11 May 2017
Somerton House Surgery is located in the village of Midsomer Norton near Radstock. The practice serves a local and rural population of approximately 6600 patients from the village and the surrounding area.
There is parking on site including spaces for patients with a disability. The practice has a number of rooms which it makes available to other services; these include physiotherapy, counselling, drug misuse services and private sport physiotherapist.
The practice has five GPs; four partners and a salaried GP of which; four are female and one is male. Between them they provide 28 GP sessions each week and are equivalent to 3.5 whole time employees. There is a nurse practitioner who is qualified to prescribe particular medicines and a practice nurse, they provided 15 sessions per week and are the equivalent to 1.6 whole time employees. There was one health care assistant and two phlebotomists, they provided 10 sessions per week and their working hours are the equivalent to 2.4 whole time employees (WTE). The GPs and nurses are supported by a practice manager and eight administrative staff.
The practice is a GP training practice and had one registrar GP placed with them at the time of our inspection in October 2016. The practice also hosts placements for fifth year medical students. One of the GP partners is a GP trainer and the practice had been graded as excellent by the Severn Deanery GP Specialty Training Quality Panel.
The general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in the ninth 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 life expectancy for males in the area is 80 years, which is one year longer than the national average and for females is 85 years, which was slightly longer than the national average.
The practice is open between 8:15am and 6:15pm Monday to Friday. Appointments are available from 8:30am and telephone access is available from 8am until 6pm. The practice operates a mixed appointments system with some appointments available to pre-book and others available to book on the day.
GP appointments are 10 minutes each in length and appointment sessions are typically 8:20am until 11:30am and 3pm until 6pm. Each consultation session has 18 appointment slots. The practice offers online booking facilities for non-urgent appointments and an online repeat prescription service. Patients need to contact the practice first to arrange for access to these services. Extended hours appointments are offered two evenings from 6:30pm until 7pm and one early morning from 7:30am until 8am. Also early morning appointments with the phlebotomist are available two mornings a week on a Tuesday and Friday from 7:30am until 8am. Pre-bookable appointments are also available from 8:30am until 11:30am once a month on a Saturday.
The practice has opted out of providing out-of-hours services to their own patients. Patients are directed to using the NHS 111 telephone service outside of normal practice hours, who work in conjunction with Vocare out of hours GP service.
The practice has a Personal Medical Services contract to deliver health care services; the contract includes enhanced services such as childhood vaccination and immunisation scheme, facilitating timely diagnosis and support for patients with dementia, minor surgery services and avoiding unplanned admissions. These contracts act as the basis for arrangements between the NHS Commissioning Board and providers of general medical services in England.
This report relates to the registered regulated activities which were provided at the following location:
Somerton House Surgery
79a North Road
11 May 2017
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Somerton House Surgery on 20 October 2016. The overall rating for the practice was good, however, we rated the practice as requires improvement for providing safe services. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for Somerton House Surgery on our website at www.cqc.org.uk.
This inspection was an announced focused inspection carried out on 26 April 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 20 October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.
Overall the practice is now rated as good, including for providing safe services.
Our key findings were as follows:
- procedures for effective staff recruitment are fully implemented and records are complete so that only staff who meet the requirements of the regulations are employed.
- systems for monitoring training are in place to ensure all staff receive relevant, up to date training and this is recorded.
- arrangements are in place to ensure patients can access information on how to complain, including via the practice website.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
10 March 2017
The practice is rated as good for the care of people with long-term conditions.
- Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
- The percentage of patients on the diabetes register who had had a foot examination in the last 12 months was 93% which was better than the clinical commissioning group (CCG) average of 92% and national average of 88%.
- The practice proactively identified patients at risk of developing long-term conditions and took action to monitor their health and help them improve their lifestyle.
- The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
- There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
- 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.
10 March 2017
The practice is rated as good for the care of families, children and young people.
- There were systems 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 accident and emergency (A&E) attendances. Immunisation rates were either in line with or slightly above CCG and national averages 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.
- The practice provided support for premature babies and their families following discharge from hospital.
- The practice performance for screening women for cervical cancer was in line with local and national averages. For example, 84% of women aged 25-64 had a record of a cervical screening test in the last 5 years, compared with the CCG average of 83% and the national average of 82%.
- Appointments were available outside of school hours and the premises were suitable for children and babies.
- The practice held quarterly safeguarding children meetings with the health visitor team and had regular contact in between.
- The practice had emergency processes for acutely ill children and young patients and for acute pregnancy complications.
- The practice offers to carry out paediatric phlebotomy due to its rural location.
10 March 2017
The practice is rated as good for the care of older patients.
Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
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 identified at an early stage older patients who may be approaching the end of life. They involved older patients in planning and making decisions about their care, including their end of life care.
The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
Where older patients had complex needs, the practice shared summary care records with local care services, including the community care teams, such as the community and palliative care nurses.
Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.
The practice had two GPs who led the monitoring of patients who lived in residential or nursing homes. They had regular liaison with the homes, for example, by attending the nursing homes for weekly ward rounds, in addition to urgent home visits. They also attended a quarterly meeting, with two other practices, for one large nursing home to enhance the coordination of care.
10 March 2017
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.
10 March 2017
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).
87% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is in line with the clinical commissioning group (CCG) average of 86% and the national average of 84%.
- The practice specifically considered the physical health needs of patients with poor mental health.
- The practice had a system for monitoring repeat prescribing for patients receiving medication for mental health needs.
- Performance for support to patients with schizophrenia, bipolar affective disorder and other psychoses was better than local and national averages. For example, 95% of patients with a diagnosed psychological condition had a comprehensive, agreed care plan documented in their records, in the last 12 months, compared with the CCG average of 92% and the 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.
- Patients at risk of dementia were identified and offered an assessment.
- 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.
10 March 2017
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.
End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
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. We saw evidence of meetings to make best interest decisions where required.
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.