The Old School Surgery

Updated 21 July 2016

The Old School Surgery is located in a converted village school building close to the centre of the village of Great Bedwyn, near Marlborough in Wiltshire. All the consulting rooms are on the ground floor.

They also deliver services from a branch surgery in a neighbouring village of Vernham Dean one afternoon a week. We did not visit this site during our inspection.

The practice delivers its services under a Personal Medical Services contract (A PMS contract is a contract between NHS England and general practices for delivering general medical services) to approximately 3,500 patients at the following addresses:

• Church Street, Great Bedwyn, Marlborough, Wiltshire, SN8 3PF.

• Vernham Dean Millennium Hall, Vernham Dean, Hampshire, SP11 0JY

The practice has its own dispensary and is a training practice although at the time of our inspection they had no trainees with them.

There are two GP partners and two salaried GPs. One is male and three are female. There are two practice nurses, four dispensary staff, a care coordinator, a team of six receptionists and administrators who support the practice manager and two cleaners.

The practice had a higher number of patients aged between 40 and 80 than average. The general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in the second least deprivation decile. (An area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score.). Average male and female life expectancy for the area is 81 and 86 years, which is broadly in line with the national average of 79 and 83 years respectively.

The practice has opted out of providing out of hours services to their patients. The out of hours service is provided by MEDIVIVO and is accessed by calling NHS 111.

This practice had not been previously inspected.

Updated 21 July 2016

Letter from the Chief Inspector of General Practice

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

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised. For example, timely prevention of a disclosure of confidential information over the phone was shared with all staff to highlight the issue.

• 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.

• The practice had a policy of reviewing patients with long-term conditions every six months.

• Feedback from patients about their care was consistently and strongly positive.

• The practice worked with other local providers to share best practice.

• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Information about how to complain was available and easy to understand.

We saw an area of outstanding practice:

• The practice took pride in the communitarian aspects of their work which they considered very important. For example, the senior GP had been writing monthly articles for the parish magazine for over 20 years. There was a strong culture of empowering patients and putting them at the centre of decisions about their care and treatment. We saw this reflected in their relationships, behaviour, attitudes and written material such as letters and the articles written for the parish magazine.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 July 2016

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

• The practice had a policy of reviewing patients with long-term conditions every six months.

• 91% of patients on the register with diabetes had a record of a foot examination in the last 12 months (04/2014 to 03/2015), compared to a national average of 88%.

• Longer appointments and home visits were available when needed.

• All patients with long-term condition had a named GP and a structured six month 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 21 July 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.

• 86% of patients with asthma on the register had an asthma review in the preceding 12 months that included an assessment of asthma control, compared to the national average of 75%

• 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.

• 83% of women aged 25 to 64 had a cervical screening test in the preceding five years compared to the national average of 82%.

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

• The local community midwife held a clinic at the practice every week.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 21 July 2016

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

• They offered a delivery of weekly dosette medicine boxes for the most vulnerable patients. The boxes were delivered by practice staff which had the additional benefit of ensuring these patients were seen at least once a week.

• The practice offered proactive, personalised care to meet the needs of the older patients 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.

Updated 21 July 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.

• Extended surgery hours were offered on Tuesday from 6.30pm to 7pm.

Updated 21 July 2016

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

• 100% of patients with a psychosis had a comprehensive agreed care plan documented in their record in the preceding 12 months (04/2014 to 03/2015), which was better than the national average of 88%.

• 88% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months (04/2014 to 03/2015), which was better than the national average of 84%.

• 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.

• A counsellor attended the practice for up to four sessions a week.

• 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.

• They worked in partnership with other organisations to support patients with substance misuse problems.

Updated 21 July 2016

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

• The practice held a register of patients living in vulnerable circumstances including travellers and those with a learning disability. We were told they had a number of canal boat travellers registered at the practice.

• 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.