Dr C A O Makanjuola and Partners Also known as Longlevens Surgery

Updated 29 September 2016

The practice is more commonly known as Longlevens Surgery and is a long established GP practice which has been providing primary care services in the current location since 1990. Longlevens is situated approximately two miles outside of Gloucester city centre.

At the time of our inspection the practice was undergoing major renovation work to expand the facilities and was providing services in part of the main building and in two porta cabins. The practice is situated in a single storey purpose built premises which is wheelchair accessible and the extension will provide a second storey at the rear of the practice to host four further consultation rooms with lift access.

The practice provides general medical services to approximately 7,400 patients. Services to patients are provided under a General Medical Services (GMS) contract with NHS England. (A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract).

The practice has four GP partners (two female and two male) which is equivalent to approximately three and a half full time equivalent GPs. The clinical team includes two practice nurses and two health care assistants (all female). The practice manager is supported by a team of administrators, receptionists and a pharmacist.

Longlevens Surgery is an approved training practice for qualified doctors with hospital experience who wish to become GPs and medical students.

The practice population averages are comparable for all age ranges when compared to local and national averages. The practice has relatively low numbers of patients from different cultural backgrounds with approximately 95% of patients being white British.

The practice is located in an area with the lowest possible social deprivation score rated by public health England. The prevalence of patients with a long standing health condition is 49% compared to the local CCG average of 55% and the national average of 54%. People living in more deprived areas and with long-standing health conditions tend to have greater need for health services.

The practice is open between 8.30am and 6.30pm on Monday to Friday. Between 8am - 8.30am on Mondays and Tuesdays telephone calls are diverted to the practice call handling service (Message Link). They refer urgent matters to the practice that have members of staff on standby to respond to issues if needed. Extended surgery hours are also offered on Wednesday, Thursday and Friday mornings from 7.30am to 8.30am.

Out of hours cover is provided by South Western Ambulance Service NHS Foundation Trust and can be accessed via NHS 111.

The practice provided its services from the following address:

Longlevens Surgery

19b Church Road

Gloucester

Gloucestershire

GL2 0AJ

This was the first inspection of Dr R H Webster & Partners.

Updated 29 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr R H Webster & Partners on 13 September 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 been trained to provide them with 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. Feedback from patients about their care was consistently positive.

• 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 was undergoing extensive building works to expand the practice by adding a second storey which would host an additional four consultation rooms, a disabled patient toilet, office space and a patient lift once completed in November 2016.
• 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.

• The provider was aware of and complied with the requirements of the duty of candour.

The area where the provider should make improvement are:

• Improve their identification and support of carers.

• Ensure that all documentation for patient group directions for nurses to administer medicines are signed in entirety by the authorised person.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 September 2016

The practice is rated as good for the care of patients 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 overall diabetes related indicators in 2014/15 was 98% which was above both the clinical commissioning group average of 95% and the national average of 89%.

• The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (2014/15) was 94% compared to a local average of 90% and a 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.

• The practice hosts an annual diabetic eye screening service.

• A heart failure nurse visits the practice weekly. However, due to the extensive building work at the time of our inspection patients were being seen by the heart failure nurses in their own setting rather than the practice due to lack of clinical space.

Updated 29 September 2016

The practice is rated as good for the care of families, children and young patients.

• 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 patients 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 patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The practice implemented a yellow “no questions” card for young patients wanting an urgent appointment. This ensured that they avoided being asked for the reason behind the appointment to make it easier for them to see a GP.

• The practice’s uptake for women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years in 2014/15 was 83% which was comparable to both the clinical commissioning group average of 84% and the national average 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 child safeguarding lead had monthly meetings with the health visitor and school nurses.

• The practice held three monthly multidisciplinary meetings with the midwife who held clinics every other week at the practice.

Updated 29 September 2016

The practice is rated as good for the care of older patients.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population and had a range of enhanced services, for example dementia, influenza, shingles and pneumococcal immunisations. Data from NHS England showed that the practice flu uptake for 2015/16 was the highest in the locality and the practice were ranked first of the 80 practices.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs. Health care assistants led on elderly care assessment clinics and provided domiciliary visits to housebound patients.

• All patients aged over 75 had a named GP.

• The practice had dedicated GPs providing care in local residential and care homes who ensured a planned review was undertaken for all patients on a fortnightly basis.

Updated 29 September 2016

The practice is rated as good for the care of working-age patients (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 GP and nurse hours to provide improved accessibility for those patients who worked. The practice held Saturday morning clinics during the winter months.

• A full range of in-house family planning including contraceptive implants, coils, and other forms of contraception were available in the practice. One of the GPs performed endometrial biopsies (a medical procedure that involves taking a tissue sample from the lining of the uterus).

Updated 29 September 2016

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

• 87% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months (2014/15), which was above both the clinical commissioning group average (CCG) of 86% and the national average of 84%.

• Performance for mental health related indicators was 100% which was above both the CCG average of 97% and national average of 82%.

• 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.

• All these patients had a named GP and a structured annual review with a longer appointment to check their health and medicines needs were being met and to agree on a mental health care plan.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• A primary mental health nurse held weekly clinics at the practice.

• The practice supported a local disability school and raised funds for them annually.

• 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 29 September 2016

The practice is rated as good for the care of patients 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.

• 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 displayed information for carers in the waiting room, on their website, on the health education screen and offered carers health checks.

• The practice held a register of carers and supported them to receive appropriate support. However the list of people so far identified who are carers was limited.