St Mary's Surgery

Updated 11 August 2016

St Mary’s Surgery is also known as Timsbury Surgery. The practice has been in the village of Timsbury for over 50 years and has been in its current location since 1975. The practice has a patient population of approximately 5,200 patients in the communities of Timsbury and the surrounding villages.

The practice population consists of a large rural community and patients from a previous mining community, the villages support a large number of patients who commute into Bristol, Bath and London and has a low rate of social deprivation. The practice has a higher than average ratio of patients over the age of 50 and higher than the local average number of patients over the age of 95. The practice supports a higher than average number of patients in nursing homes and supports a high number of patients with end of life care.

The practice team consists of three GP Partners (one female and two Male) and two female GP associates. The practice has two GP Registrars. (Registrars are qualified doctors who undertake additional training to gain experience and higher qualifications in general practice and family medicine). The practice is a teaching and training practice and also supports medical students from local universities.

The GPs are supported by two nursing sisters, two health care assistants, a practice manager and team of reception, administration and dispensing staff.

The practice provides pharmaceutical services to patients who live more than one mile (1.6km) from their nearest pharmacy premises. This includes 46% of the patients registered at the surgery.

The practice dispensary is open Monday to Friday between 8am and 6pm and two Saturday mornings each month, so patients have a choice of when to collect their prescriptions. Patients are able to use a variety of methods to request repeat prescriptions, including a telephone and on-line service.

The practice is open between 8am and 6pm Monday to Friday. Appointments are available from 8.30am to 11am every morning and 3.20pm to 5.50pm daily. Extended hours appointments are available every other Saturday from 8.30am to 10.30am. In addition to pre-bookable appointments that can be booked up to six weeks in advance, urgent appointments and often routine appointments are also available on the same day for people that need them.

The local Bath and North East Somerset area has a local agreement for the out of hours care to commence from 6pm. When the practice is closed overnight and at weekends the out of hours care is provided by Bath Doctors Urgent Care accessed via NHS 111.

The practice holds a Primary Medical Service contract to provide medical care.

The practice’s regulated activities are delivered form the following location:

Timsbury Surgery

St Mary’s Close

Timsbury

BA2 0HX

Updated 11 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Mary’s Surgery on 28 June 2016. Overall the practice is rated as good.

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

• The practice had a clear vision to deliver personalised cradle to grave care to the local community and provide continuity for patients and timely welcoming access.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• There were arrangements for identifying, recording and managing risks, issues and implementing mitigating actions.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said the care they received was excellent and caring and they were involved in decisions about their care and treatment.
• 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 they found it very easy to make an appointment with a named GP and there was continuity of care, with urgent appointments and often routine 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.

Action the provider should take to improve:

• Review their procedures for maintaining safety of their repeat prescribing and dispensary procedures.

• Ensure that a second member of staff checks completed compliance aids before they are given to patients, to reduce the risk of mistakes.

• Ensure that carers are identified for ongoing care and support.

• Ensure risk assessments for the whole premises and patients who use the service are regularly reviewed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 August 2016

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 patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators were better than the local and national averages:

• The percentage of patients with diabetes, on the register, in whom the last blood test was in the target range, in the preceding 12 months (2014/15) was 83% which was higher than the clinical commissioning group (CCG) average of 81% and the national average of 78%.

• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was in the target range was 90% which was higher than the CCG average of 81% and the national average of 78%.

• The percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was in the target range was 88% which was higher than the CCG average of 83% and the national average of 81%.

• 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.

Updated 11 August 2016

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.

• The practice's uptake for the cervical screening programme was 81%, which was comparable to the clinical commssionning group (CCG) average of 83% and the national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives and health visitors.

Updated 11 August 2016

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 people in its population.

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

• The practice supported patients in four local care homes and conducted a weekly ward round with a named GP for continuity of care.

The practice was piloting the use of remote access to medical records to improve the care for patients on home visits.

Updated 11 August 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 to ensure these were accessible, flexible and offered continuity of care.

• The practice offered extended hours appointments on Saturdays every other week for this group and on the day or bookable telephone appointments.

• 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 11 August 2016

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

• Performance for mental health related indicators were higher than the local and national averages except for dementia which was lower.

• The percentage of patients with a serious mental health problem who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (2014/15) was 100% which was higher than the clinical commissioning group (CCG) average of 92% and the national average of 88%.

• The percentage of patients with a serious mental health problem whose alcohol consumption has been recorded in the preceding 12 months (2014/15) was 100% which was higher than the CCG average of 91% and the national average of 90%.

• The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months (2014/15) was 78% which was lower than the CCG average of 86% and the national average of 84%.

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

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

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

• 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 11 August 2016

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 offered longer appointments for patients with a learning disability.

• The practice supported a local care home for young disabled patients and conducted a weekly ward round for continuity of care.

• 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. A talking therapies service was accessible at the practice.

• 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.