Archived: Salisbury Plain Health partnership Also known as Bourne Valley Practice (Salisbury Plain Health Partnership)

Updated 16 August 2017

Salisbury Plain Health Partnership is a GP partnership consisting of two local practices (Bourne Valley Practice and Cross Plain Surgery). The provider offers primary medical services across Salisbury Plain from Tilshead to the edge of Andover. The provider provides its service from two registered locations and has a branch surgery from each of these locations. This report covers our findings at Bourne Valley Practice. We did not visit the practice’s branch in Ludgershall during this inspection.

The practice premises include three consulting rooms and a treatment room on the ground floor; with a further a treatment room and consulting room on the first floor of the main location. There is a lift and an automatic door. However, we were told that the automatic doors were not in use as the practice was located on a busy main road and potentially, children could run into the main road when coming out of the practice.

The practice provides its service to approximately 3,100 patients under a Personal Medical Services (PMS) contract. (A PMS contract is a locally agreed alternative to the standard GMS contract used when services are agreed locally with a practice which may include additional services beyond the standard contract). The practice delivers its services from the following location:

Beacon House,

Station Road,

Tidworth,

Hampshire,

SP9 7NN.

And,

Ludgershall,

10-12 High Street,

Ludgershall,

Andover,

Hants,

SP11 9PZ.

The practice partnership combines their staffing across all sites and has three GP partners and one business partner. The practice also employs four salaried GPs resulting in a total of approximately four and a half whole time equivalent GPs. There is one male and six female GPs. The clinical team includes two practice nurses and two health care assistants (all of which are female), a pharmacist, a nutrition advisor, a mental health support worker and five GP assistants. The practice management and administration team consist of a business partner (who also undertakes the role of a GP assistant), two assistant practice managers, a trainee practice manager and a range of administration and reception staff. The practice also employs four dispensers; one of whom is also a mental health support worker. The practice is approved for teaching medical students and training qualified doctors undertaking further training to become GPs.

The practice population demographic shows there is a higher than average patient population aged between zero to 14 and a higher female patient population aged between 20 to 44 years 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 third 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. 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 80 and 84 years, which is above the national average of 79 and 83 years respectively. Practice data shows that the practice is the highest in the area for patient turnover mainly due to having a high proportion of patients from families of soldiers serving in the armed forces. Approximately 15% of the practice population are military veterans.

The practice is open between 8am to 1pm and 2pm to 6.30pm Monday to Friday. Appointments are from 8.30am to 1pm and 2pm to 5pm for pre-booked appointments with a GP daily. When the practice is closed, patients are advised to contact an emergency telephone number. Details of the emergency telephone number are given to patients through an answer phone message when they call the practice. Emergency appointments with a GP and nurse are available until 6pm. Extended hours are every Wednesday morning from 7.30am to 8am and every third Saturday of the month from 9am to 12.30am. Saturday appointments varied between the provider’s locations.

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 Medvivo via the NHS 111 service.

Updated 16 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Salisbury Plain Health Partnership on 8 December 2016. Overall the practice was rated as good and requires improvement for providing effective services. The full comprehensive report on the 8 December 2016 inspection can be found by selecting the ‘all reports’ link for Salisbury Plain Health Partnership on our website at www.cqc.org.uk .

This inspection was an announced focused inspection carried out on 1 August 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 8 December 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of effective services. Overall the practice remains rated as good.

Our key findings were as follows:

• The practice reviewed their process for the exception reporting of patients with long term conditions and had ensured patients who had previously been excepted, had received the appropriate reviews. (Exception reporting is the removal of patients from Quality Outcomes Framework calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects)

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 March 2017

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 (04/2015 to 03/2016) was 98% which was above the clinical commissioning group of 91% and national average of 89%.

• The practice took part in a pilot in partnership with Public Health England and a third sector provider to look at pre-diabetes checks. The practice had shared its learning and findings which has led to approximately 40,000 patients at risks of developing diabetes in the locality being invited to attend a pre-diabetes course. Staff from the practice were part of the team delivering the course. The practice were also able to demonstrate how they had adjusted the way the course was delivered to enable greater patient uptake.

• Patients with chronic obstructive pulmonary disorder (a lung disease) were referred to a Community Pulmonary Rehabilitation Course so that those patients could self-manage their condition.

• The practice held a clinic for patients who were obese twice a week. This included advice on exercise, diet and nutrition.

• 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 7 March 2017

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 women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years was 85% which was comparable to the clinical commissioning group average of 86% and national average of 81%.

• The practice recognised that they were located in a large military garrison and identified the needs of military veterans and the families of serving personnel. The practice developed an initiative called “Serving on UK”, where staff with personal knowledge of the armed forces can assist patients to have their needs met within the NHS. The practice believed that this facilitated conversation for military veterans and families of serving personnel as practice staff had experience and understanding of the armed forces.

• 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 7 March 2017

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.

• Older patients had a named GP and the practice facilitated those patients to see a GP or nurse of their choice to encourage continuity of care.

• There was a care co-ordinator attached to the practice who liaised between elderly patients and the practice to ensure those patients had regular checks and advice.

• As part of the Transforming Care for Older Patient initiative, the practice held a weekly clinic in one of its branch surgeries. This was led by one of the healthcare assistants who had nursing home experience and arranged for external speakers to attend.

• There was a GP and a GP assistant who supported patients admitted to intermediate nursing home care beds in Amesbury, which provided an environment that would enable successful rehabilitation at a place close to home. Both the GP and GP assistant attended weekly multi-disciplinary team meeting to review the care of those patients.

Updated 7 March 2017

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

• The practice offered extended hours on Wednesday mornings from 7.30am to 8am and every third Saturday of the month from 9am to 12.30am. Saturday appointments varied between the provider’s locations.

Updated 7 March 2017

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 (04/2015 to 03/2016), which was above the clinical commissioning group (CCG) average of 88% 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 (04/2015 to 03/2016) was 100% compared to the CCG average of 92% and national average of 89%.

• The practice recognised that there was a gap in service provision for patients with mental health who needed advise and support on a regular basis. They had set up an in house Mental Health team which included two mental health support workers employed by the practice under the leadership of a lead GP who had a specific qualification and experience in mental health issues. This enabled patients to be reviewed and have increased access to support when they needed it. The team met monthly and patients on the register were discussed and followed up. The practice shared several examples where the support had benefited patients to return to work, avoid hospital admission, and manage their anxieties with coping strategies as opposed to medicines.

• 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 7 March 2017

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

• Practice data showed that 80% of patients with a learning disability have had an annual health check to date.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. There was a care coordinator attached to the practice who saw vulnerable patients and acted as a link between the patient, the practice and other health professionals to ensure the needs of those patients were met.

• The practice was part of the Wiltshire “stay safe” scheme, where anyone in need of assistance or, who are anxious or distressed would be supported by practice staff to stay safe until they received further assistance.

• The practice recognised that a large proportion of their population were military veterans and understood the support needs of those patients. They worked closely with local military charities and “Turning Point” which supports patients with substance and alcohol misuse. Two of the GPs at the practice had qualifications in substance misuse and could therefore support patients safely with alcohol and substance misuse.

• 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.