Archived: The Hermitage Surgery

Updated 26 January 2017

Hermitage Surgery is located in the centre of Swindon. The practice serves a local population of approximately 4,000 patients from the centre of Swindon and an area called Old Town. The practice population has similar numbers of patients between the ages of 35 to 75 compared to local and national averages, lower than average numbers of those under 35 and higher than average numbers of patients over 75.

The prevalence of patients with a long standing health condition is 67% compared to the local clinical commissioning group (CCG) average of 55% and the national average of 54%. The practice serves some areas of social deprivation. Patients living in more deprived areas and with long-standing health conditions tend to have greater need for health services. An area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score.

The practice was in negotiation with the local CCG, NHS England and local GP providers regarding the contract to provide medical services. The practice has been under tender for its contract to provide GP services throughout most of 2016 and has therefore been through a period of uncertainty over the future of the surgery. Due to this the practice list has been closed to new patients since May 2016 in agreement with NHS England. The practice had previously been a two partner practice although one had recently left and the remaining GP partner was in the process of registering as an individual provider with the Care Quality Commission.

The practice was a training practice and had until recently supported a GP registrar in training. (Registrars are qualified doctors who undertake additional training to gain experience and higher qualifications in general practice and family medicine).

The practice is currently run by a managing GP partner supported by three salaried GPs, a part time practice manager, they are supported by one part time nurse, a regular locum health care assistant and a phlebotomist. The clinical team are supported by a team of receptionists and administration staff.

All the Hermitage Surgery clinical rooms for patients are situated on the ground floor with level access and automatic entrance doors.

The practice supports a number of patients in a number of local care homes and all the patients in two nursing homes (although the practice list has been closed since May 2015, the practice still accept new residents at these nursing homes).

The practice is open between 8.30am and 6pm Monday to Friday with phone access for any emergency from 8am to 8:30am and 6pm to 6:30pm. Appointments are available from 8am to 1pm and 2pm to 6:30pm daily. Extended hours appointments were available from 7am to 8am from Tuesday to Friday and until 7:30pm from Monday to Thursday.

When the practice is closed the care is provided by the out of hour’s service currently provided by Great Western Hospital accessed via NHS 111.

The Hermitage Surgery was incorrectly registered at the time of our inspection as the application to register as an individual provider had not been completed.

The practice was registered to provider services from:

Hermitage Surgery

Dammas Lane

Swindon

SN1 3EF

This was our first inspection of Hermitage Surgery.

Updated 26 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hermitage Surgery on 20 December 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• The practice had a clear vision to provide the best healthcare and be as effective and efficient as possible whilst remaining small, friendly and accessible.
• We observed a strong patient-centred culture, all staff supported the ethos that patient care was central to everything the practice did and that all patients were treated as individuals.
• The practice had been through a period of uncertainty regarding their on-going contract to offer GP services. The practice had been in negotiation with the local clinical commissioning group, NHS England and local providers to discuss how the contract was going to continue in the future due to the planned retirement of the GP partner and the nurse.
• There was a clear leadership structure and staff felt supported and valued.
• There was an open and transparent approach to safety and an effective system 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. The practice worked with local initiatives including the local community navigator scheme, care co-ordinators and community pharmacists to improve the care and treatment for patients.

• Feedback from patients about their care and treatment was consistently positive.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The provider was aware of and complied with the requirements of the duty of candour.

We noted one area where the provider should improve:

• Continue to develop the patient participation group for wider patient feedback.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 January 2017

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

• The clinical team all engaged in chronic disease management and any patients at risk of hospital admission were identified as a priority and had individualised care plans.
• Performance for diabetes related indicators were above the local and national averages, for example:
• The percentage of patients with diabetes who had their blood pressure recorded as within the target range (in the preceding 12 months 2015/16) was 96% which was higher than the clinical commissioning group (CCG) average of 91% and the national average of 91%.
• The percentage of patients with diabetes who had the correct foot review (in the preceding 12 months 2015/16) was 91% which was higher than the CCG and national average of 88%.
• 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 26 January 2017

The practice is rated as good 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 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’s uptake for the cervical screening programme was 83%, which was comparable to the clinical commissioning group average of 82% and the national average of 82%.

• The practice offered sexual health advice including Chlamydia testing and offered contraceptive services including emergency contraception. If patients needed coils or implants they were referred to a local provider.

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

We were told that the practice worked effectively with the associated midwife and that the GPs were proactive about following up any care needs or treatments, and had good effective communication for these patients.

Updated 26 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 people in its population. The practice population contained approximately 25% of the patients aged 65 or older and 14% aged 75 or older.

• The practice was responsive to the needs of older people; home visiting was recognised as required for clinical and complex social reasons, for acute problems, chronic disease management and palliative care.

• The practice encouraged medicine compliance aides for medicines administration and liaised closely with local pharmacies to improve compliance.

• The practice held a register of patients at risk of an unplanned hospital admission. Patients had a personalised care plan, and an early review following hospital discharge.

Updated 26 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 hours appointments for patients who could not access the practice during normal working hours.

Updated 26 January 2017

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

• Performance for mental health related indicators were mostly higher compared to the local and national averages, for example:

• The percentage of patients with a serious mental health illness who had their care plan reviewed (in the preceding 12 months 2015/16) was 94% which was higher than the CCG average of 87% and the national average of 89%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The percentage of patients with dementia who had had their care reviewed in the preceding 21 months (2015/16) was 75% compared to the CCG average of 81% and the national average of 83%.

• 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.

Updated 26 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 homeless people and those with a learning disability.

• There were longer appointments available for patients with a learning disability, all the patients with a learning disability were offered an annual health review, we saw that 100% were offered in 2015/16 and all except one (who declined) were completed.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients, for example the community navigator (a member of staff who helps support social support needs as well as medical health needs).

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations. Patients were able to access counselling services within the practice and at local centres.

• 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.