The Burbage Surgery Also known as Dr Jones and Partners

Updated 28 April 2017

Burbage Surgery is situated in the village of Burbage on the outskirts of Hinckley in North West Leicestershire. It has a branch surgery in the village of Wolvey, about 4 miles away. Both sites have dispensaries. The practice is able to offer dispensing services to those patients on the practice list who lived more than one mile (1.6km) from their nearest pharmacy. There is a local population of about 17000. Burbage is an area with private housing alongside some small pockets of social deprivation. The practice has approximately 10500 patients with relatively high numbers of elderly patients and patients with long-term conditions.

The practice also uses two community buildings in Sharnford and Sapcote. The practice had reviewed the use of these buildings and had decided they were not suitable to use as a surgery but still wanted to provide a service to their mainly elderly patients living in these areas. Patients had to telephone to arrange to see the GP who attended for an hour each week. It was explained that this was to collect medicines from the dispensary or a prescription. If there were any concerns about the patient’s health they were offered an appointment at the main or branch site or a home visit. There are no treatment or examination facilities but the practice has put in Wi-Fi so patients’ records can be checked.

The practice occupies premises in Burbage and in Wolvey which were purpose built in the 1980s. There are disabled car parking spaces.

There are 5 GPs, 3 of whom are female. There are two nurse practitioners and a practice nurse (all female) who provide minor illness and urgent care, and manage long-term conditions such as diabetes, asthma and chronic pulmonary disease. (COPD) There are also two health care assistants. The clinical team is supported by a practice manager, and other support staff some of whom take responsibilities for areas such as reception and prescriptions. The practice is a training practice which has trainee GPs.

The main site in Burbage is open between 8.00am and 6.30pm Monday to Friday. Appointments can be pre-booked up to 6 weeks in advance. The practice operates a telephone triage system in the morning with GPs and Nurse practitioners calling patients back after they have spoken with a receptionist and when needed offering a same day appointment. Telephone appointments are also available. The branch in Wolvey is open on Monday and Thursday afternoons from 2.00pm to 6.00pm and on Tuesday, Wednesday and Friday mornings from 8.30am until 12.30pm.

Out of hours services are commissioned by West Leicestershire Clinical Commissioning Group and provided by DHU (Derbyshire Health United).

Updated 28 April 2017

Letter from the Chief Inspector of General Practice

Burbage surgery was inspected on the 28 and 29th April 2015 when the practice was rated as 'requires improvement' as it was found to require improvement in the four key questions of safe, effective, responsive, and well led; it was rated as good for caring.

The practice submitted an action plan detailing how they would meet the regulations governing providers of health and social care and we carried out a further announced inspection on 26 October 2016.

At our inspection we found the practice had made improvements across the key questions which required improvement: safe, effective, responsive, and well led. Overall the practice is rated as good.

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

• There was a system in place for reporting and recordings events and lessons were learned to make sure action was taken to improve safety in the practice.
• 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.
• Urgent appointments were made available for vulnerable patients and unwell children even where sessions were fully booked.
• The practice had adequate facilities and equipment.
• Appropriate checks were carried out before staff started employment.
• 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 practice should:

Consider recording verbal complaints to ensure any potential improvements to patient care are identified and actioned.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 April 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management with support from GPs.

• The practice had identified 2% of its patients who were at risk from unplanned hospital admissions and shared information with out of hours and district nurse services to help keep people out of hospital where possible.

• Performance for diabetes management was similar to or slightly higher than national averages, for example, the practice scored 87% for the QOF indicator relating to blood sugar control management for diabetic patients compared to the local average of 83% and national average of 78%.

• Longer appointments and home visits were available when needed. The practice kept a register of patients who were housebound.

• All 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 kept a list of patients such as those receiving end of life care, patients with mental health problems and patients with multiple conditions to ensure that they received same-day call-backs from their regular GP wherever possible.

Updated 28 April 2017

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 comparable with local and national averages.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

• Data showed 80% of eligible women had received a cervical screening test compared with the local average of 83% and national average of 81%.

• Appointments were available outside of school hours and the premises were suitable for children and babies. Young children who were ill were always seen and the practice used a sepsis screening tool to help identify this condition.

• The practice provided facilities for baby changing and mothers wishing to breastfeed.

• The practice offered 24 hour and 6 week baby checks.

• We saw examples of joint working with midwives, health visitors and school nurses. The practice informed the health visitor of new child registrations and relevant safety alerts.

• The practice provided a room for antenatal visits so pregnant women could be seen at the surgery.

Updated 28 April 2017

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. It had a register of those patients who were housebound and provided vaccinations at home when necessary.

• The practice had identified those older patients at high risk of hospital admission and had developed care planning which identified key health problems and their ongoing management. Special notes were included on records for out of hour’s services to avoid unnecessary or inappropriate hospital admissions.

• The practice provided care for approximately 100 patients living in a local care home some of whom were receiving end of life care. A named GP attended the home on a weekly basis to do a ward round offering continuity of care for the patients.

Updated 28 April 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 offered online services as well as a full range of health promotion and screening that reflected the needs for this age group.

• The telephone triage system helped patients obtain advice and if necessary a same day appointment.

• Bookable telephone consultations were available.

• The practice offered a travel vaccination service.

Updated 28 April 2017

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

• 97% of patients with severe mental health problems had a comprehensive agreed care plan documented in their records compared with the local average of 95% and national average of 89%. Alerts on their records meant that they were routinely offered longer appointments and annual health checks with a GP or Mental Health Facilitator

• 80% of patients living with dementia had a face-to-face care review in the previous 12 months, compared with the local average of 87% and national average of 84%.

• The practice carried out advance care planning for patients with dementia which included appropriate end of life care plans.

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

• The practice had told patients experiencing poor mental health and where appropriate their carers 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 knew many of the patients well and an understanding of how to support patients with mental health needs and those living with dementia. For example, whether a patient preferred an appointment at a quieter time of day.

Updated 28 April 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 carers, people with a learning disability (LD), people who were housebound and those with alcohol or substance misuse problems.

• The practice offered longer appointments for patients, for example, those with serious mental health issues and those 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.

• The practice had identified 87 or 1% of its patients over 18 who had caring responsibilities. They were offered a referral to local support services for a carer assessment, and given information about local authority services such as First Contact, which could offer practical assistance with a variety of housing and other matters. There was also information available in the waiting area and on the website. The practice had recognised that it was very likely that more patients than recognised had a caring responsibility and was actively trying to encourage more carers to identify themselves to the practice, for example, by working with the PPG with awareness displays in the surgery. There was also information on the web site about support for young carers.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of concerns and how to contact relevant agencies in normal working hours and out of hours.

• The practice had a named safeguarding lead.