Archived: The Butchery Surgery

Updated 8 March 2017

The Butchery Surgery is a GP practice located in the town of Sandwich, Kent. It provides care for approximately 4500 patients. It is located within the town and has a mainly urban patient population.

There are two GP partners, one female and one male. There is a vacancy for a full time GP. Regular locum doctors are employed when the need arises. There are two nurses and one healthcare assistant all female. There is a practice manager and administrative and reception staff.

The demographics of the population the practice serves is different to the national averages in that it is much older. The number of patients between 20 and 40 years of age is approximately two thirds the national average. However the number of patients in age range from 50 to 85 and over is more that that nationally, sometimes markedly so.

The majority of the patients describe themselves as white British. Income deprivation is less than the national average and unemployment less than half the national average. Although the practice as a whole is not in an area of deprivation there are pockets of urban and rural deprivation within it.

The practice has a general medical services contract with NHS England for delivering primary care services to local communities. The practice offers a full range of primary medical services. The practice is a teaching practice for third year medical students.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments were determined by individual GPs and patients might be seen at any time that the practice was open.

The surgery is a former town house. There are consulting, treatment rooms and administration on both floors. There is a second practice in the town. There is a merger planned for the two practices.

Services are provided from

The Butchery Surgery,

7 The Butchery,

Sandwich,

Kent.

CT13 9DL.

The practice is a member of a “Vanguard”. Vanguard sites are being developed as part of implementing the NHS Five Year Forward View. Part of the objective is to support improvement and integration of services. The Butchery Surgery’s particular Vanguard site is called Encompass.

The practice has opted out of providing out-of-hours services to their own patients. This is provided by Primecare. There is information, on the practice building and website, on how to access the out of hours service when the practice is closed.

Updated 8 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Butchery Surgery on 8 December 2016. Overall the practice is rated as outstanding. Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from incidents were maximised.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.

• Feedback from patients about their care was consistently positive and was significantly above the local and national averages.

• 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 (PPG). For example, the PPG had put together the carers’ pack, using of their knowledge of local services that the practice provided to new carers.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw several areas of outstanding practice including:

• Following a significant event, the practice had instituted a “watch list” for their most vulnerable patients so that they had improved access and additional monitoring.

• The practice maintained a database of all home visits (including out of hours service visits). The practice used the data to see if any patients were receiving an increased number of visits which might indicate a deterioration in their health.

• All referrals of children to other services, including accident and emergency attendances, were reviewed by the GP lead for safeguarding.This helped the practice to take an holistic, family based approach to safeguarding children.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 March 2017

The practice is rated as outstanding for the care of people with long-term conditions.

• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were above average in almost all long-term conditions compared to the local and national averages and had been so consistently over the years.
• The percentage of patients on the diabetes register, with a record of a foot examination and a risk classification within the proceeding twelve months was 92% compared to a national average of 89%. The practice had outperformed the national average for this measure by between 4% and 14% every year over the last ten years.
• There are common long-term conditions, where it is recommended the patients have an annual influenza vaccination. The practice results for the two conditions where results were available were; diabetes 99% against the CCG average of 93% and national average of 94%. For chronic obstructive pulmonary disease (COPD) it was 100% (for the second consecutive year against the CCG average of 97% and national average of 98%.
• 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.

Updated 8 March 2017

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

• There were systems 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 Accident and emergency 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.
• The practice’s uptake for the cervical screening programme was 84%, which was comparable to the CCG and the national averages 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.
• The practice was an accredited “child friendly” practice under a local authority scheme.
• All correspondence relating to children was reviewed by the GP lead for safeguarding in order to help provide holistic care.

Updated 8 March 2017

The practice is rated as outstanding for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. The practice recorded all home visits (including out of hours service visits). This was updated each week. The practice used it to see if any patients were receiving an increased number of visits which might indicate a deterioration in their health.
• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were above average in almost all areas compared to the local and national averages and had been so consistently over the years. Older people were most affected by these conditions.
• The number of emergency admissions per 1000 patients per year for certain recognised conditions, at 14, was marginally less that the CCG and national average of 15 despite the practice having significantly more elderly patients than the comparator practices.
• The practice worked in partnership with a day centre for the elderly in the town and referred patients there when there was a need to address their social needs, such as loneliness, as well as their medical needs.

Updated 8 March 2017

The practice is rated as outstanding 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. GPs were willing to see patients outside of the normal appointment times if this was necessary.
• 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. Text messages were used to remind patients of their appointments.
• The practice provided telephone consultations and email advice.

Updated 8 March 2017

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

• Eighty three percent of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months for which figures were available (to March 2015), which was comparable to the national average of 84%.

• Performance for mental health related indicators was better than the CCG and national average. For example, the percentage of patients with schizophrenia and other psychoses who had a comprehensive care plan in the preceding 12 months, agreed between individuals, their family and/or carers was 90%. This was better than the CCG at 83% and the national average at 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. The practice worked in partnership with a day centre for the elderly in the town, which also catered for dementia patients, and referred patients there when there was a need to address their social needs, such as loneliness, as well as their medical needs.
• The practice carried out advance care planning for patients with dementia. Staff had a good understanding of how to support patients with mental health needs and dementia. The practice was a dementia friendly practice.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

Updated 8 March 2017

The practice is rated as outstanding 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. The practice offered longer appointments for patients with a learning disability.
• Homeless patients were able to register with the practice using the practice’s address or the address of a local homelessness support organisation.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients. Vulnerable patients were identified and their needs discussed at a monthly meeting.
• Patients recently discharged from hospital were contacted and their needs discussed.
• The practice had a “watch list” for their most vulnerable patients so that they had improved access and additional monitoring.
• The practice maintained a notice board, in the waiting room, specifically with information on local services and support groups
• 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.