Archived: Belvoir Vale Surgery

Updated 10 December 2015

Belvoir Vale Surgery is a small practice which provides primary medical services to approximately 3,370 patients. The practice dispenses medicines to patients who live more than one mile from the surgery.

At the time of our inspection the practice employed one GP partner (male), a Practice Manager partner, one salaried GP(female) , one locum GP (female), one Information technology supervisor, two practice nurses, two dispensers, reception and administration staff.

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

The practice has one location registered with the Care Quality Commission (CQC) which is Belvoir Vale Surgery, 17A Walford Close, Bottesford, Nottinghamshire. NG13 0AN

Belvoir Vale Surgery is open from Monday 8.30am to 7.30pm, Tuesday, Wednesday, Thursday and Friday 8.30am to 6.30pm. Patients can book appointments by phone, online or in person.

The practice has an open surgery every morning 8.30am to10am. Appointments are available Wednesday 8.30am to 11am and 8.30am to 10.50am on a Friday. Afternoon appointments are available Monday to Friday from 3.20pm to 5.50pm. Nurse appointments are available 8.30am to 12 midday and 3pm to 5.50pm Monday to Friday.

Appointments could be booked up to four weeks in advance.

Extended hours are available on Monday evenings between 6.30pm and 7.30pm. These appointments were particularly useful to patients with work commitments.

The practice is located within the area covered by NHS SouthWest Lincolnshire Clinical Commissioning Group (SWLCCG). The CCG is responsible for commissioning services from the practice. A CCG is an organisation that brings together local GP’s and experience health professionals to take on commissioning responsibilities for local health services.

NHS South West Lincolnshire Clinical Commissioning Group (SWLCCG) is responsible for improving the health of and the commissioning of health services for 128,000 people registered with 19 GP member practices and the surrounding villages.

The practice had a website which we found had an easy layout for patients to use. It enabled patients to find out a wealth of information about the healthcare services provided by the practice. Information on the website could be translated by changing the language options. This enabled patients where English is not their first language to read the information provided by the practice.

We inspected the following location where regulated activities are provided: - Belvoir Vale Surgery, 17a Walford Close, Bottesford, Nottinghamshire. NG13 0AN

Belvoir Vale Surgery had opted out of providing out-of-hours services (OOH) to their own patients. The OOH service is provided by Lincolnshire Community Health Services NHS Trust. There were arrangements in place for services to be provided when the practice is closed and these are displayed on the practice website.

We spoke with the management team in regard to the practice’s registration certificate. The practice were registered with the Care Quality Commission but the certificate had not been updated since the retirement of a GP partner. We spoke with the management team who told us the relevant forms had now been submitted to progress a new registration certificate.

Updated 10 December 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Belvoir Vale Surgery on 20 October 2015. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 95% of patients who completed the national patient survey described their experience of making an appointment as good compared with a CCG average of 73% and a national average of 73%.

• Patients comments cards we reviewed were overwhelmingly positive about the excellent care received by all members of the practice team.

• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that 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.

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

Importantly the provider should

• Ensure CQC registration is up to date and correct in regard to registration of the practice.
• Consider incidents which occur in the dispensary are recorded as significant events when in line with practice policy.
• Put in place a separate policy for the management, testing and investigation of legionella to provide guidance to staff.

• Put a system in place to ensure full clinical audit cycles have been completed.
• Within the Business Continuity Plan ensure mitigating risks and actions are included.
• Embed a system where fridge temperatures in treatment rooms are reset in line with practice policy.
• Ensure that nursing staff who act as a chaperone have received appropriate training.
• Improve the system for the identification of carers and vulnerable patients.
• Have a system in place to ensure that care plans are routinely used for end of life patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 December 2015

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.

95.5% of patients with diabetes had received an annual medication review. The practice hosts the diabetic screening retinopathy van in order for patients to receive the screening nearer to home. The practice uptake for diabetic eye screening was 84% which was above the CCG average of 83.3% and national average of 80%. The practice have produced a diabetes information leaflet for patients which gives information on diabetes. It also informs them on what they can expect from the practice, for example, an annual health check, referral for an exercise plan or a specialist referral to more in-depth information.

89% of patients with asthma had received an annual medication review.

97% of patients with chronic obstructive pulmonary disease (COPD) had received an annual medication review.

92% of patients on three medicines or more had received a medication review.

Longer appointments and home visits were available when needed. All these patients had a named GP and had a six month review followed by a more structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 10 December 2015

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 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. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses. A GP was a breastfeeding peer support counsellor and offered support and advice to new mothers.

Updated 10 December 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice had 365 patients over the age of 75. Information about patients’ outcomes were used to make improvements, for example, 2.5% of the practice population had received opportunistic screening for Atrial Fibrillation (AF).

The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care.

The practice had a register for patients who received end of life care. We found good examples of communication documented on the electronic patient records between the practice and members of the multi-disciplinary team, for example, Macmillan nurses. However we found that care plans were not routinely used for this group of patients.

It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Updated 10 December 2015

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.

The practice’s uptake for the cervical screening programme was 88.4%, which was comparable to the CCG average of 80.9%. The practice also encouraged its patients to attend national screening programmes for bowel and breast cancer screening. The practiced uptake for bowel screening was 58.9% which was slightly below the CCG average of 60.8%. The uptake for breast cancer screening was 80.9% which was above the CCG average of 75.8% and national average of 70%.

51% of eligible patients had received an NHS Health check.

Updated 10 December 2015

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

100% of people experiencing poor mental health had received an annual review.

The practice had recognised that they had low numbers of patients with dementia. In conjunction with the Clinical Commissioning Group (CCG) they now have the CANTAB tool for early identification of dementia. They also have plans to work with the Alzheimer’s Society to provide training and produce information for patients registered with the practice.

Members of the practice staff had become Dementia Friends. This meant they had learnt about what it is like to live with dementia. They were able to support patients registered with the practice who had dementia. 89.5% of patients who have dementia had received an annual review.

72.4% of patients who have depression have received an annual review.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

Updated 10 December 2015

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 homeless people, travellers and those with a learning disability.

87.5% of patients who had a learning disability had received an annual review.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations, for example, Drug and Alcohol Recovery Team (DART) and Addaction.

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.