Whitchurch Surgery

Updated 1 June 2017

Whitchurch Surgery is located at Bell Street, Whitchurch RG28 7AE. There are currently around 8,700 patients registered with the practice.

Whitchurch Surgery is part of the West Hampshire Clinical Commissioning Group. The practice building is purpose built with wheelchair access to all areas including toilets for the disabled and there are two designated disabled parking bays directly outside the front door. The practice has a medicine dispensary and is a training practice for newly qualified doctors. Whitchurch Surgery is part of the Two Rivers Partnership that covers the populations of Whitchurch, eastern Andover and the surrounding rural areas. The local population falls into the least deprived decile but there are a higher than average percentage of patients with a long term health condition.

Since the previous inspection in August 2016 the practice has recruited two additional clinical staff – a part time advanced nurse practitioner and a part time practice nurse. Therefore the total staff at the practice now includes three male GP partners, one female salaried GP, a practice manager, four advanced nurse practitioners, two practice nurses, two health care assistants, a phlebotomist, two pharmacy dispensers and nine reception and administrative staff.

Whitchurch Surgery is open from Monday to Friday between 8am and 6.30pm. The practice offers extended opening hours on alternating Monday evenings and one Saturday morning per month.  These appointments are pre-bookable only. When the practice is closed the patients are requested to call the NHS 111 service.

Updated 1 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Whitchurch Surgery on 10 August 2016. The practice was rated good for effective, caring, responsive and well-led, and was rated requires improvement for safe. The overall rating for the practice was good. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Whitchurch Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 12 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 10 August 2016. This report covers our findings in relation to those requirements.

At our previous inspection on 10 August 2016, we rated the practice as requires improvement for providing safe services as the practice was not operating an adequate system with regards to water safety; there was no system in place to track blank prescription forms and pads and monitor their use; not all staff had up to date training with regards to infection control and prevention.   

It was also noted on the previous inspection that the practice should ensure that dispensary staff had the correct qualifications and that there were embedded systems in place for monitoring the dispensing process. It was noted that there was no designated sink for use in the dispensary for the hygienic preparation of medicines, cleaning and hand washing and no standard operating procedures in place to reflect current good practice in the dispensary processes. The practice was also asked to consider how to ensure greater privacy for patients at the reception area and consider how to improve patient outcomes for those with long term conditions.  

Our key findings for 12 April 2017

• We found that there were processes in place for ensuring water safety at the practice.

• The practice had systems in place to track prescription storage and usage.

• All staff had received up to date and formal training with regards to infection control and prevention.

• Steps were being taken to remedy the problems with privacy for patients at the reception area with some work already undertaken to reduce the risk of being overheard.

• The dispensary had fully qualified and experienced staff and was evidenced to have quality processes in place to maintain and improve the dispensary processes.

• Patients with long term conditions now have more support with a dedicated lead GP for each type or group of conditions and a lead nurse has undertaken an extensive review programme.  A revised recall system was introduced that operated more on patient need.

   

  The practice is now rated as good for providing safe services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 October 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 and patients at risk of hospital admission were identified as a priority. Disease and condition specific clinics as well as multi-morbidity reviews with nurses or GPs took place.
• 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.
• Regular medication reviews, including pharmacist polypharmacy reviews took place. GPs had protected repeat prescribing time.
• Clinical audits took place regarding specific long-term conditions, for example asthma.
• Data from the Quality and Outcomes Framework (QOF) 2014/2015 showed patient outcomes for those with long term conditions were similar or worse than the local and the national average. The practice had identified this as an area for improvement and had taken actions to improve their performance. For example by revising the protocol for the management of long term conditions and changing the patient re-call system for patient health and medicines reviews.

Updated 13 October 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. The practice had a lead person designated for safeguarding children. There was a protocol for managing urgent safeguarding requests and the practice monitored its activity regarding the safeguarding of children.
• The practice provided flexible childhood immunisations clinics and the immunisation rates were relatively high for all standard childhood immunisations.
• The practice’s uptake for the cervical screening programme was 80%, which was comparable to the clinical commissioning group (CCG) average of 82% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice was engaged with health visitors and midwifery teams. Routine safeguarding children meetings took place that the health visitor attended and clinics were run by the midwife for patients within the practice.
• Post-natal and six week baby checks were offered and there was regular contact with health visiting team via the booking of the baby checks.

Updated 13 October 2016

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. People aged over 75 had a named GP.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Multidisciplinary team meetings took place on alternate weeks and older people in need were referred to community and social services.
• Hospital admission avoidance care planning and reviews took place.
• The practice supported a local nursing home and provided weekly ward rounds by one pod (a GP and a nurse). The practice also organised for the community support pharmacist to perform polypharmacy reviews at the nursing home.
• The practice signposted patients to a directory of local services on their website which included befriending services, support for carers, help at home and guidance of personal wellbeing.
• The practice participated in a local project called “Two Rivers Stay Connected Programme” which aimed to reduce the isolation of elderly people in the area by encouraging and facilitating the availability of technology and internet access.
• The practice offered an in-house podiatry service which was free to patients.

Updated 13 October 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 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.
• There was an administrative protocol for managing online queries, patients were able to book appointment and order medicines at any time. Patients were also able to ask the nurses or GPs a question via the practice’s website
• The practice also provided:
• Saturday flu clinics during flu campaigns;
• Extended hours enhanced service – early and late surgeries, including opening one Saturday a month;
• On the day minor illness and urgent same day clinics;
• Telephone consultation appointments;
• Travel vaccination clinics.

Updated 13 October 2016

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

• Data from the Quality and Outcomes Framework (QOF) 2014/2015 showed patient outcomes were worse than the local and the national average. The practice had identified this as an area for improvement and patients are now routinely re-called as part of the practice’s re-call system to ensure that patients who have historically not attended for a review/care plan were seen by their GP.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. For example with the community psychiatric nurse who carried out proactive community reviews for patients who had dementia and/or took anti-psychotic medicines. The practice was also in regular communication with the local mental health services.
• 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• The practice had arrangements for weekly medicine prescriptions for monitoring purposes and had close links with the local pharmacy.
• The practice hosted elderly mental health consultant clinics within the practice and were engaged with “iTalk” clinics.

Updated 13 October 2016

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. The practice identified children who may be at risk and alerts were put on to patient records. Regular meetings were held with the health visitor to discuss children who may be at risk and specific patient issues were discussed with all clinicians. Clinicians also met at the end of each session for a patient review with Nurse Practitioners to discuss any concerns.
• At risk patients and their cares and families were discussed at the practice’s “virtual ward” meetings. Details were recorded on clinical records and the meeting was a platform for any member of the multi-disciplinary team to raise issues and directly refer to community and social services. Staff demonstrated they understood their responsibilities and all had received training on safeguarding children and vulnerable adults.
• The practice offered longer appointments for patients with a learning disability and for patients with complex needs.
• 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.
• Patients were offered chaperones.