Stock Surgery

Updated 18 August 2016

Stock surgery is a three doctor dispensing practice providing medical services to about 4,000 patients living in and around the village of Stock. The practice is housed in a modern, purpose-built building, with a waiting area with many facilities for patient care. Wheelchair access is available throughout the ground floor clinical areas. There is ample car parking facilities situated adjacent to the surgery with disabled spaces located close to the entrance. At the time of our inspection, the practice list was open to new patients.

The practice has two female and two male GPs. There are four part time practice nurses and two health care assistants. There is also a practice manager, administrative and reception staff.

The practice population is slightly higher than the national average for patients over 65, 75 and 80 years. Economic deprivation levels affecting children, older people and unemployment are lower than the practice average across England. Life expectancy for men and women is slightly higher to the national averages. The practice patient list is slightly higher to the national average for long standing health conditions and lower disability allowance claimants.

The surgery is open Monday to Friday from 8am until 6.30pm. Telephone access is available from 8am. They offer both face-to-face and telephone appointments. Patients also have on line options to book appointments.

Emergency appointments are available throughout the day. The practice has opted out of providing GP out of hours services. Unscheduled out-of-hours care is provided by the NHS 111 service and patients who contact the surgery outside of opening hours are provided with information on how to contact the service. This information is also available on their website and the NHS choices website.

The practice provides the following directed enhanced services:

• Childhood immunisations and vaccinations.
• Dementia screening.
• Flu vaccinations.
• Unplanned hospital admissions avoidance.
• Improving on-line access.

Minor surgery

Updated 18 August 2016

We carried out an announced comprehensive inspection at Stock Surgery on 28 April 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. Information about safety was monitored, appropriately reviewed and addressed. Learning from when things went wrong was shared with staff through meetings and discussions.
• There were systems in place for assessing risks associated with medicines, premises, equipment and infection control.
• The practice had processes in place for monitoring dispensed medicines that were not collected from the pharmacy, particularly where patients had been identified as experiencing poor mental health.
• 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. They were complimentary about the dedication of the doctors and nurses at the surgery.

• Information about services and how to complain was available.

• The practice contributed monthly to a charity called ‘Stock cares.’ This service provided transport to medical appointments for patients who required support.

• 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 implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.

• The premises were purpose built and maintained to an acceptable standard throughout the clinical areas. Access for disabled people was in place including parking for the disabled and washroom facilities.
• 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:

• Improve the system for the identification of patients who are carers and provide them with appropriate support and guidance.

• Ensure verbal complaints are recorded to achieve wider learning.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 18 August 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.

• The practice achieved 99% for clinical indicators within QOF. This was 7% higher than the local CCG average and 5% above the national average.

• Performance for diabetes related indicators at 99.7% was above the CCG average of 79% and the national average of 89%. The level of exception reporting for diabetes patients was also noted to be lower than local and national averages.

• QOF indicators for asthma were higher than CCG and national averages. For example, 95% of patients with asthma received a review in the preceding 12 months, compared to the CCG and national averages of 88% and 89% respectively.

• All patients with a long-term condition received a structured annual review to check their health and medicines needs were being appropriately met.

• For those patients with the most complex needs and associated risk of hospital admission, the practice team worked closely with the local community health providers including the community matron and respiratory team to deliver a multidisciplinary package of care.

• Longer appointments and home visits were available when needed.

Updated 18 August 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 and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• The practice provided an online appointment booking facility and online ordering of repeat prescriptions.

• Patients we spoke with on the day, and feedback received from our comment cards, stated young people were treated in an age-appropriate way and were recognised as individuals.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The premises were suitable for children and babies. Toys were provided for children attending the surgery. Baby changing facilities were available and the practice accommodated young mothers who wished to breastfeed.

• Personal GP patient lists enabled the doctor to build family relationships, and promote continuity for patients.

• The practice held quarterly meetings with the health visitor, and also reviewed any children on a child protection plan at their own monthly clinical meeting.

• The practice provided neonatal checks, six week post-natal checks for new mothers and eight week baby checks.

• The practice’s uptake for the cervical screening programme was 90% which was above the CCG average of 81% and the national average of 82%.

Updated 18 August 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.

• Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs in order to deliver care more effectively. Monthly meetings with wider members of the healthcare team were held to review more complex and vulnerable patients.

• Each GP maintained their own personal list to promote continuity of care and to establish strong relationships with individuals and their families.

• Longer appointments were available for patients. Double or triple appointment slots could be booked for patients with complex needs.

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

• The practice contributed monthly to a charity called ‘Stock cares’ and this service provided transport for patients to medical appointments.

Updated 18 August 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.

• Telephone consultations were available each day for those patients who had difficulty attending the practice due, for example, to work commitments.

• The practice provided an online appointment booking facility and online ordering of repeat prescriptions.

• Feedback from patients was consistently positive about their experience in obtaining an appointment quickly and a time that was convenient to them. For example, the January 2016 national GP patient survey indicated that 97% of patients were able to get an appointment to see or speak to someone the last time they tried compared to a CCG average of 92% and a national average of 91%.

• A text reminder service was used to help reduce non-attendance for appointments.

• 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.

Updated 18 August 2016

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

• 80% of patients who had been diagnosed with dementia had a face to face review within the previous 12 months compared with the CCG average of 81 and national average of 84%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia for whom they carried out advance care planning.

• The practice had processes in place for monitoring prescriptions that were not collected from the dispensary, particularly where patients have been identified as experiencing poor mental health.

• Each GP maintained their own personal list to promote continuity of care and to establish strong relationships with individuals and their families.

• For patients with dementia, written consent for relatives to share in medical information and treatment planning was encouraged.

• 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.

• The practice told patients experiencing poor mental health and patients with dementia about how to access services including talking therapies and various support groups and voluntary organisations. Information was available for patients in the waiting area.

Updated 18 August 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 including those with a learning disability.

• Longer appointments were available for patients. Double or triple appointment slots could be booked for patients with learning disabilities.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice worked with multi-disciplinary teams in the case management of vulnerable people and informed patients how to access various support groups and voluntary organisations.

• The practice provided good care and support for end of life patients and strove to deliver high quality palliative care. Patients were kept under close review by the practice in conjunction with the wider multi-disciplinary team.

• 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.