Archived: Dr Y E M Owen & Dr D I A Smith Also known as The Wolds Practice

Updated 3 March 2016

The Wolds Practice provides primary medical care for approximately 2,700 patients living in the rural area of Tetford and neighbouring villages. It is located in the Lincolnshire Wolds some 27 miles from the City of Lincoln and 6 miles from the market town of Horncastle.

The service is provided under a General Medical Services contract with Lincolnshire East Clinical Commissioning Group.

The practice had a higher number of older people aged between 50 and 79 on the patient list than the national average. 27.1 % of patients were aged 65 or over compared to the national average of 16.7%.

Care and treatment is provided by two GP partners, one male one female, a nurse practitioner, a practice nurse, phlebotomist and a counsellor. They are supported by a team of dispensers, receptionists and administration staff.

It is a dispensing practice, and dispenses to 68% of its patients.

The surgery is open between 8am and 6.30pm Monday to Friday, closing each lunchtime from 1 to 2 pm.

When the surgery is closed GP out-of- hours services are provided by provided by Lincolnshire Community Health Services NHS Trust which can be contacted via NHS111.

Updated 3 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr Y E M Owen & Dr D I A Smith, The Wolds Practice on 21 January 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had been responsive to the identified needs of patients and employed a counsellor to assist people experiencing anxiety and a nurse practitioner to meet the needs of the over 75s.
• The practice was proactive in identifying carers and supporting them as far as possible in both looking after the health and social needs of both themselves and the cared for patient.
• Information about services and how to complain was readily available and easy to understand.
• Patients said they found it easy to make an appointment and that 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.

We found areas of outstanding practice which included;

• The practice had employed a nurse practitioner with the aim of reducing the number of emergency admissions and inappropriate attendance at accident and emergency for patients aged over 75. Their work had resulted in a reduction in emergency admissions for a sustained period of ten months and a sustained reduction in inappropriate attendance for nine months.This has been acknowledged by the CCG as a ‘ step change’. Avoiding inappropriate admissions and attendance at A&E is important because it ensures that patients receive timely care in an environment which is familiar and more convenient for them.

• The practice employed a counsellor to provide talking therapies to bereaved patients and those experiencing mild to moderate anxiety. This had reduced the wait time to access help and support for this group of patients from in excess of six months to around a month.

However there was an area of practice where the provider should make improvements:

• The provider should ensure that clinical meetings are properly recorded and non-attenders made aware of the content.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 March 2016

The practice is rated as good for the care of people with long-term conditions. GPs had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 3 March 2016

The practice is rated as good for the care of families, children and young people. 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. Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 3 March 2016

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

The practice had employed a nurse practitioner with the aim of reducing the number of emergency admissions and inappropriate attendance at accident and emergency for patients aged over 75. Their work had resulted in a reduction in emergency admissions for a sustained period of ten months and a sustained reduction in inappropriate attendance for nine months respectively.  This has been acknowledged by the CCG as a ‘ step change’. Avoiding  inappropriate admissions and attendance at A&E is important because it ensures that patients receive timely care in an environment which is familiar and more convenient for them.

Updated 3 March 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, include on-line telephone booking of appointments and repeat prescriptions 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 reflected the needs for this age group.

Updated 3 March 2016

The practice is rated as outstanding for the care of people experiencing poor mental health. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia. All staff had received awareness of dementia through the ‘Dementia Friends’ program.

The practice had employed a counsellor to provide talking therapies and support for the bereaved and those experiencing mild to moderate anxiety.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

Updated 3 March 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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. It carried out annual health checks for people with a learning disability. It offered longer appointments for people with a learning disability.

The practice was pro-active in identifying carers and providing support and advice to meet their healthcare and social needs as well as the cared for patient.