The Fordingbridge Surgery

Updated 6 September 2016

The Fordingbridge Surgery is located at Bartons Road, Fordingbridge, Hampshire, SP6 1RS. The practice is based in the town centre of Fordingbridge, a market town on the north western edge of The New Forest and close to the county borders of Wiltshire and Dorset. The practice has approximately 12,600 registered patients who live within a practice boundary of approximately 100 square kilometres. The practice building was converted from a Victorian workhouse in 1993 and was extended approximately 15 years ago to add more clinical areas.

The practice provides services under a NHS General Medical Services contract and is part of NHS West Hampshire Clinical Commissioning Group (CCG). The practice is based in an area of low deprivation compared to the national average for England. A total of 13% of patients at the practice are over 75 years of age, which is higher than the CCG average of 10% and national average of 8%. A total of 61% of patients at the practice have a long-standing health condition, which is higher than the CCG average of 55% and national average of 54%. Less than 1% of the practice population describe themselves as being from an ethnic minority group; the majority of the population are White British.

The practice has five GP partners, three of whom are female and two who are male, as well as employing four salaried GPs, two of whom are male and two are female. Together the GPs provide care equivalent to approximately 6.5 full time GPs. The GPs are supported by four advanced nurse practitioners who are able to diagnose and prescribe treatments for a specific range of conditions. The practice also has two practice nurses and four health care assistants who provide a range of treatments and are equivalent to just under four whole time equivalent nurses. The clinical team are supported by a management team with secretarial, estates and administrative staff. The practice is a training practice for doctors training to be GPs (registrars) and a teaching practice for medical students. At the time of our inspection the practice were supporting two doctors training to be GPs and two medical students.

The Fordingbridge Surgery is open between 8am and 6.30pm Monday to Friday. Appointments with a GP are available until 12.30pm and again from 2pm until 6pm daily. Extended hours surgeries are available every Monday evening from 6.30pm until 7.30pm, every Thursday and Friday mornings from 7.30am and for one Saturday per month from 8am to 11am. The GPs also offer home visits to patients who need them. Care to patients is provided on the ground floor of the building and two waiting areas are available to patients. The first floor houses managerial and administration staff as well as staff linked to the practice such as health visitors.

The practice offers a range of primary care services as well as minor surgery, family planning services, joint injections and a vasectomy service for patients residing in West Hampshire. The practice is a dispensing practice and dispenses medicines to approximately 40% of the practice population. The dispensary also operates a home delivery service for frail or vulnerable patients.

The practice has opted out of providing out-of-hours services to their own patients and refers them to the Out of Hours care via the NHS 111 service. The practice offers online facilities for booking appointments and for requesting prescriptions.

The practice had a branch site located at 12 Park Lane, Alderholt, Dorset SP6 3AJ, approximately three miles away. The branch surgery is open on weekdays from 11.30am until 1pm and patients can make appointments at both sites. We did not visit the branch site as part of this inspection. We visited The Fordingbridge Surgery as part of this inspection, which has not previously been inspected by the Care Quality Commission.

Updated 6 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Fordingbridge Surgery on 25 July 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 been trained to provide them with 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.
• 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.

We saw areas of outstanding practice:

The practice supported a GP to perform in-house vasectomies (male sterilisation). Annual audits of practice were conducted and the GP received regular review by a specialist. In 2014-2015, 170 procedures were performed with a complication rate of less than 2%. The practice received consistently excellent patient feedback about the service. For example, 99% felt that the GP’s communication during the procedure was excellent and 91% felt that the procedure was better or much better than they had anticipated.

The patient participation group reviewed anonymised complaints from patients to deliver a patient perspective and enhance any learning from complaints.

The areas where the practice should make improvement are:

Review the processes for meeting the needs of all patients with long term conditions; specifically for conditions such as asthma and diabetes. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 September 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.
• 86% of patients with diabetes had an acceptable cholesterol level in 2014-2015 compared to the clinical commissioning group (CCG) average of 82% and national average of 80%.
• The percentage of patients with COPD (a chronic lung condition) who had a review in the preceding 12 months was 95%. This was better than the CCG and national average of 90%.
• 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 6 September 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. There was a system in place to follow up children who did not attend for 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.
• 83% of eligible women received a cervical smear in the preceding 5 years, which is similar to the national average of 82% and clinical commissioning group 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 and health visitors.
• The practice ran a vasectomy (male sterilisation) service for patients across the West Hampshire locality.
• The practice liaised with local infant and junior schools to provide health education to parents, staff and children. 

Updated 6 September 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 people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice had a care navigator, whose role it was to reduce hospital admissions for patients over 75 years of age and other vulnerable patients.
• Performance for conditions common in older patients was similar to national averages. For example, 97% of patients with atrial fibrillation (an irregular heart beat) received appropriate treatment, compared to the clinical commissioning group and national average of 98%.
• The practice had a dispensary service which delivered medications to the homes of patients who found it difficult to attend the practice.

Updated 6 September 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 different methods of communication to meet patients’ needs such as written, text, online and social media.
• The practice offered a range of extended hours appointments aimed at patients who could not attend in working hours.

Updated 6 September 2016

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

• 81% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is similar to the clinical commissioning group (CCG) and national average of 84%.
• 87% of patients with schizophrenia, bipolar affective disorder and other psychoses had an agreed care plan documented in their notes, which is similar to the national average of 88% and CCG average of 89%.
• 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.
• The practice achieved dementia friendly status in November 2013.

Updated 6 September 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 homeless people, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice had identified 51 patients with a learning disability. All had been offered a physical health check in the past year, of which 28 had accepted. This is equivalent to 55% of patients.
• 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.