Campden Surgery

Updated 20 October 2016

Dr Bointon and Partners, also known locally as The Chipping Campden Surgery is a GP partnership located in Chipping Campden. The practice’s premises are purpose built and have a ramp access to the main door. The practice does not have automatic doors, however, there is a door bell to assist patient with mobility issues and wheelchair. There are five consulting rooms and one treatment room which are all located on the ground floor of the practice.

The practice provides its services to approximately 4800 patients under a General Medical Services (GMS) contract. (A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract). The practice delivers its services from the following location:

Back Ends,

Chipping Campden,

Gloucestershire,

GL55 6AU.

The practice partnership has three GP partners and one salaried GP making a total of approximately two and a half whole time equivalent GPs. There are one male and three female GPs. The clinical team includes four practice nurses and two phlebotomists, all of which are female. The practice management and administration team consist of a practice manager, an accounts manager, an IT administrator, one medical secretary, an administration manager, a receptionist team leader and six receptionists. The practice is approved for teaching medical students.

The practice also has a dispensary and it dispenses to around 26% of the practice registered patients. The dispensary team included three dispensers and a dispensary manager. Two of the dispensers also share the role of receptionist.

The practice population demographic shows there is a lower than average patient population aged between 20 to 44 years and higher than average patient population aged between 45 to 85 years and above compared with local and national averages. The general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in the least deprivation decile. (An area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score. It is important to remember that not everyone living in a deprived area is deprived and that not all deprived people live in deprived areas). Average male and female life expectancy for the practice is 84 and 88 years, which is above the national average of 79 and 83 years respectively.

The practice is open from 8.30am to 1.30pm and 2pm to 6.30pm Monday to Friday. Extended hours are available from 6.30pm and 9pm on the first Tuesday of the month then on Wednesday evenings for the rest of the month. There are plans to introduce extended hours on one Saturday every eight weeks. When the practice is closed during core hours, calls are diverted to a call handling service (Message Link), which diverts any urgent calls to a designated member of staff at the practice.

The practice has opted out of providing out of hours services to its patients. Patients can access the out of hour’s services provided by South Western Ambulance Service NHS Foundation Trust via the NHS 111 service.

At the time of our inspection, one of the GPs was not registered as a partner with the Care Quality Commission and was in the process of registering as a partner.

This is the first inspection of Dr Bointon and Partners.

Updated 20 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Bointon and Partners on 14 September 2016. Overall the practice is rated as good.

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

• 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. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their 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 easy to make an appointment with a named GP and 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 October 2016

The practice is rated as good for the care of patients 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.

• The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (04/2014 to 03/2015) was 96% which was above the clinical commissioning group of 90% and national average of 88%.

• 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.

• The practice participated in the winter resilience program. They provided additional appointments between January and March primarily for patients diagnosed with chronic obstructive pulmonary disease to avoid unnecessary hospital admissions. All the practice’s patients could access the additional appointments.

Updated 20 October 2016

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

• 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 patients 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 patients 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 80% (2014/15) which was comparable to the clinical commissioning group average of 84% and national average of 82%.

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

• Weekly ante-natal clinic with the midwife and a fortnightly drop in clinic with the health visitor were held at the practice.

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

Updated 20 October 2016

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

• 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 supported a local nursing home and a dedicated GP visited the home every week. The practice also supported a local residential home where another GP provided fortnightly visits.

• Patients at the practice had access to a volunteer transport service to enable them to attend their appointment at the practice.

• The practice held quarterly multi-disciplinary meeting with community based staff where care plans were routinely reviewed and updated.

Updated 20 October 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 ran a 5pm clinic every week day for urgent cases and the practice told us any patients who feel they need to be seen by a clinician will be seen on the day.

• The practice offered extended hours from 6.30pm and 9pm on the first Tuesday of the month and on Wednesday evenings for the rest of the month. There were plans to introduce extended hours on one Saturday every eight weeks.

• 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.

• The practice told us how they responded quickly to the needs of a group of students who needed travel vaccine at short notice by providing an additional evening travel clinic specifically for those students.

Updated 20 October 2016

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

• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months (04/2014 to 03/2015), which was above the clinical commissioning group (CCG) average of 86% and the national average of 84%.

• The percentage of patients with severe mental health problems who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months (04/2014 to 03/2015) was 100% compared to the CCG average of 93% and national average of 88%.

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

• There was a mental health gateway worker who held fortnightly clinics at the practice.

• 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 20 October 2016

The practice is 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 including homeless people, travellers and those with a learning disability.

• 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 informed vulnerable patients about how to access various support groups and voluntary organisations through social prescribing.

• 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.

• The practice could refer patients to see a local alcohol advisor and they could book a room to see patients at the practice if this was needed.