Downton Surgery

Updated 18 January 2017

Downton Surgery is located in Downton village, which is around six miles from the city of Salisbury, Wiltshire. Rooms for consulting, treatment and minor illness are located on the ground floor, with rooms for administration and other office functions on the first floor.

Downton Surgery is one of 57 GP practices in the NHS Wiltshire Clinical Commissioning Group (CCG) area and has around 6,700 registered patients, most of whom live within a three mile radius of the practice. The practice patient populations deviate from the England average for some age groups, thus giving an indication of the area’s demographic profile. These deviations are most noticeable for the 0 to 4, 20 to 24 and 25 to 29 year age groups, which are below the England average; and the 55 to 59 and 60 to 64 year age groups, which are above the England average. 91% of the practice population describes itself as white British, with the largest minority ethnic population (around 2.5%) describing itself as Asian or Asian British. A measure of deprivation in the local area recorded a score of ten, on a scale of one to ten. A higher score indicates a less deprived area. (Note: an area itself is not deprived, it is the circumstances and lifestyles of the people living there that affect its deprivation score. Not everyone living in a deprived area is deprived and not all deprived people live in deprived areas).

The practice team consists of four GP partners (two male, two female) and three practice nurses. The clinicians are supported by a practice manager, four dispensers, a dispensary manager, and teams of secretaries, administrators and receptionists. The practice has a General Medical Services contract with NHS England (a locally agreed contract negotiated between NHS England and the practice).

Downton Surgery is a training practice for doctors and currently has one trainee in their second year of a specialty training programme.

Downton Surgery takes patient calls from 8am. Normal opening hours are from 8.30am to 6.30pm, Monday to Friday, but doors are open for emergencies only from 8am. Routine GP appointments vary from day to day but are typically available from 8.30am to 12.30pm and from 2pm to 6pm, Monday to Friday. Nurse appointments are available from 8.30am to 5.30pm, Monday to Friday. The practice provides (pre-booked only) extended hours appointments with a GP from 7.30am to 8am on Tuesday and Wednesday, and from 6.30pm to 7.30pm on Monday and Tuesday. All appointments can be pre-booked up to four weeks in advance.

Downton Surgery has a dispensary and a member of the dispensary team is available from 8.30am to 1pm and from 2pm to 6pm, Monday to Friday.

The practice has opted out of providing Out Of Hours services to its own patients. Outside of normal practice hours, patients can access NHS 111 and an Out Of Hours GP service. Information about the Out Of Hours service was available on the practice website, on the front door, in the patient registration pack, and as an answerphone message.

Downton Surgery provides regulated activities from its sole location at Moot Lane, Downton, Salisbury, Wiltshire SP5 3JP.

Updated 18 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Downton Surgery on 13 October 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 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.
• The practice worked closely with a local charity that provided patient transport for practice and hospital appointments.
• 100% of patients with schizophrenia, bipolar affective disorder and other psychoses had their alcohol consumption recorded in the preceding 12 months, which exceeded both the clinical commissioning group (CCG) average of 93% and national average of 90%.
• 100% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in their records in the preceding 12 months, which exceeded the national average of 88%.
• Patients had access at the practice to drop-in clinics from outside agencies such as those specialising in bereavement care.
• The practice was proactive in ensuring that vulnerable patients who did not attend their scheduled appointments were contacted by the practice nurse, assessed and if necessary booked for a same day appointment at the practice.
• 91% of patients found it easy to get through to the practice by telephone compared with the national average of 73%.
• 87% of patients were able to get an appointment to see or speak to someone the last time they tried compared with the national average of 76%.
• The practice was proactive in addressing patient need by helping to develop a ‘Virtual Ward’ for patients aged 75 years and over who are considered to be at risk of unplanned hospital admissions. The Virtual Ward is a weekly meeting with the GPs and community health team and enables medical, nursing and social care to be directed appropriately. The Virtual Ward consists of a maximum of 30 patients at any point in time.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology and were told about any actions to improve processes to prevent the same thing happening again.
• The practice hosted a talking therapy service for patients who had experienced bereavement, were carers, or were experiencing mental health issues. The service was funded by the CCG and was available on referral.

We found one area where the provider should make improvements:

• The provider should seek support to recruit more members to its patient participation group, to better reflect the patient population it serves.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 January 2017

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.
• Performance for patients with long-term conditions compared with national averages. For example, 76% of patients with asthma, on the register, had had an asthma review in the preceding 12 months, compared to the national average of 75%. The review included three patient-focused outcomes that acted as a further prompt to review treatment.
• 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.
• The practice routinely offered longer appointments for patients with complex medical needs.
• The practice was proactive in purchasing equipment to improve patient care. For example, a machine for examining skin lesions, and a cardiac event monitor for patients with intermittent heart rhythms or a history of sudden collapses.

Updated 18 January 2017

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. The practice assessed the capability of young patients using Gillick competencies. These competencies are an accepted means to determine whether a child is mature enough to make decisions for themselves.
• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in a target period of three-and-a-half or five-and-a-half years was 75%, which was comparable to the national average of 74%.
• 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 did not have a designated health visitor at the time of inspection. A limited health visiting service was being provided in the interim. When we spoke to the practice, they told us that they were working with the local clinical commissioning group (CCG) to resolve this and that the CCG would shortly be recruiting to the position.

Updated 18 January 2017

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 patients in its population.
• Older patients with complex care needs or those at risk of hospital admissions had personalised care plans which were shared with local organisations to facilitate continuity of care.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice was aware that hospital admission avoidance and the facilitating of a timely hospital discharge was affected by low availability of home care support packages, and had raised this concern with the local clinical commissioning group (CCG). The practice was proactive in addressing this patient need by helping to develop a ‘Virtual Ward’ for patients aged 75 years and over who were considered to be at risk of unplanned hospital admissions. The Virtual Ward is a weekly meeting with the GPs and community health team and enables medical, nursing and social care to be directed appropriately. The Virtual Ward consists of a maximum of 30 patients at any point in time.
• The practice referred patients to local community health improvement schemes.
• Patients had access at the practice to drop-in clinics from outside agencies such as Cruse Bereavement Care.

Updated 18 January 2017

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.
• The practice offered extended morning and evening appointments with a GP.
• Patients were able to order repeat prescriptions on-line.
• The practice offered text reminders for appointments.
• Telephone appointments were offered where appropriate, as an alternative to face-to-face consultations.

Updated 18 January 2017

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

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months was 100%, which was better than both the clinical commissioning group (CCG) average of 93% and national average of 90%.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in their records in the preceding 12 months was 100%, which was better than the national average of 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of people 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.
• The practice care co-ordinator supported patients living with dementia in their own homes.

Updated 18 January 2017

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.
• 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.
• 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 was proactive in ensuring that vulnerable patients who did not attend their scheduled appointments were all contacted by the practice nurse, assessed and if necessary, booked for a same day appointment at the practice.