Dr Richard Hyslop Also known as The Cole House Surgery

Updated 5 November 2015

Dr Hyslop (known locally as The Old Cole House Surgery) is located in Bedworth, North Warwickshire. The Old Cole House Surgery is a single handed GP practice operating from a converted and extended end of terrace house in a residential area of Bedworth town. The practice provides primary medical services to patients in an urban area which has areas of deprivation and social issues related to drugs and alcohol. As a former mining town there are significantly larger numbers of elderly patients who worked in the pits with a relative high occurrence of lung diseases. The GP is supported by a practice manager, a practice nurse, administrative and reception staff. There were 2985 patients registered with the practice at the time of the inspection.

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

The practice is open for appointments from 8am to 6.30pm Monday to Thursday and from 8am to 2pm on Fridays. The practice is closed at weekends. Home visits are available for patients who are too ill to attend the practice for appointments. There is also an online service called ‘patient access’ which allows patients to order repeat prescriptions and book new appointments without having to phone the practice. The practice offers extended hours appointments which are available from 6.30pm till 8pm on Wednesdays.

The practice does not provide an out-of-hours service but has alternative arrangements in place for patients to be seen when the practice is closed. If patients call the practice when it is closed, an answerphone message gives the telephone number they should ring depending on the circumstances. Information on the out-of-hours service is provided to patients and is available on the practice’s website and in the patient practice leaflet.

Patient support is provided when the practice is closed at lunchtimes and on Friday afternoons by a network support group that has been set up locally. Dr Hyslop and two other local practices operate an on-call system to cover these times. Telephone calls are routed via the nearby ambulance station and forwarded to the duty GP for a response.

The practice treats patients of all ages and provides a range of medical services. This includes disease management such as asthma, diabetes and heart disease. Other appointments are available for minor surgery, maternity care, family planning and smoking cessation.

Updated 5 November 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr R Hyslop on 27 August 2015. Overall, the practice is rated as good for providing safe, effective, caring, responsive and well led services.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• Information about how to complain was available and easy to understand
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had a clear vision about providing a quality and caring service in a safe way.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 November 2015

The practice is rated as good for the care of people with long-term conditions. The practice nurse had a lead role in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All patients diagnosed with a long term condition had a named GP and a structured annual review to check that their health and medicine needs were being met. For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 5 November 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 of abuse. For example, children and young people who had a high number of accident and emergency (A&E) attendances.

Childhood immunisation rates were similar to or higher than the local Clinical Commissioning Group (CCG) averages, with 100% take up for 14 of these.

The practice nurse carried out six week baby checks as well as post-natal checks for mothers. Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence that confirmed this.

Appointments were available outside of school hours and the premises were suitable and accessible for children, with changing facilities for babies. We saw good examples of joint working with midwives, health visitors, school nurses and district nurses. The practice also offered a number of online services including booking appointments and requesting repeat medicines.

Updated 5 November 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The practice also arranged blood tests for patients at home where they were unable to get to the hospital. Health checks were carried out for all patients over the age of 75 years.

Updated 5 November 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 offered weekly evening extended hours so that patients could access appointments around their working hours. We learned that the GP stayed at the end of the day to make sure all patients needing to be seen on the same day received an appointment.

The practice was proactive in offering online services as well as a full range of health promotion and screening services that reflected the needs for this age group. The practice nurse had oversight for the management of a number of clinical areas, including immunisations, cervical cytology and some long term conditions.

Updated 5 November 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advanced care planning and annual health checks for patients with dementia and poor mental health. The GP and practice nurse understood the importance of considering patients ability to consent to care and treatment and dealt with this in accordance with the requirements of the Mental Capacity Act 2005.

The practice had completed care plans for a high proportion of its patients experiencing poor mental health (90% compared with the national average of 86.04%) and was proactive in monitoring their smoking and alcohol status in addition to their general health.

The practice had advised patients experiencing poor mental health how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

For example, there had been times when patient referrals for access to specific support had been made but had not been immediately available to them. The GP and nurse had often supported patients through a mental health crisis as a result. They had monitored and supported the patient during and after their crisis by giving them time or counselling to help them make progress. The GP and practice nurse told us they would always see the patient and give them time whether they had an appointment or not.

Updated 5 November 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 patients with a learning disability. For example, the practice had carried out annual health checks and offered longer appointments for patients with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had advised vulnerable patients on how to access various support groups and voluntary organisations. Alerts were placed on these patients’ records so that staff were aware they might need to be prioritised for appointments and offered additional attention such as longer appointments.

Staff had received training and knew how to recognise signs of abuse in vulnerable adults and children who were considered to be at risk of harm. 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.

Staff told us that patients had been supported throughout particularly difficult times and described to us a number of occasions when they had done this. For example, we were told about safeguarding issues had occurred where the GP and the practice nurse had provided support and counselling over and above usual provision to ensure patients remained safe from the risk of harm. This had often been out of hours or when surgeries had ended for the day. There had been a number of times when the GP had visited patients on their way home as part of the support they provided.