Archived: Dr B Newmarch and Partner Also known as Victoria Gate Surgery

Updated 11 June 2015

Dr B Newmarch and Partner, Victoria Gate Surgery, East Reach, Taunton, Somerset. TA1 3EX is located close to the centre of Taunton. The premises are purpose built. The practice has approximately 4,250 registered patients and has seen a growth in the patient list of about 5% annually. The practice accepts patients from an area from Eastwick and Selworthy Road to the North, Ruishton to the East, Killams to the South and Mary Street and Station Road to the West.

The practice has very recently merged with another local practice and was in the process of re-registering with the Care Quality Commission. It is currently proposed that the two practices will retain independent patient lists but will make many aspects of their services available to both groups of patients.

There are four salaried GPs and a team of clinical staff including practice nurses and a health care assistant. Three GPs are female and one is male, the hours contracted by GPs are equal to 2.55 whole time equivalent employees. Collectively the GPs provide 22 patient sessions each week. Additionally there are two nurses employed equal to 1.4 whole time equivalent employees and a health care assistant equal to .56 whole time equivalent employees employed. Non-clinical staff included secretaries, IT staff, support staff and a small management team including a practice manager. A practice pharmacist employed by the Clinical Commissioning Group supports the practice one day a week.

The practice population ethnic profile is predominantly White British with an age distribution of male and female patients’ equivalent to national average figures. There are about 28% of patients from Other White ethnic groups, the majority being patients from Poland The average male and female life expectancy for the practice is 80 and 84 years respectively, both figures are very slightly above the national average. The National GP Patient Survey published in January 2015 indicated 78% of patients said they would recommend the practice to someone new to the area. This was slightly below the Somerset Clinical Commissioning Group average of 83%. Most patients attending the practice live in urban populations with about 60% of patients living in the Halcon estate which is the second most deprived area of Somerset. The practice directly supports patients from nine learning disability homes and a large 60 place hostel for homeless people and has an enhanced contract for supporting violent patients in the Taunton and Wellington area.

The practice has a Personal Medical Services (PMS) contract to deliver health care services; the contract includes enhanced services such as extended opening hours, online access and diabetes services. It also provides a drug misuse shared care enhanced service. These contracts act as the basis for arrangements between the NHS Commissioning Board and providers of general medical services in England.

The practice has opted out of providing out-of-hours services to their own patients. This service is provided by Somerset Doctors Urgent Care and patients are directed to this service by the practice during out of hours.

Updated 11 June 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Victoria Gate Surgery on 8 May 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, effective, caring and responsive services. It was also good for providing services for patients with long term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

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.
• Patients said they were treated with compassion, dignity and respect by all staff 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.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent and triage 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.

We saw areas of outstanding practice:

• The practice had identified an issue caused by some patients repeatedly losing or claiming their prescriptions had been stolen. To address this issue the practice met with staff from the local homeless hostel and the police to develop a strategy to manage the problem. This approach had considerably reduced the incidents of claimed lost or stolen prescriptions.
• All patients had access to 15 minute appointments, with longer appointments available for those that required more time. Patients with a learning disability had their medicines reviewed at least three times a year and more often if they had complex needs. The Somerset drug and alcohol service provided appointments once a fortnight for vulnerable patients in conjunction with GPs in the practice.
• The practice had developed an innovative approach to support vulnerable patients with chaotic lifestyles who required Med 3 sick notes to access benefits. They had identified lost sick notes caused delays in accessing benefits which subsequently impacted on patients’ health. The practice established an arrangement with the Department of Work and Pensions (DWP) whereby the sick notes were emailed directly to the DWP.

However there was an area of practice where the provider could make improvements.

Importantly the provider should

• Review the process for recording legionella testing.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 11 June 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. Longer appointments and home visits were available when needed. All these patients had a named GP and a 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 11 June 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 relatively 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.

Updated 11 June 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 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. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Updated 11 June 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.

Updated 11 June 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The majority of people experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It 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 including MIND and SANE. 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. Staff had received training on how to care for people with mental health needs and dementia.

Updated 11 June 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. It had carried out annual health checks for people with a learning disability and the majority of these patients had received a follow-up. It offered longer appointments for people with a learning disability.

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. 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.