Archived: Ladies Walk Practice

Updated 14 February 2017

Ladies Walk Practice is located in Thornhill, a residential area to the east of Southampton in Hampshire. The practice is based over two sites. The main site at Thornhill Park Road is located in a purpose built centre built in 1998, which is leased from a private landlord. Thornhill Park Road has six consulting rooms and three treatment rooms, all based on the ground floor. The practice has car parking for patients, including a dedicated bay for disabled drivers. The waiting area in the practice is large, bright and airy, with wipeable chairs and suitable seating for patients including young children. The patient has a self-check blood pressure machine for patient use, in a private area off of the main waiting area.

The practice had a branch site at Midanbury Surgery located a few miles away. Patients registered at Ladies Walk Practice can make appointments at either site. In 2016, the practice merged with Weston Lane surgery and created the business partnership, "The Living Well Partnership". Weston Lane Surgery and The Living Well Partnership are registered as a separate location with the CQC. Weston Lane Surgery was inspected by CQC in October 2016 and was rated good overall.

The practice provides services under a NHS General Medical Services contract and is part of NHS Southampton City Clinical Commissioning Group (CCG). The practice has approximately 8,200 patients registered most of whom live within a five mile radius of the practice.

The practice is located in an area considered to be in the fifth most deprived band out of ten for England. The average life expectancy for both males and females is comparable to local and national averages. A total of 57% of patients at the practice are working or are in full-time education compared to the national average of 60%. A total of 60% of the practice population has a long-standing health condition compared to the national average of 54%; areas with higher numbers of patients with long-term conditions can have more health needs. Approximately 2% of the practice population have English as an additional language.

The practice has four female GP partners and one male GP partner. Together, the GPs provide care equivalent to approximately three and a half full-time GPs. The practice has three practice nurses and two health care assistants, all of whom are female and who provide a range of services to patients such as wound care and long-term condition reviews. The practice also employs two advanced nurse practitioners who are non-medical prescribers and who offer minor illness clinics to patients. Together the nurses are equivalent to approximately five full time nurses. The clinical team are supported by a practice manager and a team of 16 administration and reception staff. The practice is also a training practice for doctors training to be GPs (GP registrars). At the time of our inspection, the practice was supporting one GP registrar.

The practice and reception desk is open from 8am until 6.30pm Monday to Friday. Morning appointments are available between 8.30am and 12pm daily. Afternoon appointments are available from 2pm until 6.30pm Monday to Friday. Extended hours appointments are offered on Mondays from 6.30pm until 8pm and on Saturdays between 7.30am and 8.30am. Ladies Walk Practice has opted out of providing out-of-hours services to their own patients and refers them to the out of hours service via the NHS 111 service or the Minor Injuries Unit based in Southampton.

The practice offers a range of additional in-house services to patients including minor surgery, phlebotomy, travel advice and sexual health services.

The practice has a branch site located a few miles away at Midanbury Surgery, 1 Woodmill Lane, Midanbury, SO18 2PA, which we did not visit as part of this inspection. We carried out our inspection at the practice’s Thornhill location which is situated at:

Ladies Walk House

90 Thornhill Park Road

Southampton

SO18 5TS

Updated 14 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ladies Walk Practice on 11 January 2017. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was a commitment to providing co-ordinated, responsive and compassionate care for patients.
• 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. There was a commitment to staff development and staff were trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Feedback from all of the patients we spoke with or who provided feedback and other stakeholders was continuously positive about the way staff treated them and other patients. Patients said staff went the extra mile and the care they received exceeded their expectations.
• 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 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.

The areas where the provider should make improvement are:

• Review the responses to complaints to ensure they are consistently in line with recommended national guidance.
• Review the processes for working with the patient participation group to fully meet the group’s needs. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 February 2017

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 received appropriate training to provide care in line with national guidance.
• Patients at risk of hospital admission were identified as a priority.
• Data for patients with diabetes were comparable to or better than national figures. For example, the percentage of patients with diabetes, on the register, who had an acceptable blood pressure reading in the preceding 12 months was 87%, compared to a national average of 78%.
• 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. For example, the practice nurse ran a joint clinic with a specialist dietician and nurse for patients with diabetes and held a virtual clinic with a specialist diabetes doctor to ensure patients’ needs were met .
• All patients with COPD (Chronic Obstructive, Pulmonary Disease, a chronic lung condition) are given ‘rescue’ packs of medicines to enable them to start appropriate treatment immediately in the event of deterioration.

Updated 14 February 2017

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.
• A total of 81% of eligible women attended for a cervical smear in 2015-2016. This is similar to the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice held regular meetings with other professionals to ensure the needs of this group were met. For example, joint meetings with health visitors, the family navigator and local truancy officers to gain a holistic understanding of the needs of this group.

Updated 14 February 2017

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

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• Performance indicators for conditions commonly found in older patients were comparable to national averages. For example, 99% of patients with a history of a stroke or mini-stroke, received a flu vaccine in the preceding 12 months compared to a national average of 96%.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

Updated 14 February 2017

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.
• A text messaging service for reminders to attend appointments and routine reviews was offered to patients.
• Pre-bookable appointments with GPs and nurses were available in extended hours to meet the needs of this group.

Updated 14 February 2017

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

• A total of 84% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the clinical commissioning group (CCG) average of 87% and national average of 84%.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 months was 93% compared to the CCG average of 91% 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.
• The practice carried out advance care planning for patients living with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. The practice hosted specialist health professionals who offer psychological support on a weekly basis.
• 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 February 2017

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 those with a learning disability.
• The practice had 38 patients with a learning disability. At the time of our inspection, 82% of patients had received a health check in the previous 12 months.
• The care offered by the practice for patients with learning disabilities was reviewed by specialists from the local Hospital NHS Trust and found to be of a high standard.
• The practice offered longer appointments for patients with a learning disability.
• The practice supported a local travelling community with their health needs, for example by offering them flexible appointments.
• The practice had developed communication cards for patients who were unable to express their needs verbally, to help ensure their needs were met.
• 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.