Penn Hill Surgery

Updated 20 December 2016

Penn Hill surgery is located close to the centre of Yeovil in the middle of a small housing development. The practice serves a semi-rural population of approximately 9730 patients from Yeovil and the surrounding villages.

The practice building was purpose built in 1989 and a major extension was added in 1997. The extension allowed the practice to provide additional consulting rooms, space for nurses and a clinical suite available for further health related activities.

Penn Hill Surgery has four partner GPs and a salaried GP. They provide 37 GP sessions each week and are equivalent to 4.9 whole time employees. One GP is female and five are male.

There are six female nurses including a nurse manager, two advanced nurse practitioners and four health care assistants whose working hours are equivalent to 4.1 and 1.75 whole time employees respectively.

The GPs and nurses are supported by 23 management and administrative staff including a business manager, a practice manager and deputy practice manager.

The practice has been a training practice for many years. They usually have foundation year 2 (FT2) and GP specialist training (ST) doctors attached to the practice.

The practice is open between 8 am and 6:30 pm Monday to Friday; appointments are available during these times. Extended hours are offered at the following times on Monday evenings between 6:30 and 8 pm and every Saturday 8 am until 9:30 am for pre-booked appointments for those patients who cannot visit the practice during normal hours.

The practice has opted out of providing out-of-hours services to their own patients. This service is provided by SDUC (Somerset Doctors Urgent Care) and patients are directed to this service by the practice during out of hours.

The practice has a Personal Medical Services (PMS) contract to deliver health care services; the contract includes enhanced services such as extended opening hours, childhood vaccination and immunisation scheme, facilitating timely diagnosis and support for patients with dementia and minor surgery services. It provides an influenza and pneumococcal immunisations enhanced service. These contracts act as the basis for arrangements between the NHS Commissioning Board and providers of

general medical services in England.

The practice is linked to Pathways Health and Social Care Alliance Limited, the provider of the Yeovil Health Centre and Somerset Primary Healthcare Limited. They are active members of the South Somerset Healthcare Federation consisting of 17 practices in South Somerset and are partners in the Somerton Surgery Partnership.

Updated 20 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Penn Hill Surgeryon 29 October 2015. Overall the practice was rated as good for effective, caring, responsive and well-led with the safe domain being rated as requires improvement. We issued one requirement notice for the following:

• Breach of Regulation 19 of The Health and Social Care Act (Regulated Activity) Regulations 2014, Fit and proper persons employed. The requirement notice was for the practice to ensure all staff received appropriate employment checks prior to employment ensuring the safety of patients using the service.

Our key findings during this inspection were as follows:

The areas where the provider must make improvement were:

• Review recruitment processes to ensure staff requiring a valid Disclosure and Barring Service check were in possession of this prior to their employment.

• Review processes for staff undertaking a chaperone role who do not have a Disclosure and Barring Service check.

The areas where the provider should make improvement were:

• Review the policy for legionella to ensure risks to staff and patients were effectively managed.

• Review how governance arrangements were recorded and managed for complaints and risk assessments to ensure best practice was reflected.

A copy of the report detailing our findings can be found at www.cqc.org.uk.

We undertook a focused desk based inspection on the 21 November 2016 to follow up the requirement notice and to assess if the practice had implemented the changes needed to ensure patients who used the service were safe.

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

• The provider had updated staff recruitment policies to ensure staff were recruited appropriately. All staff files at the practice now contained evidence that appropriate recruitment checks had been undertaken.

• The provider had updated the policy and procedure for staff chaperoning duties. Staff that chaperone patients had a Disclosure and Barring Service check in place and had received appropriate training for this extended role.

• A Legionella risk assessment had been undertaken by an external contractor in August 2016. Subsequently, the provider had developed an action plan and was in the process of developing a system to undertake regular water system checks.

• The provider had implemented a system of recording and monitoring complaints and risk assessments, ensuring best practice was reflected.

We found the provider had made the required improvements since our last inspection in October 2015. Following this focused inspection the practice is rated as good for providing a safe service and has an overall rating for the practice of good.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 December 2015

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. Nurse lead roles included care planning, diabetes, asthma and chronic obstructive pulmonary disease (COPD).
• 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 people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• Trained health care assistants offered home visits for this service when necessary.
• Some patients were managed by a tele monitoring service and increasing numbers of their most complex patients were being looked after in a shared care arrangement with the local Symphony complex care hub to optimise the care of their long term conditions. (The Symphony project provides new integrated care models for people with long term conditions in South Somerset).

Updated 10 December 2015

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 children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• 83.89% of female patients at the practice aged 25-64 had a record showing a cervical screening test had been undertaken in the preceding 5 years; slightly above the national average of 81.88%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw good examples of joint working with midwives, health visitors, school nurses and other health professionals.
• All patients had named GPs and families were kept together with one GP where they chose to see the same GP.

Updated 10 December 2015

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.
• It was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• All older patients living in residential or nursing homes had care plans which were reviewed annually or as required.
• Alerts were put on the patient record system for patients with poor hearing, memory problems along with details of family contacts or requirement for home visits.
• Home visits were provided for influenza vaccinations and phlebotomy when required.
• All staff had either completed or were in the process of completing dementia awareness training.
• Staff from the practice attended monthly palliative care meetings to discuss the active care of those patients nearing the end of their lives.

Updated 10 December 2015

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 reflected the needs for this age group.
• Cervical smear appointments were offered early morning, lunchtime and in the evening to support working women and students.
• The practice had received an award in 2013 for outstanding support of students with learning disabilities from a local college for exceptional services to their students. The practice provided a regular clinic at the college as well as medical health checks and routine appointments to the students. One of the practice nurses provided a detailed training session for staff at the college about helping students to manage their epileptic seizures. This was to ensure staff were safely skilled in supporting students. Enhanced services were provided to patients diagnosed with a learning disability. Services included visiting for influenza vaccinations, health promotion talks, staff training, new patient medicals and facilitated access to same day appointments.

Updated 10 December 2015

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

• All of the most vulnerable patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• There was a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• All staff in the practice had either completed or almost completed training in dementia awareness.
• Staff had a good understanding of how to support people with mental health needs and dementia through attending training courses such as dementia awareness.

Updated 10 December 2015

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 drug and alcohol problems and those with a learning disability.
• It offered longer appointments for people with a learning disability if required.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• Reception staff were encouraged to offer flexibility in access to same day appointments for all vulnerable patients.
• The practice 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.