Dr Miles and Partners Also known as Wye Surgery

Updated 16 January 2017

Drs Miles, Fox and Di Biasio (also known as Wye Surgery) are a well established doctor’s practice with a purpose-built surgery, near Ashford in Kent. Their rural, training and dispensing practice covering 125 square miles with a catchment area of approximately 8,477 patients and provide a wide range of medical support services for all the family, with easy parking and full disabled access. The practice building is arranged over two storeys, with all the patient accessible areas being located on the ground floor.

The practice is in one of the least deprived areas of Kent and the ethnicity of the local population is White British. The practice is similar to the national averages for each population group. For example, 5.1% of patients are aged 0 - 4 years of age compared to the clinical commissioning group (CCG) average of 6% and the national average of 5.9% and 33% are 5 to 18 years of age compared to the CCG average of 35% and the national average of 33%. Scores were similar for patients aged 65, 75 and 85 years and over.

The practice provided care and treatment for 28 patients who lived in a residential home, who often had complex needs, dementia and were vulnerable. The practice offered a weekly ward round to the care home and unlimited telephone consultations.

The practice is able to provide dispensary services to over 3,500 patients who live more than one mile (1.6km) from their nearest pharmacy premises. This service is delivered by a team of eight qualified dispensers. A delivery service is provided for housebound and vulnerable patients.

The practice holds a General Medical Service contract and consists of three partner GPs (male). The GPs are supported by four female salaried GPs, a nurse practitioner, four practice nurses (female), two healthcare assistants (female), a practice manager supported by an assistant practice manager (head of administration and reception), as well as two heads of department (dispensary and nursing). The clinical team are supported by a team of receptionists, administrators, medical secretaries and dispensers.

The practice is an approved host for NHS outpatient clinics and services in East Kent. All of these consultant led clinics are fully integrated with secondary care. The GP’s ensure patients have had all the necessary diagnostic checks, so there is no need for second scans, blood tests or ECGs before seeing the consultant at the surgery. The consultant or specialist has full access to the GP records including investigations and waiting lists; the practice see this as a great advantage when compared to hospital outpatients where consultants would only see the referral letter. Should the patient require a hospital procedure then the consultant can list directly and offer patients a choice of hospital.

The practice is a training practice which takes foundation year three registrar GPs and has two trainee GP Registrars working at the practice. The practice regularly host student nurses and paramedic practitioner placements.

Drs Miles, Fox and Di Biasio (also known as Wye Surgery) is open Monday to Thursday 8.30am to 7pm and Friday 8.30am to 5.30pm. GP telephone access appointments are available morning and afternoon, whereby a doctor will aim to call the patient back usually within the hour or at a later time to suit the patient.The practice operates a duty doctor system to ensure there is GP cover from 6pm to 6.30pm and urgent and emergency cases, as well as test results are monitored and responded to appropriately.

The practice have a contract with IC24 who manage all the out of hours calls. The practice operates a duty doctor system to ensure there is GP available to deal with all urgent out of hour calls forwarded to them by IC24.

Services are provided from:

• Drs Miles, Fox and Di Biasio, Wye Surgery, Oxenturn Road, Wye, Ashford, Kent,

  TN25 5AY

Updated 16 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Miles, Fox and Di Biasio on 31 August 2016. Overall the practice is rated as outstanding.

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 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.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. There was a very wide range of services, clinical and non-clinical. The practice was a Multi-speciality Community Provider with an ethos to bring services to the patient rather sending patients to the service.
• 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 worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.The practice was an approved host for NHS outpatient clinics and services in East Kent and a wide range of services and clinics are offered in the practice.
• The practice was part of a vanguard site combining with other providers to deliver services across a substantial area of East Kent.
• 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 practice had strong and visible clinical and managerial leadership and governance arrangements.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw areas of outstanding practice:

• Wye Surgery was one of the first practices chosen to roll out this service.For example, the Community Tele-Dermatology service ( which had reduced referrals by 40%. The practice was proactive in reducing medicines waste. An audit of repeat ordering of prescriptions had identified significant cost savings that could be made, if patients were directly involved in the ordering process and were educated to only order what they needed. In line with Better health Better care and Social prescribing initiatives, the practice met with the secretary of the programme management group for ‘Our Place Wye’ (OPW) to help coordinate social support for isolated people. Another new initiative in the village was the ‘Wye Shed’ project; men would meet in a shed for a cup of tea and chat, maybe learn new skills off of each other or repair tools.
• The practice had employed a senior district nurse care coordinator who visited patients to ensure they received the best possible support and prevent unplanned admissions.

The areas where the provider should make improvement are:

• Continue to ensure that the dosage, type, batch number and expiry date of local anaesthetic given is being recorded into patient’s notes.
• Revise the system that identifies patients who are also carers to help ensure that all patients on the practice list who are carers are offered relevant support if required.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 January 2017

The factors that led to the practice being rated as outstanding overall applied to all the population groups, therefore the practice is rated as outstanding 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 were lower the local and national average. For example, 69% of patients with diabetes, on the register, in whom the last IFCCHbA1c is 64 mmol/mol (a blood test to check blood sugar levels) or less in the preceding 12 months (local average 79% and national average 78%).

• 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 16 January 2017

The factors that led to the practice being rated as outstanding overall applied to all the population groups, therefore the practice is rated as outstanding 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 people who had a high number of accident and emergency (A&E) attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• 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 81%, which was comparable to the national average.

• 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.

Updated 16 January 2017

The factors that led to the practice being rated as outstanding overall applied to all the population groups, therefore the practice is rated as outstanding for the care of older patients.

• 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 care and treatment for 28 patients who lived in a residential home, who often had complex needs, dementia and were vulnerable. The practice offered a weekly ward round to the care home and unlimited telephone consultations.

• The practice was able to provide dispensary services to over 3,500 patients who lived more than one mile (1.6km) from their nearest pharmacy premises. This service was delivered by a team of eight qualified dispensers. A delivery service was provided for housebound and vulnerable patients.

• The practice had employed a senior district nurse care coordinator who visited patients to ensure they received the best possible support and prevent unplanned admissions. This role was first introduced as a Clinical Commissioning Group (CCG) funded Over 75s scheme but having seen the value, the practice made the decision to continue and expand this service even after funding was withdrawn. One GP told us that having the care coordinator freed up valuable time for GPs to do other things, as the care coordinator would carry out home visits and produce care plans for patients as and when needed.One GP told us about one patient who was facing considerable life style changes due to their diagnosis and that they had received many visits from the care coordinator to ensure that they were taking their medication correctly and that they had been able to access the services available to them, this would otherwise have been done by a GP during a home visit or potentially admitted to hospital as an unplanned admissionThe scheme was on-going and the outcomes have not yet been fully assessed, however, the practice hope to demonstrate a reduction in unplanned admissions as well as improvements in the quality of care for patients living in their own homes.

• The practice offered proactive, personalised care to meet the needs of the older people in its population. It had a scheme for patients, who lived in a local residential care home. This involved registering all the patients (with their consent) with one of two lead GPs who looked after that home. Weekly and as required visits to the residential home were conducted.

Updated 16 January 2017

The factors that led to the practice being rated as outstanding overall applied to all the population groups, therefore the practice is rated as outstanding 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 remained open throughout the day and offered extended opening hours.

• 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.

Updated 16 January 2017

The factors that led to the practice being rated as outstanding overall applied to all the population groups, therefore the practice is rated as outstanding for the care of people experiencing poor mental health (including people with dementia).

• 74% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.

• Performance for mental health related indicators were similar to the national average. For example, 63% of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (local average 89% and national average 89%), which is comparable to other practices.

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

• The nurse care coordinator oversaw the care of those living in the community with dementia. She worked closely with ‘Our Place Wye’.

• The practice involved the memory clinic for those with dementia to co-ordinate testing, diagnosis and support services.

• Those recently discharged from hospital received a follow up call.

• 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 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 16 January 2017

The factors that led to the practice being rated as outstanding overall applied to all the population groups, therefore the practice is rated as outstanding for the care of people whose circumstances may make them vulnerable.

• In line with Better health Better care and Social prescribing initiatives, the practice met with the secretary of the programme management group for ‘Our Place Wye’ (OPW) to help coordinate social support for isolated people. Support now included a befriending service, weekly lunch, and support for half a day from a volunteer council coordinator for either shopping, dog walking, befriending or taking to local appointments.Another new initiative in the village was the ‘Wye Shed’ project; men would meet in a shed for a cup of tea and chat, maybe learn new skills off of each other or repair tools. Currently, six men meet on a regular basis. One of the aims of the “Wye Shed Project” was to try and combat loneliness in the elderly and to reach out to men who were not always the easiest to engage with and could shy away from medical and social initiatives.

• The practice held a register of patients living in vulnerable circumstances including those with dementia, frailty, blindness, deafness, a learning disability and those with a carer.

• 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.