The Apples Medical Centre Also known as Dr Miles and Partners

Updated 5 September 2016

The Apples Medical Centre is located at East Mill Lane, Sherborne, Dorset, DT9 3DG.

The Apples Medical Centre is based near the centre of Sherborne, Dorset, and is part of NHS Dorset Clinical Commissioning Group (CCG). The Apples Medical Centre provides services under a NHS Personal Medical Services contract to approximately 5200 people living in Sherborne and the surrounding villages. The practice population has a higher proportion of older people (more than 65 years of age) compared to the average for England.

The practice has four GPs who together work an equivalent of just under 3.5 full time staff. The practice has one female and three male GPs. The practice also has two practice nurses and two health care assistants all of whom are female. The clinical team are supported by a practice manager and team of eight administration staff who carry out administration, reception and secretarial duties.

The Apples Medical Centre is open Monday to Friday between 8am and 6.30pm. Routine appointments are available daily and urgent appointments are made available on the day of the patient’s request. The practice also offers a range of extended hours appointments to patients. Later appointments are available from 6.30pm until 7.10pm on Monday and Tuesday evenings. The practice is also open on Saturday mornings, once a month from 8.30am until 11.10am. The practice also offers on-line services, such as medication requests and booking of appointments, to its patients.

The practice has a dispensary which catered for patients who needed medication, appliances and dressings who lived more than one mile from their nearest pharmacy.

The Apples Medical Centre has opted out of providing out-of-hours services to their own patients and refers them to South Western Ambulance Service NHS Foundation Trust via the NHS 111 service.

We previously inspected The Apples Medical Centre on 27 August 2015. Following this inspection, the practice was given a rating of good. The practice was rated as requires improvement for providing safe care. This was because the practice had not conducted a risk assessment for the prevention and control of Legionella.

A copy of the report detailing our findings can be found at www.cqc.org.uk/  

Updated 5 September 2016

Letter from the Chief Inspector of General Practice

We carried out a focused desktop inspection of The Apples Medical Centre on 2 August 2016 to assess whether the practice had made the improvements in providing safe care and services.

We had previously carried out an announced comprehensive inspection at The Apples Medical Centre on 27 August 2015 when we rated the practice as good overall. The practice was rated as requires improvement for providing safe care. This was because a risk assessment for the control and prevention of Legionella had not been completed.

We asked the provider to send a report of the improvements they would make to comply with the regulations they were not meeting at that time. The practice is now able to demonstrate that they are meeting the regulations. The practice is now rated as good for providing safe care and the overall rating remains as good.

This report should be read in conjunction with the full inspection report dated 5 November 2016.

Our key finding across the area we inspected was as follows:

• The practice had an assessment to determine the risk from infection from Legionella and had taken action to ensure effective and safe water systems.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 November 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 5 November 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 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. 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 5 November 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 5 November 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 reflected the needs for this age group.

Updated 5 November 2015

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

• 85.71% of patients experiencing poor mental health had received an annual physical health check.
• 94.12% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the preceding 12 months.

The practice regularly worked with multi-disciplinary teams in the case management of patients 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 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 when they may have been experiencing poor mental health. Staff had received training on how to care for patients with mental health needs and dementia.

Updated 5 November 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 patients with a learning disability and these patients had received a follow-up. It offered longer appointments for patients with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. It had told vulnerable patients 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.