Archived: Lydbrook Health Centre

Updated 6 June 2016

Lydbrook Practice is situated in Upper Lydbrook, Gloucestershire which is a rural area in the Forest of Dean. The practice is one of two locations the provider has, the second larger practice is Brunston practice which is located in the town of Coleford five miles away. Due to the practices being registered separately Brunston practice was inspected in 2015 and we were inspecting Lydbrook practice only. Lydbrook is a dispensing practice.

The practice provides general medical services to approximately 5,800 patients. Services to patients are provided under a General Medical Services (GMS) contract with NHS England. (A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract).

The practice consists of five GP partners of which there are three male and two female GPs. The practice is supported by three practice nurses (all female), two phlebotomists (obtaining blood samples for testing) and six dispensary staff. The administration team includes a practice manager, a deputy practice manager and a team of administration staff. All of the GPs and staff work across the two practice locations.

The practice population has a higher proportion of patients aged between 65 and 74 compared to local and national averages. For example, 23% of practice patients are aged between 65 and 74 compared to the local clinical commissioning group (CCG) average of 20% and the national average of 17%. Of the working population 2% were unemployed which is below the national average of 5%.

The practice is located in an area with low social deprivation. The prevalence of patients with a long standing health condition is 58% compared to the local CCG average (55%) and national average (54%). People living in more deprived areas and with long-standing health conditions tend to have greater need for health services.

Lydbrook practice reception is open between 8.30am and 6pm on Monday to Friday. Emergency appointments are available Monday to Friday between 8am to 8.30am, 1pm to 2pm and 6pm to 6.30pm. Routine appointments are available from 8.30am to 12.30pm Monday to Friday and 3pm to 5.30pm Monday and Tuesday. Afternoon appointments are available Wednesday to Friday at Brunston Practice in Coleford. The practice telephone system allows the practice to answer calls and deal with patient queries at both practices. Patients calls are automatically directed to the practice number they have dialled however, if the phone lines are busy then they are redirected to the other practice.

Out of hours cover is provided by South Western Ambulance Service NHS Foundation Trust and can be accessed via NHS 111.

The practice provided its services from the following address:

Lydbrook Practice

Upper Lydbrook

Gloucestershire

GL17 9LG

This was the first inspection of Lydbrook Practice.

Updated 6 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lydbrook Practice on 12 May 2016. Overall the practice is rated as good.

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 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.

The areas where the provider should make improvement are:

• Ensure there is a robust and consistent system in place for signing in returned controlled medicines.

• Ensure actions are taken to improve patient satisfaction on access to the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 June 2016

The practice is rated as good for the care of patients 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 overall diabetes related indicators in 2014/15 was 91% which was below the clinical commissioning group average of 95% and above the national average of 89%.

• 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.

• Multidisciplinary meetings were held every fortnight with community based staff.

Updated 6 June 2016

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

• 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 patients who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The practice’s uptake for women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years in 2014/15 was 83% which was comparable to the clinical commissioning group average of 84% and the national average of 82%.

• 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 through minutes of regular safeguarding meetings.

• The practice have set up social media accounts to engage young patients.

Updated 6 June 2016

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

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• The practice have been selected to take part in a pilot scheme with Carer’s Gloucestershire and the clinical commissioning group to actively search for those patients who are a carer and refer them for a Carer’s Assessment with Carer’s Gloucestershire. The practice had been nominated for a Carer’s Award.

• The practice held fortnightly meetings with community based staff to discuss the care of patients in this population group including those receiving palliative care.

Updated 6 June 2016

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 online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• The practice did not offer extended hours appointments; however due to having two sites (Brunston practice at Coleford and the branch practice at Lydbrook which we inspected) patients had flexibility and choice of appointments.

Updated 6 June 2016

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

• 95% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months (04/2014 to 03/2015), which is above both the clinical commissioning group average (CCG) of 86% and the national average of 84%.

• Performance for mental health related indicators was 100% compared to the CCG average of 97% and national average of 82%.

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

• 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 in place 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 and all staff had received dementia awareness training.

Updated 6 June 2016

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

• The practice held a register of patients living in vulnerable circumstances including homeless and those with a learning disability. The practice care for patients from two local learning disability care homes.

• 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 and held fortnightly multi-disciplinary meetings to highlight any patients of concern or any safeguarding issues.

• 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.

• The practice participated in a local social prescribing initiative.