Archived: Dr Andrew Buffey Also known as Church Walk Surgery

Updated 20 October 2016

Dr Andrew Buffey, also known as Church Walk Surgery provides primary medical services to approximately 4,090 patients surrounding the village of Metheringham and surrounding areas in Lincolnshire. The practice also provides services to patients residing in an assisted living home which cares for patients with learning disabilities. The practice has a dispensary on site and dispenses medicines to approximately 20% of its patient population.

The practice is registered with the Care Quality Commission to provide the regulated activities of; the treatment of disease, disorder and injury; diagnostic and screening procedures; family planning, maternity and midwifery services and surgical procedures.

At the time of our inspection the practice employed two GPs, a business manager, an administrative manager, a nurse consultant, a specialist practice nurse and one other practice nurse. The practice also employed a health care assistant a secretary and a team of receptionists and dispensers.

The practice is a training practice for nurse students who are enrolled with the University of Lincoln. Members of the nursing team are trained to support student nurses during placement with the practice.

Church Walk Surgery is open from 8am to 6.30pm Monday to Friday. The practice offers on-line services for patients including ordering repeat prescriptions, booking routine appointments and viewing patient summary care records.

The practice has a General Medical Services (GMS) contract. The GMS contract is the contract between general practices and NHS England for delivering care services to local communities.

The practice has a higher population of patients aged 65 years and above. The patient list has low levels of deprivation.

The practice offers on-line services for patients including ordering repeat prescriptions, booking routine appointments and viewing patient summary care records.

The practice has an active patient participation group (PPG) who meet on a regular basis.

The practice is part of a Federation of six practices called South Lincoln Healthcare within West Lincolnshire Clinical Commissioning Group (WLCCG)

The practice has opted out of the requirement to provide GP consultation when the surgery is closed, the out-of-hours service is provided by Lincolnshire Community Health Services NHS Trust.

Updated 20 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Andrew Buffey’s practice, also known as Church Walk Surgery on 14 June 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.

• A care coordinator worked directly with patients who suffered with a long term health condition both in-house and in the community to improve their level of care and to help reduce unplanned admissions to hospital.

• 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.

• The practice was a training practice for nurse students who were enrolled with the University of Lincoln. Members of the nursing team were trained to support student nurses during placement with the practice.

• In 2015, the practice launched a free fruit and vegetables scheme whereby patients who were either on a low income, suffered with a learning disability or other long term health condition were encouraged to help themselves to free fruit and vegetables provided from the practice.

• The practice provided an effective menopause clinic for female patients to ensure they received additional information, support and advice and access to various treatment options.

• 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.

The areas where the provider should make improvement are:

• Ensure appraisal processes include competency assessments at least annually for staff working within the dispensary.

• Ensure minimum and maximum ambient room temperature ranges are recorded within the dispensary to provide assurance that medicines are not stored above the recommended upper limit of 25 degrees centigrade.

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 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 was 98.4% which was higher than the national average of 89%.

• The practice achieved a performance rate of 97.2% for the prescribing of novel oral anticoagulants (NOACs) which was higher than the CCG target of 94.19%.(NOACs are prescribed to patients suffering particular long term conditions such as atrial fibrillation and are effective in the prevention of stroke).

• 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.

• A care coordinator worked directly with patients who suffered with a long term health condition both in-house and in the community to improve their level of care and to help reduce unplanned admissions to hospital.

Updated 20 October 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 above CCG and national averages for standard childhood immunisations given for children aged up to 24 months with some immunisations achieving 100% uptake rate.

• 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 84%, which was comparable to the CCG average of 84% 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, health visitors and school nurses.

• There was a women’s health clinical lead in place for those patients who suffered post-menopausal health issues.

Updated 20 October 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 provided same day access to either an appointment, telephone consultation or home visit for older people who required this.

• Patients received personalised care plans from a named GP to support continuity of care.

• The premises were accessible to patients with mobility difficulties.

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 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 participated in an electronic prescribing service.

• The practice offered a text reminder service for booked appointments.

Updated 20 October 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 was 100% which was higher than the national average of 93%. (This included an exception reporting rate of 20.5% which was slightly higher than the CCG average of 15.1%).

• 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.

• Staff had received Mental Capacity Act and dementia awareness training.

Updated 20 October 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 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.

• 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.