Background to this inspection
Updated
2 August 2019
Symphony Health Services Ltd (SHS) is the registered provider of Buttercross Health Centre. SHS is a NHS health care provider, based in Somerset that was developed as part of the South Somerset Symphony Programme – a project which aimed to create new and innovative ways to delivering high quality care to patients and strengthening and supporting primary care in the local area. SHS have been providing a service from Buttercross Health Centre since August 2016.
Buttercross Health Centre service is provided from Behind Berry, Somerton, Somerset TA11 7PB, and delivers a general medical service (GMS) to approximately 7,500 patients. The branch surgery is situated at The Ilchester Surgery, 17 Church Street, Ilchester BA22 8LN. Further information about the practice can be found at www.buttercrosshc.nhs.uk.
According to information from Public Health England the practice area population is in the eighth least deprived decile in England. The practice population of children and those of working age is similar to local and national averages. The practice population of patients living with a long-term condition was similar to local and national averages at 67%, the CCG being 58% and national being 54%.
The practice team is made up of four salaried GPs which equates to 2.32 WTE (whole time equivalent) GPs at the practice (two male and two female). There are three advanced nurse practitioners (ANP), three practice nurses and five health care assistants. The practice has additional clinical specialist staff including an emergency care practitioner (ECP) and a pharmacy technician. Pharmacist support is available through SHS medicines management hub. There are five health coaches. The practice manager is supported by administrators, secretaries, and reception staff.
When the practice is not open patients can access treatment via the NHS 111 service.
The practice provides family planning, surgical procedures, maternity and midwifery services, treatment of disease, disorder or injury and diagnostic and screening procedures as their regulated activities. The Registered Manager is the medical director for Symphony Health Services.
Updated
2 August 2019
This practice was rated October 2018 as Requires Improvement overall.
We carried out an announced comprehensive inspection at Buttercross Health Centre on 5 June 2019 to follow up on breaches identified at a previous inspection in 22 and 23 August 2018.
At the last inspection in October 2018 we rated the practice as requires improvement overall and requires improvement for providing safe, effective and well led services and requires improvement for the patient population groups of people with long-term conditions and mental health needs.
Key concerns were:
Safe
The areas where the provider must improve were that safe care and treatment was provided regarding infection prevention, staff immunisation status was in line with Public Health England (PHE) guidance. In addition, improvements were required related to fire safety, checks for safe equipment, medicines management and mandatory training for staff. Improvements were also needed in record keeping for the outcomes of patient specific meetings, for the sharing information for significant events and complaints.
Effective
The provider must ensure patients received an adequate review of their care and treatment needs on a regular basis. Improvements were needed in the monitoring systems for the quality of care outcomes (QOF) and clinical management of long-term conditions including mental health. The provider should improve how they review and maintain practice held disease registers such as for patients who are homeless and continue with a programme to develop cervical cancer screening uptake.
Well Led
The provider must ensure there were effective systems and processes for good governance. Improvements were needed for the processes in place with regards complaints and concerns and management to the classification of complaints and concerns, the clinical audit programme and the risk management of emergency cover at the branch surgery at Ilchester as a GP is not on site to respond to medical emergencies.
At this inspection, we found that the provider had satisfactorily addressed these areas.
We based our judgement of the quality of care at this service is on a combination of:
- what we found when we inspected
- information from our ongoing monitoring of data about services and
- information from the provider, patients, the public and other organisations.
We have rated the practice as Good overall.
In particular we found:
- Care and treatment was provided in a safe way to patients with regards to infection prevention and control including the necessary information was available regarding staff immunisation status in line with Public Health England (PHE) guidance.
- There were safe systems in place for fire safety including regular fire drills, checks for safe equipment, including calibration and mandatory training completion for staff.
- Medicines were stored safely and risk assessments for emergency medicines were in place.
- There were effective systems in place to respond to medical emergencies at the registered location and at the branch surgery.
- Patients received an adequate review of their care and treatment needs on a regular basis. The practice continued to implement actions to improve the quality of care outcomes (QOF) and clinical management of long-term conditions including mental health.
- Efforts to improve the uptake of cervical screening had increased the number of eligible patients participating to above 83%.
- Childhood immunisation uptake rates were above the World Health Organisation (WHO) targets
- Significant improvements had been made in the care and provision for patients with mental health needs.
- Feedback from patients was positive, staff were reported to be kind and caring.
- The health coach staff team worked well and led on patient communication, community support and monitoring of the most vulnerable patients.
- Disease registers were in place to identify and prioritise meeting patient’s needs.
- The documentation, record keeping processes and follow-up action for patient specific action taken at meetings, including safeguarding and meeting ‘huddles’ was in place.
- There was documentation to support actions taken, lessons learnt and the sharing of information within the practice team related to significant events and complaints
- There were effective systems and processes to ensure good governance including staffing levels, audit, the management of complaints and concerns
Areas where the provider should continue to develop:
- The practice should continue with their program to improve meeting the needs of the patients with long term conditions.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care
Please refer to the detailed report and the evidence tables for further information