Archived: Ledbury Market Surgery

Updated 2 February 2017

Ledbury Market Surgery is a small single storey, purpose built, building in the market town of Ledbury. At the time of the inspection the practice served a population of 4,797 patients in the town. The practice is an active member of the Herefordshire Clinical Commissioning Group (CCG) and the GP federation. A federation is formed of a group of practices who work together to share best practice and maximize opportunities to improve patient outcomes. The practice patient group is one of lower than average deprivation with a larger population of older people compared with the county average.

There are three male GP partners and two female salaried GPs at the practice. The GPs are supported by a practice manager, two practice nurses, two healthcare assistants, administration staff, reception staff and a cleaner.

Opening hours are from 8am to 6pm on Monday to Friday each week with appointments between these times. A contract is held with Herefordshire CCG to provide cover from 6pm to 6.30pm daily. The practice is closed at weekends.

The practice is part of the local Prime Minister’s GP Challenge Fund service for extended opening hours to improve access for patients. These are available late evening and at weekends at nearby practice hubs in Hereford, Ross on Wye and Leominster.

The practice does not provide an out-of-hours service but has alternative arrangements for patients to be seen when the practice is closed. For example, if patients call the practice when it is closed, an answerphone message gives the telephone number they should ring depending on the circumstances. Information on the out-of-hours service (provided by Primecare) is available in the patient practice leaflet. The practice does not have a website but ensures that information on NHS Choices web pages is kept up to date.

Home visits are available for patients who are housebound or too ill to attend the practice for appointments. There is also an online service which allows patients to order repeat prescriptions and to view medical records.

The practice has a General Medical Services (GMS) contract with NHS England. The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities. The practice also provides minor surgery.

The practice treats patients of all ages and provides a range of medical services. This includes disease management such as asthma, diabetes and lung diseases. Other appointments are available for health checks, childhood vaccinations and contraception advice.

Trainee nurses currently on placement at the practice are mentored by the practice nurses.

Updated 2 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ledbury Market Surgery on 24 November 2016. The overall rating for this service is good.

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

• The practice was aware of and provided services according to the needs of their patient population.
• Patients told us they were treated with dignity and respect and that they were fully involved in decisions about their care and treatment.
• There were processes and procedures to keep patients safe. This included a system for reporting and recording significant events, keeping these under review and sharing learning where this occurred.
• Staff received regular training and skill updates to ensure they had the appropriate skills, knowledge and experience to deliver effective care and treatment.
• Regular meetings and discussions were held with staff and multi-disciplinary teams to ensure that patients received the best care and treatment in a coordinated way.
• There was a clear leadership structure and staff told us they felt supported by management.
• The practice was aware of the requirements of the duty of candour and systems were ensured compliance with this.
• There was a culture of openness and accountability.
• The practice had an active Patient Participation Group (PPG). The PPG was proactive in representing patients and assisting the practice in making improvements to the services provided.
• Information about services and how to complain was available and easy to understand. Patients told us that they knew how to complain if they needed to.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 February 2017

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

• The practice nurses had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Nursing staff had received appropriate training in chronic disease management, such as asthma and diabetes.
• Longer appointments and home visits were available when needed.
• All patients diagnosed with a long term condition had a named GP and a structured annual review to check that their health and medicine needs were being met.
• Clinical staff had close working relationships with external health professionals to ensure patients received up to date care.
• NHS health checks were offered for early identification of chronic disease and there was proactive monitoring.
• The practice patient leaflet provided information about other organisations and websites patients could access.

Updated 2 February 2017

The practice is rated as good for the care of families, children and young people.

• Same day appointments were offered to all children under the age of five.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• There were systems to identify and follow up children living in disadvantaged circumstances and who were considered to be at risk of harm. For example, children and young people who had a high number of accident and emergency attendances.
• The practice worked with midwives and health visitors to coordinate care.
• Performance for cervical screening indicators was in line with Clinical Commissioning Group (CCG) and national averages. For example, the percentage of women aged 25-64 who attended for a cervical screening test in the last five years was 80% compared with CCG and national averages of 81% and 82%.
• The practice nurses had oversight for the management of a number of clinical areas, including immunisations, cervical cytology and some long term conditions.
• Childhood immunisation rates for the vaccinations given were comparable to local and national averages.
• The practice offered a number of online services including requesting repeat medicines and booking appointments.

Updated 2 February 2017

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

• The practice offered personalised care to meet the needs of the older people in its population. It was responsive to the needs of older patients.
• Home visits and rapid access appointments were offered for those patients with enhanced needs.
• The practice offered a range of enhanced services, for example, in dementia and end of life care.
• Nationally reported data showed that outcomes for patients were above local and national standards for conditions commonly found in older patients.

Updated 2 February 2017

The practice is rated as good for the care of working-age patients (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 a full range of health promotion and screening services that reflected the needs of this age group.
• Health promotion advice was offered such as smoking cessation and nutrition.
• The practice offered online appointment booking and the facility to request repeat prescriptions online.

Updated 2 February 2017

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

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• Advanced care planning and annual health checks were carried out for patients with dementia and poor mental health.
• Nationally reported data showed that outcomes for patients were above national average for conditions commonly found for patients with poor mental health.
• 95% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was 12% above the Clinical Commissioning Group (CCG) average and 13% above the national average.
• Patients experiencing poor mental health were advised how to access various support groups and voluntary organisations. There was a system to follow up patients who had attended accident and emergency departments where they may have been experiencing poor mental health.
• Clinical staff were trained to recognise patients presenting with mental health conditions and to carry out comprehensive assessments.

Updated 2 February 2017

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

• Staff had been trained to recognise signs of abuse in vulnerable adults and children and the action they should take if they had concerns. There was a lead GP for safeguarding adults and children. GPs were trained to an appropriate level in safeguarding adults and children. All safeguarding concerns were discussed at the weekly GP meetings.
• The practice held a register of patients living in vulnerable circumstances including those patients with a learning disability.
• Longer appointments were available for patients with a learning disability. The practice had carried out annual health checks for all 16 of the patients on their register for 2015/2016.
• Vulnerable patients were informed how to access various support groups and voluntary organisations.
• Sign language interpreters could be booked for face-to-face consultations for patients with hearing impairments.
• Clinical staff regularly worked with multidisciplinary teams in the case management of vulnerable patients. Alerts were added to patients records for staff awareness so that longer appointments could be allocated.