Cam & Uley Family Practice Also known as The Orchard Medical Centre

Updated 11 February 2016

Cam & Uley Family Practice was created in 2013 from a merger of Orchard Medical Centre and Uley Surgery. The Orchard Medical Centre is situated in the village of Cam close to Dursley, Gloucestershire, GL11 5NE; 12 miles south of Gloucester and 25 miles north of Bristol. The practice operates from a purpose built medical centre which was undergoing an extension to provide a further six clinical rooms.

Uley Surgery is a branch surgery situated at 42 The Street, in the village of Uley, Gloucestershire GL11 5SY; 4 miles from Orchard Medical Centre. The practice operates from a converted end of terrace cottage in a conservation area. The practice provides a dispensary service to 1,600 patients. During our inspection we visited both practice sites.

The practice has a population of approximately 10,120 patients. The practice has a higher than England average of patients aged over 45 years and a lower than average group of patients between 15 years to 39 years old. The practice has a deprivation score of 11.2 meaning the area has a lower deprivation compared to the Clinical Commissioning Group average of 14.7 and a lower deprivation than the national average of 23.6.

The practice team includes nine GP partners, (male and female). In addition there was one female salaried GP and two female GPs working under the retainers’ scheme. (A GP retainer works as a short term support for GPs who are restricted from working in General Practice in the usual way due to personal circumstances). This equated to a whole time equivalent of 8.25 GPs. In addition the practice employs one female nurse practitioner; five female practice nurses and three health care assistants; a practice manager; dispensing staff; administrative staff which includes receptionists; secretaries; IT support and a cleaner.

The practice is a training practice for medical students and GP trainees with one GP providing training support. At the time of our inspection a GP trainee was being supported by the practice.

The practice had a General Medical Services contract (GMS) with NHS England to deliver general medical services. The practice provided enhanced services which included extended hours for appointments; facilitating timely diagnosis and support for patients with dementia; learning disabilities and minor surgery.

Orchard Medical Centre is open between 8am to 6.30pm Monday to Friday. Extended hours surgeries are offered on Mondays from 7.30am and 6.30pm until 8.30pm. Uley Surgery is open from 8am until 12.45pm then 1.45pm until 6.30pm except Wednesday when the practice closes at 5pm. When Uley Surgery is closed telephone access was available through Orchard Medical Centre.

The practice provided 44 GP sessions per week at Orchard Medical Centre and 11 GP sessions per week at Uley Surgery between 8.30am to 12.30pm and 2pm to 6pm Monday to Friday. The national GP patient survey (July 2015) reported patients were satisfied with the opening times and making appointments. The results were above local and national averages.

The practice has opted out of providing Out Of Hours services to their own patients.  Patients can access NHS 111 and South Western Ambulance Service provided an Out Of Hours GP service.

Updated 11 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cam & Uley Family Practice on 17 November 2015. 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.
• 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.
• 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 practice provided a GP for emergency ward cover at the local community hospital.
• The practice helped patients book the most appropriate and quickest hospital appointments by accessing the choose and book system during the patients consultation.

• The practice had a lead GP for DoLS (Deprivation of Liberty Safeguards) who led on best interest decision making process for patients in care homes and worked closely with Independent Mental Capacity Advocates (IMCA).

We saw an area of outstanding practice:

• The practice met the needs of their housebound patients and those patients who would benefit from home visits. For example, joint home visits were available with the Psychiatrist for patients living with dementia or those with poor mental health; practice nurses visited those patients who had difficulty attending the practice following a hospital discharge.

The areas where the provider should make improvement are:

• Blank prescriptions at Uley Surgery should be handled in accordance with national guidance.

• The practice should complete an infection control audit to monitor the on going management of infection control.

• The practice should review the complaint documentation process so concerns are documented appropriately.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 February 2016

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.

• 93% of newly diagnosed diabetics had taken part in a diabetic education programme.

• 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 11 February 2016

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 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 positive examples of joint working with midwives, health visitors and school nurses. This included GPs attending a regular local child safeguarding forum.

Updated 11 February 2016

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 patient in its population.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• The practice had a lead GP for Deprivation of Liberty Safeguards (DoLS).

• Uley Surgery provided a delivery service for medicine and medical equipment.

Updated 11 February 2016

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.

• 85% of patients were receiving electronic prescribing.

• The practice provided commuter clinics one morning and one evening per week. Following patient feedback telephone consultations had been increased.

Updated 11 February 2016

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

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  Data for mental health showed the practice performed better than local and national averages.

• 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 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. This included helping patients make best interest decisions about their care and treatment.

Updated 11 February 2016

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 multi-disciplinary teams 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.