Lyndhurst Surgery

Updated 20 December 2016

Lyndhurst surgery is located in a purpose built, single storey building at 2 Church Lane, Lyndhurst, Hampshire SO43 7EW. It is situated just off the high street close to the town’s municipal car park. The practice has approximately 5300 registered patients

Lyndhurst surgery is registered with the Care Quality Commission as a partnership provider. The practice holds a General Medical Services contract with NHS England and is part of the NHS West Hampshire Clinical Commissioning Group. The population distribution shows the practice has 4% of patients over 85 years of age which is higher than the national average of 2% and CCG average of 3%. The practice is in a less deprived area and has lower unemployment when compared to the national average. The male life expectancy for the area is 82 years compared with the CCG average of 81years and the national average of 79 years. The female life expectancy for the area is 84 years compared with the CCG average of 85 years and the national average of 83 years.

The practice is owned and managed by a team of four GP partners, one of whom is male and three are female. The combined hours worked by the GPs equated to 2.3 whole time equivalent GPs. The partners are assisted by three female practice nurses and one phlebotomist, a practice manager, a deputy practice manager, two medical secretaries and a team of administration and reception staff. The practice is a recognised GP training practice for doctors training to be GPs (registrars). Three of the GPs at the practice are approved GP trainers and at the time of the inspection were supporting two trainees.

The practice is open from 8.30am until 6.30pm every day except Tuesday when it opens at 9.30am due to staff training. Phone lines are open from 8am until 6.30pm Monday to Friday. It is closed at the weekend and at lunch time between 1pm and 2pm but the phone lines remain open during this lunchtime period. There are appointments available two evenings a week until 8.30pm. These appointments are usually for people who would otherwise find it difficult to see a GP during normal opening hours. Nursing services are not provided during extended opening hours. There is level access to the building and a disabled toilet near the entrance

The practice provides out-of-hours services to their patients from 8am until 8pm each day of the week as part of an agreement with six other local GP practices. Patients requiring care outside of 8am and 8pm are referred to the NHS 111 service. The practice offers online facilities for booking appointments and for requesting prescriptions. The practice also offers an online GP consultation service.

Lyndhurst Surgery has not previously been inspected by the Care Quality Commission. The practice is registered to provide the following regulated activities; diagnostic and screening procedures, treatment of disease, disorder or injury, surgical procedures, maternity and midwifery services and family planning.

Updated 20 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Lyndhurst Surgery on 21 September 2016. Overall the practice is rated as Good.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Our key findings 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.
• 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.
• 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.

There were areas of practice where the provider needs to make improvements.

The provider should:

• Review emergency equipment to ensure the most effective equipment is available for children requiring oxygen in emergency situations.
• Review arrangements for effective communication with those patients who had hearing loss and who used a hearing aid.
• Review information provided following complaints in regard of escalating complaints if complainants are dissatisfied with the practices response.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 December 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 including diabetes, asthma, and chronic obstructive pulmonary disease (COPD).
• Performance for the five diabetes related indicators were comparable or better than the local and national averages. For example, the percentage of patients with diabetes, on the register, in whom an acceptable blood pressure reading was recorded was 89%, which was higher than the clinical commissioning group (CCG) 77%, and national average of 78%

• Patients had a structured annual or biannual review to check their health and medicines needs were being met.
• There were twice weekly diabetes, asthma and COPD clinics. Patients had access to both face to face reviews and telephone contact.

Updated 20 December 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 on child protection plans.
• There was positive liaison with the health visitor and school nurse and a baby clinic was offered once a fortnight.
• The practice offered family planning and contraceptive services including implant fitting and coil insertion.

Updated 20 December 2016

The practice is rated as good for the care of older people.

• The practice offered proactive personalised care to meet the needs of older patients and referred and signposted these patients to relevant local services
• The practice was responsive to the needs of older people by offering home visits and urgent appointments for those with enhanced needs. Doctors visited local nursing and dementia care homes on a weekly basis
• The practice used a ‘red flag’ alert system on the patients’ notes to indicate the most vulnerable patients so that reception staff could allocate an urgent appointment when patients contacted the surgery.
• There were twice monthly meetings with the primary care team to discuss vulnerable older people and share information so care was appropriate.
• The practice worked closely with the Care Navigator to provide support for patients with social needs. Care Navigators are employed by New Forest Healthcare Ltd which is a collaboration between 17 GP practices across the New Forest area. Care Navigators support, signpost and assist the frail elderly over 75 years of age with the aim of preventing hospital admission. The Care Navigator was an integral member of the practice team and GPs were able to directly refer patients to them. An evaluation of the effectiveness of this service and how hospital admissions were avoided was in the process of being undertaken.
• The practice offered a monthly hearing aid battery replacement service.

Updated 20 December 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 surgery had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. For example, students attending university were able to stay registered at the practice.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
• The practice offered extended hours two evenings a week with appointments available until 8.30pm.
• The practice provided NHS health checks for patients aged 40-74

Updated 20 December 2016

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

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• Performance for poor mental health indicators was in line with or better than local and national averages. For example, 94% of patients with enduring poor mental health had a recent comprehensive care plan in place compared with the CCG and national average of 88%.

• The practice encouraged patients to access local support groups and voluntary organisations, for example the ITalk counselling service (italk is a free service for people suffering from depression and anxiety. It is part of an Improving Access to Psychological Therapies (IAPT) service offered in Hampshire).

Updated 20 December 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice had a lead GP for patients with a learning disability and offered an annual review to these patients.
• The practice regularly worked with multi-disciplinary teams 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.