Background to this inspection
Updated
29 November 2016
Burbage Surgery is located in Burbage, a village and civil parish in the Vale of Pewsey, Wiltshire. The practice has occupied its current, single-storied facility since 1980. The practice has three GP consulting rooms, a treatment room, a general office area located behind the reception desk, and a dispensary.
Burbage Surgery is one of 57 GP practices in the NHS Wiltshire Clinical Commissioning Group (CCG) area. Burbage Surgery has around 3,600 registered patients dispersed over an area of 400 square miles, most of whom live within a five to six mile radius of the practice. The practice patient populations deviate from the England average for certain age groups, thereby providing an indication of the area’s demographic profile. For instance, patient populations aged between 45 and 54 years are noticeably above the England average, and all age groups between 20 and 34 years are noticeably below the England average.
The practice population is 97% white, with the largest minority ethnic population (around 1.3%) being Asian or Asian British. A measure of deprivation in the local area recorded a score of 9, on a scale of 1-10. 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 two GP partners (one male, one female) and two salaried GPs (both female). In addition there are two practice nurses and two phlebotomists. The clinicians are supported by two dispensers, a practice manager, and a team of administrators and secretaries. The practice has a Personal Medical Services contract.
Burbage Surgery takes calls from 8am. Doors are open from 8.30am to 6.30pm on Monday, Tuesday, Thursday and Friday. On Wednesday doors are open from 8.30am to 12pm. The practice is closed on Wednesday afternoon but a sign on the practice front door, and an answerphone message, informs patients that a nearby surgery will deal with emergencies and urgent problems from 12pm to 6.30pm.
Routine GP appointments are available from 9am to 12pm and 4.30pm to 5.50pm on Monday, Tuesday, Thursday and Friday. Routine nurse appointments are available from 8.30am to 6.30pm on Monday, Tuesday, Thursday and Friday; and from 8.30am to 12pm on Wednesday. The practice provides some extended hours evening appointments with a GP and a nurse until 7pm on Monday and Tuesday and with a nurse until 6.45pm on Thursday. Extended hours appointments are provided at a nearby surgery until 6pm on Wednesday. All appointments can be pre-booked up to four weeks in advance.
Burbage Surgery has a dispensary and dispenses to around 90% of its patients. A member of the dispensary team is available from 9am to 6pm on Monday, Tuesday, Thursday and Friday, and from 9am to 12pm on Wednesday.
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 is available from 6pm to 8am, Monday to Friday. 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.
Burbage Surgery provides regulated activities from its sole location at 9 The Sprays, Burbage, Wiltshire SN8 3TA.
Updated
29 November 2016
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Burbage Surgery on 29 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 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 patient participation group (PPG) were well engaged and represented across a diverse range of ages and backgrounds. The PPG suggestions for changes to the practice management team had been acted upon and as well as this, the group had raised awareness about patient services.
- 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was better than both the clinical commissioning group (CCG) average of 86% and national average of 84%.
- 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%.
- 99% of patients said they could get through easily to the practice by phone (national average 73%).
- 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.
- 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.
- 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 hosts a talking therapy service on one afternoon per week, for patients who have experienced a bereavement, were carers, or were experiencing mental health issues. The service is funded by the local clinical commissioning group (CCG) and available on referral.
- The practice offers a ‘community clinic’ run by a nurse and GP, for patients with complex medical needs. Patients are allotted one hour, during which time their medical condition is reviewed and managed, and they are screened for dementia.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
People with long term conditions
Updated
29 November 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.
- Performance for patients with long-term conditions was better than national averages. For example, 83% 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 act 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 and a ‘community clinic’ run by a nurse and GP.
- The practice provides an unpaid out of hours service for terminal care patients. We saw evidence that the GP was available at all times by telephone and carried out home visits as necessary.
- The practice worked with the CCG to purchase urgent nursing home beds and had commissioned a taxi service for late afternoon urgent blood samples, measures taken in order to prevent unnecessary hospital admissions.
Families, children and young people
Updated
29 November 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 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 record that a cervical screening test had been performed in a target period of three-and-a-half or five-and-a-half years was 88%, which was better than 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.
Updated
29 November 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 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.
- A care co-ordinator based at the practice worked closely with district nurses, occupational therapists and social services agencies to avoid unplanned hospital admissions for older patients.
- The practice referred patients to local community health improvement schemes.
- The practice offered cryotherapy treatment for benign and malignant tissue damage.
Working age people (including those recently retired and students)
Updated
29 November 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 reflects the needs for this age group.
- The practice offered extended hours appointments with a GP on two evenings a week.
- 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.
People experiencing poor mental health (including people with dementia)
Updated
29 November 2016
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).
- 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was better than both the clinical commissioning group (CCG) average of 86% and national average of 84%.
- 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.
People whose circumstances may make them vulnerable
Updated
29 November 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 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 contacted by the practice nurse, assessed and if necessary, booked for a same day appointment at the practice.