Lapworth Surgery

Updated 22 March 2017

Lapworth Surgery serves the rural villages of Lapworth, Rowington, Baddesley Clinton and Shrewley in Warwickshire. It operates under a General Medical Services (GMS) contract with NHS England. A GMS contract is one type of contract between general practices and NHS England for delivering primary care services to local communities. The practice’s current premises were purpose built in 1991 and the current GP partnership has been in place since 2008. Parking and facilities for the disabled are available.

Lapworth Surgery has a patient list of 2,556. The majority of the patient list is aged between 45 and 80, with a below average number of young families. Levels of deprivation in the area are low. The practice has expanded its contractual obligations to provide enhanced services to patients. An enhanced service is above the contractual requirement of the practice and is commissioned to improve the range of services available to patients. Enhanced services offered by the practice include for example minor surgery, extended hours access and facilitating timely diagnosis and support for people with dementia.

The clinical team comprises one male and one female GP partners, a specialist nurse practitioner, a health care assistant and a phlebotomist. The team is supported by a practice manager, a dispenser, a secretary and dispensary assistant, and a team of five reception staff.

The practice’s reception and dispensary operate from 8.30am and 6.30pm on Monday, Wednesday and Friday, and from 8.30am to 4.30pm on Tuesdays and Thursdays. The reception and dispensary close daily between 1pm and 2pm. Appointments are available at a variety of times during opening hours. Additional appointments are offered during extended hours until 7pm on Monday and Wednesday.

When the practice is closed for periods between the hours of 8am and 6.30pm, the phone system alerts the duty GP of any urgent calls via a pager. There are further arrangements in place to direct patients to the NHS 111 out-of-hours service between 6.30pm and 8am.

Updated 22 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lapworth Surgery on 4 August 2016. Overall the practice is rated as good.

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

• The practice had a practical approach to safety and effective systems for managing incidents and significant events.

• Risks were assessed and measures implemented to protect staff and patients from harm.

• Staff were suitably skilled to carry out their roles effectively and in line with current evidence based guidance. The practice supported their continued development using a system of appraisal.

• Patients told us that clinical staff listened to them and gave them enough time in consultations. They were informed about their choices and decision making rights, and were able to be involved in their own care and treatment.
• Information for patients about the services available was easy to understand and accessible. Alternative formats such as large print were available for patients to meet their needs.
• Patients told us they were happy with the timely availability of appointments, and were able to see the GP of their choice. Urgent appointments were available on the same day for those who needed them.
• The practice had suitable facilities and was equipped to treat patients with a wide range needs.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice had a clear leadership structure and staff told us they were supported by management as well as the wider team which was well established with many staff members in post for a significant length of time. The practice requested feedback from staff and patients, and was responsive to suggestions for improvement.

• Clinical rooms were kept locked when they were not in use, but staff using these rooms on occasions did not lock doors and remove computer access cards when they left the room unattended for short periods during the day. Paper patient records were stored in cabinets located in area of the building which was kept locked when not in use.

• The practice used the information collected for the Quality and Outcomes Framework (QOF) to monitor its performance. QOF is a system aimed at improving the quality of general practice and rewarding good practice. Results from 2014/15 showed that the practice was performing in line with or higher than both Clinical Commissioning Group (CCG) and national average achievements, and data from 2015/16 which has been published since the inspection was similar. The practice had higher than average exception reporting in several areas. Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects.

We saw one area of outstanding practice:

• Data from the National GP Patient Survey published in July 2016 showed the practice results were significantly higher than local and national averages, indicating a consistently high level of patient satisfaction with all areas of the service. Analysis of the GP Patient Survey results previously published in January 2016 had placed Lapworth Surgery as the second highest achieving practice in England. This strong level of patient engagement and satisfaction was corroborated by a high return rate of positive CQC patient comment cards (58 in total), and the positive comments by patients we spoke with during the inspection.

The areas where the provider should make improvement are:

• Improve the security at the practice in relation to computer access cards when rooms are unoccupied during opening hours.

• Continue to review higher than average exception reporting for heart failure, peripheral arterial disease, and cardiovascular disease to ensure patients are receiving the most appropriate treatment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 March 2017

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

• The practice maintained registers of patients with long-term conditions and used these to monitor their health and ensure they were offered appropriate services. For example, the practice offered review appointments and the flu vaccination to such patients annually.
• The practice nursing team had lead roles in chronic disease management such as diabetic care.
• Performance for diabetes related indicators was higher than local and national averages. 90% of patients with diabetes’ last blood pressure reading within an acceptable range which was in line with the CCG and national averages of 81% and 78%. 100% of patients on the register had had a foot examination and risk classification in the previous 12 months, in between the CCG average of 92% and the national average of 88%.
• Longer appointments and home visits were available when needed.
• Patients with long-term conditions had a named GP. Clinical staff engaged with relevant health and care professionals to deliver a multidisciplinary package of care.
• GPs made themselves available for home visits to patients nearing the end of life outside of working hours and during the night, as they wanted to offer personalised continuous care to patients in these circumstances.

Updated 22 March 2017

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

• Clinical staff showed a clear understanding of a patient’s ability to consent if they were under the age of 16.
• Appointments with GPs and the practice nurse were available outside of school hours and during extended hour’s appointments until 7pm on Monday and Wednesday evenings.
• There were children’s toys available in the waiting area, and the premises were suitable for children and babies.
• Childhood immunisation rates for the vaccinations given were comparable to CCG averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 82% to 96%, which was comparable to the CCG average of 84% to 99% and five year olds from 91% to 100%, which was comparable to the CCG average of 93% to 98%.
• The practice worked with midwives, health visitors and school nurses. One of the GPs was the practice’s safeguarding lead who engaged with local health visitors, and staff were trained to the appropriate child safeguarding level.
• Children could access appointments on the same day.

Updated 22 March 2017

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

• The practice had an above average number of patients aged from 75 to 80. The proportion of patients above this age was in line with the national average. The practice provided personalised care to meet the needs of these patients.
• Home visits were available for older patients who had difficulty attending the practice.
• The practice dispensary provided dossette boxes to older patients where appropriate to assist them in taking regular medicines. Members of the reception team who had received a Disclosure and Barring Service check delivered dispensed prescriptions to housebound patients.
• The practice liaised with Age UK and local healthcare teams to assess and monitor the needs of older patients.
• An over 75s health check was offered to help the practice identify any changes in the physical or mental health of older patients and the support needed.
• Older patients were invited to receive vaccinations to protect them against illnesses such as flu and shingles.
• A number of clinics were offered at the practice to accommodate patients who found it difficult to travel to other services to receive these. For example, phlebotomy and wart clinics.

Updated 22 March 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice offered extended hours appointments until 7pm on Monday and Wednesday evenings for patients who could not attend during normal opening hours.
• Patients could access telephone consultations, and these were made available outside usual hours to accommodate working people if requested.
• Flu vaccination clinics were held on two Saturday mornings in the autumn to enable those who worked during usual hours to attend.
• The practice was proactive in offering online services such as repeat prescription ordering.
• A full range of health promotion and screening was available, including NHS health checks for those aged 40 to 74.
• Non-NHS examinations, such as insurance medicals, were available outside of opening hours by request.

Updated 22 March 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 was similar to CCG and national averages. For example, 100% of patients experiencing poor mental health had a comprehensive agreed care plan documented within the last 12 months. This was higher than the CCG average of 93% and the national average of 88%.
• 80% of patients diagnosed with dementia had a face to face care review in the past 12 months, compared with an average 85% in the CCG area and 84% nationally.
• All staff at the practice had completed Mental Capacity Act and Deprivation of Liberty Safeguards training within the year prior to the inspection.
• The practice maintained a register of patients with mental health problems and used this to monitor their wellbeing. Patients on the register were offered longer appointments or appointments at the end of surgery so that additional time could be allowed.
• The practice liaised with multi-disciplinary teams in the management of patients experiencing poor mental health and we saw that care plans were in place for those with dementia.
• Information about how to access various support groups and voluntary organisations was available to patients experiencing poor mental health.

Updated 22 March 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice often provided care to patients travelling through the area on narrowboats who had no fixed abode or were away from home. The practice registered these people as temporary patients. There were no homeless patients registered at the time of the inspection, but it was the practice’s policy to register and treat people from this group.
• There were no patients with a learning disability over the age of 18 registered with the practice, but staff explained that they were able to facilitate these patients and had training and protocols in place to do so.
• There was a system for highlighting vulnerable patients on records, such as those recently bereaved or with a history of domestic violence.
• Longer appointments were available to patients in vulnerable circumstances.
• The practice worked with other health care professionals in the case management of vulnerable patients.
• Staff signposted relevant services and support groups to vulnerable people.
• All staff we spoke to during the inspection knew how to recognise signs of abuse in vulnerable adults and children and how to escalate concerns.

• The practice had identified patients who were carers and directed them to support available.