relatively low numbers of patients from different cultural backgrounds. The practice area is in the low to mid-range for deprivation nationally and has a lower than average number of patients (1.5%) who are unemployed compared to the local average of 3%. The practice also has a lower than average (47%) number of patients living with a long term condition, compared to the local average (55%). A higher than average can mean there is an increased demand for GP services.

The practice is managed by one GP partner (male) and one female non-clinical partner. The practice is supported by three salaried GPs, (two female and one male), two practice nurses, one phlebotomist and an administrative team led by the practice manager. The dispensary is supported by one dispensary manager and two trained dispensers.

The practice is open between 8.30am until 1pm and 2pm until 6pm on Monday to Friday apart from a Thursday when the practice closes at 1pm. Appointments are from 8.30am until 11.30am every morning and 3pm until 5.30pm except for Thursday afternoons. From 8am until 8.30am, 1pm until 2pm and after 6pm telephone calls were transferred to the out of hours cover provided by Medvivo. Telephone appointments are also available to book. Extended hours appointments are offered from 6.30pm to 7.30pm on a Monday evening and 6.30pm until 8pm on a Wednesday evening. In addition to appointments can be booked up to four weeks in advance, urgent appointments are available for patients that need them.

When the practice is closed patients are advised, via the practice website and telephone answer machine that all calls will be directed to the out of hour’s service. Out of hours services are provided by Medvivo accessed via NHS 111.

The practice has a Primary Medical Services (PMS) contract to deliver health care services. A PMS contract is a locally agreed alternative to the standard General Medical Services contract used when services are agreed locally with a practice which may include additional services beyond the standard contract.

Jubilee Field Surgery is registered to provide services from the following location:

Yatton Kennel, Chippenham, Wiltshire SN14 7EJ.

Updated 3 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Jubilee Field Surgery on 15 December 2016. The overall rating for the practice was requires improvement. We found the practice to be inadequate for providing safe services, requires improvement for providing effective and well led services and good for providing caring and responsive services. The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Jubilee Field Surgery on our website at www.cqc.org.uk.

This announced comprehensive inspection was undertaken on 15 June 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection in December 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again. For example, the practice had responded quickly and effectively to issues raised at the previous inspection in December 2016.
• Staff assessed needs and delivered care in line with current evidence based guidance.
• Clinical audits demonstrated quality improvement.
• There was evidence of appraisals and personal development plans for all staff. For example, the practice had employed a nurse practitioner mentor to improve support and development for the nursing staff.
• Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
• Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.
• Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
• 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 areas where the provider should make improvements are:

• Ensure staff competencies are reviewed and current to their area of work.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 July 2017

The provider had resolved the concerns for safety, effective and well-led identified at our inspection on 15 December 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

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

• Nursing staff and GPs shared the care of patients with long term  diseases.
• The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (2015-2016) was 93% and similar compared to a local average of 92% and a national average of 91%.
• Multi morbidity appointments were offered to reduce multiple visits to the practice and a holistic approach to care.
• Patients at risk of hospital admission were identified as a priority.
• 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 3 July 2017

The provider had resolved the concerns for safety, effective and well-led identified at our inspection on 15 December 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

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

• 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 the standard childhood immunisations for one year olds.
• Patients told us, on the day of inspection, that children and young patients were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• The practice had emergency processes for acutely ill children and young patients and for acute pregnancy complications.

Updated 3 July 2017

The provider had resolved the concerns for safety, effective and well-led identified at our inspection on 15 December 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

The practice is now 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 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. For example the out of hours service.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.
• Joint home visits were arranged with the community based geriatrician, community nurses and palliative nurse care specialist when appropriate.

Updated 3 July 2017

The provider had resolved the concerns for safety, effective and well-led identified at our inspection on 15 December 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

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

• The needs of this population group 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 3 July 2017

The provider had resolved the concerns for safety, effective and well-led identified at our inspection on 15 December 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

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

• The practice carried out advance care planning for patients living with dementia.
• 80% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example, the practice had hosted meeting with the Alzheimer’s Society to raise awareness amongst staff of being a dementia friendly community. Members of the patient participation group, and staff from local shops were also invited.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• 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 3 July 2017

The provider had resolved the concerns for safety, effective and well-led identified at our inspection on 15 December 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

The practice is now 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
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.