Archived: Bampton Surgery

Updated 10 March 2016

Bampton Surgery is located in Bampton, Devon. It is a rural practice where patients’ backgrounds include farming, tourism, commuting groups and the retired population. Sixty-five per cent of the patients are aged 45 years and over. The practice has more older patients aged 65 years and over (both female and male) that both the CCG and the national average. The practice has approximately 4000 registered patients.

The practice has two full-time male GP partners. There are also two part-time female salaried GPs who provide an additional six GP sessions per week. There are two practice nurses employed at the practice providing 14 sessions per week between them.

Bampton Surgery is a teaching practice that takes medical students. It is also a training practice for foundation doctors.

The practice is open between 08:00 am – 18:30pm Monday to Friday for appointments. Extended hours surgeries are offered from 07:30am – 08:00am on four days week days a week for working people.

When the practice is closed there is a telephone service to a NHS out of hours provider.

Updated 10 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bampton Surgery on 19 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 that 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 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.
• Clinical staff knew their patients very well and offered good continuity of care.

We saw some areas of outstanding practice:

• Services for older people were tailored to individual need, for example with detailed, regularly reviewed care plans for people with serious illnesses and/or palliative care considerations.

• The practice had initiated additional support for dementia patients by liaising with a local charity to jointly fund and start a weekly cognitive stimulation therapy group.

• The uptake of childhood immunisations was excellent, with staff conversing with families to promote childhood vaccination programmes.

• Medicines reviews for patients were performed six monthly as standard at the practice to ensure prescribing was appropriate and safe and patients received the most effective treatment based on their diagnosis.

• Appointments were readily available. There were standard 15 minute appointments (the norm is 10 minutes) to allow time to listen to patients and involve them in their care. Longer appointments were available for complex needs or annual health checks.

• The practice had adapted and developed a range of templates with reference to NICE guidelines. This standardised care across the practice and ensured patients received a comprehensive and holistic review of long-term health conditions.

• Patient satisfaction with the practice was very high across the board with indicators such as appointment access, considerate care and treatment, when compared with both the local CCG and national averages.

The areas where the provider should make improvement are:

• Provide all GPs with child safeguarding training to the recommended level three.

• Seek reassurances that practice nurses are aware of the practice’s Mental Capacity Act (MCA) (2005) protocol, and review the provision of MCA training where relevant to their roles.

• Consider the appropriateness of risk assessing staff working unsupervised out of practice hours in relation to the storage of confidential patient paper records.

• Consider how to better engage with pregnant women with the loss of some community midwifery services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 March 2016

The practice is rated as outstanding for the care of people with long-term conditions.

• Nursing staff had lead roles in some chronic disease management and patients at risk of hospital admission were identified as a priority.

• The practice performed better than the national average for monitoring patients with diabetes and managing their health. (Latest figures available were taken from the 01/04/2013 – 31/03/2014 periods).

• Longer appointments and home visits were available when needed.

• All these patients had a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• Clinical updates regularly discussed in monthly clinical meetings to ensure practice protocols were quickly adopted.

• Personalised care plans were widely used to engage patients and assist self-management.

• The practice had adapted and developed a range of templates with reference to NICE guidelines. This standardised care across the practice and ensured patients received a comprehensive and holistic review of long-term health conditions.

Updated 10 March 2016

The practice is rated as good for families, children and young people. We noted some elements of outstanding care and treatment for this population group particularly around how patients were responded to.

• There were systems in place to identify and follow up children living in disadvantaged circumstances. This included children who were at risk, for example, children and young people who had a high number of A&E attendances.

• There were processes in place to identify foster children newly registered with the practice. These children were reviewed by GPs as standard practice even if there were no medical concerns.

• Immunisation rates were very 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 percentage of women aged 25 – 64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 85.19%. This was better than the national average of 81.88% (figures available from 01/04/2013 – 31/03/2014). The practice had a system for contacting women who had not attended their invited cervical smear appointment.

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

• The practice was accessible for buggies. There was a breast feeding area and a child age appropriate section in the patient waiting room.

• The practice had a baby welcome pack for new parents registering their baby. The pack was designed by the practice as a way of supporting parents to make an informed choice in advance of scheduled immunisation appointments.

• Mixed gender GPs were available.

• Administrative staff were trained to ensure requests for post coital contraception were dealt with timely and sensitively.

• Leaflets regarding sexual health, sexually transmitted diseases and domestic violence were discretely available in the patient toilet.

• Local midwifery services had been reduced; the practice was considering how this impacted upon services they could provide to pregnant women.

Updated 10 March 2016

The practice is rated as outstanding for the care of older people.

• The practice offered personalised care to meet the needs of the older people in its population.

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

• The practice staff had excellent knowledge of individual older patients health needs.

• There was ground floor access to the practice building and disabled parking bays.

• Clinicians escorted patients to consulting rooms.

• Treatment rooms had been extensively modified with low level bariatric scales available.

• There were weekly scheduled visits to a local nursing and a residential home. Each GP took responsibility for all the residents ensuring good communication and continuity of care. We received feedback from the local nursing home, which cited excellent communication with the practice and praised the effectiveness of care and support to people at the nursing home registered with the practice.

• GP partners were very experienced in palliative care. Community based end of life nursing teams attended a monthly clinical team meeting at the practice to discuss patients in their care.

• Palliative care patients were regularly visited out of hours and at weekends by the GPs ensuring continuity of care.

• Case management and admissions avoidance enhanced service were fully implemented with monthly meetings, care plans and same day telephone access.

• There was wide use of future care planning and treatment escalation plans.

• Controlled medicines and emergency injectable medicines were available for use by GPs on home visits, to ensure patients received timely pain management.

• There were arrangements with pharmacists to deliver medicines and blister packs if required.

• There were annual ‘flu clinics with open appointments held in a local hall over three day period to allow flexibility for patients and carers.

Updated 10 March 2016

The practice is rated as good for the care of working-age people (including those recently retired and students). We noted some elements of outstanding care and treatment for this population group particularly around how patients were responded to.

• 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. There were extended hours appointments 07:30am – 08:00am on four weekday mornings.

• Appointments were available from 08:00am with GPs and from 08:20am with nurses for the convenience of patients travelling to work.

• The practice offered online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• Emergency medicines were dispensed at the practice if the local pharmacy was not open.

• There was an answerphone for 24 hour prescription requests and cancelling appointments.

• NHS health checks were offered to eligible patients over 40 years.

Updated 10 March 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). We noted some elements of outstanding care and treatment for this population group particularly around how patients were responded to.

• All patients at the practice with diagnosed mental health needs had a care plan. People vulnerable to alcohol dependency were also monitored. (Figures from the same period 01/04/2013 – 31/03/2014).

• Performance for mental health related indicators was better than the national average with 100% performance at the practice compared with national figures ranges of between 86.04% - 88.61%.

• There were 30 minute comprehensive mental health and dementia annual reviews with the GPs. Fifteen minute GP appointments were available as standard.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• It 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. Local depression and anxiety service leaflets were available in the patient waiting room and were available for printing on demand.

• It 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 people with mental health needs and dementia.

• The practice had recently set up a local weekly cognitive stimulation therapy group aimed at patients with dementia and/or mental health conditions.

Updated 10 March 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. There was a 30 minute annual learning disability review with GP for these patients. The review could take place at the person’s home if this was more convenient.

• The practice offered longer appointments for people with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• It had told 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.

• Case managed patients had the same day telephone access and were reviewed monthly.

• The practice had a carer’s registration and information pack for patients who cared for relatives.