St Chads Surgery

Updated 25 January 2017

St Chads Surgery, known locally as St Chads and Chilcompton Surgery, is located in Midsomer Norton, a Somerset town around 10 miles south west of Bath. The practice has occupied its current, purpose-built facility since 1988 and is arranged over two floors. There are 14 GP consulting rooms on the ground floor along with two rooms for phlebotomy, two nurses rooms and a phone room situated away from the front reception desk. An administration office is located on the first floor, which can be accessed by stairs.

St Chads Surgery is one of 26 GP practices in the NHS Bath and North East Somerset Clinical Commissioning Group (CCG) area. The practice has around 12,572 registered patients, most of whom live within a two to three mile radius of the practice. The practice patient populations do not align with the England average for some age groups, thus giving an indication of the area’s demographic profile. These deviations are most noticeable for all patient age groups between 20 and 39 years, which are below the England average; and all patient age groups from 65 years and upwards, which are above the England average.

96% of the practice population describes itself as white British, and around 2% as having a Black, Asian and Minority Ethnic background. 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).

St Chads Surgery is the main site. There is a local branch practice around three miles away at Carter’s Way. The branch practice was not inspected during this inspection. This report relates to the main location at Gullock Tyning. Most of the practice patients live within a five mile radius of the main or branch locations, and around 80% of the practice’s patients are seen at the main site.

The practice team consists of seven GP partners (four male, three female) and two salaried GPs (both female). The nursing team consists of two nurse team leads, two research nurses and one senior nurse. There are two health care assistants (HCAs) and two phlebotomists, one of whom is working towards their Care Certificate.. The clinicians are supported by a practice manager and teams of receptionists, administrators and medical secretaries. The practice has a Personal Medical Services contract with NHS England (a locally agreed contract negotiated between NHS England and the practice).

The main practice (Gullock Tyning. BA3 2UH) is open from 8am to 6pm, Monday to Friday and the practice will take calls during these times. Routine GP appointments are available from 8.30am to 11am and from 2.30pm to 5.30pm, Monday to Friday. The practice provides extended hours appointments one morning per week, with a GP and a nurse from 7.30am to 8am. Extended hours appointments are provided on two evenings per week from 6.30pm to 7.30pm. The practice is open on one Saturday per month from 8am to 12pm, for pre-booked appointments. All appointments can be pre-booked up to six weeks in advance.

The branch practice (Carter’s Way. BA3 4XH) is open from 8am to 6pm, Monday to Friday and the practice will take calls during these times. Routine GP appointments are available from 8.30am to 11am and from 3pm to 5.30pm, Monday to Friday. The practice provides extended hours appointments one morning per week, with a GP and a nurse from 7.30am to 8am. Extended hours appointments are provided on two evenings per week at the branch practice from 6.30pm to 7.30pm. The practice is open on one Saturday per month from 8am to 12pm at the main location, for pre-booked appointments.

St Chads Surgery is a training and research practice. The practice currently has two registrars in their final year of a postgraduate medical training programme.

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. 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.

St Chads Surgery provides regulated activities from its main and branch locations. The main location address is Gullock Tyning, Midsomer Norton, Radstock BA3 2UH. The branch location address is Carter’s Way, Chilcompton, Radstock BA3 4XH.

Updated 25 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Chads Surgery on 23 November 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.
• 83% of patients said they could get through easily to the practice by phone compared to the national average 73%.
• 93% of patients were able to get an appointment to see or speak to someone the last time they tried compared with the national average of 85%.
• The patient participation group (PPG) was 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 the group had raised awareness to patients about the practice’ services.
• The practice participated in a social prescribing scheme to support people who attend their GP surgery but did not necessarily require medical care. Social prescribing supported patients with issues such as social isolation and coping with caring responsibilities, to connect to services and groups that could help improve their wellbeing and meet their wider needs.
• Results from the NHS Friends and Family Test showed that 467 respondents (94%) would recommend the practice to family and friends.
• Staff had lead roles that improved outcomes for patients such as a carer’s lead.
• 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 hosted a talking therapy service for patients who had experienced bereavement, were carers, or were experiencing mental health issues. The service was funded by the local clinical commissioning group (CCG) and was available on referral.

We saw three areas of outstanding practice:

• There was a proactive approach to understanding the needs of different groups of people and to deliver care in a way that met these needs and promoted equality. St Chads Surgery identified patients at risk of developing diabetes who were not on the diabetes register, and implemented changes that could help to delay or prevent the progression of this health condition. Changes offered to patients included lifestyle interventions and annual blood testing. The practice identified 138 patients who were not on the diabetes register and the practice developed a new information technology template to record their needs.

• The practice developed a ‘tiered letter recall system’ so that patients need only attend one annual review to address multiple health concerns. For example, 783 patients with diagnoses of diabetes, chronic kidney disease and hypertension had these health issues addressed in a single annual review in the last year.
• In 2015 and 2016, the practice received an award from the National Institute for Health Research (NIHR). The reward recognised the practice for developing innovative models of recruitment, and for consistently delivering its research findings to time and on target.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 January 2017

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 compared with national averages. For example, 79% 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.
• The practice identified patients at risk of developing diabetes and implemented changes that could help to delay or prevent the progression of this health condition.
• The practice developed a recall system so that patients need only attend one annual review to address multiple health concerns.
• The practice collaborated with seven practices, to support patients who had been diagnosed with diabetes, heart failure or depression.
• The practice referred patients to a scheme to help with medical conditions such as diabetes and coronary heart disease. The scheme enabled these patients (who are not normally active) to access a supported 12-week exercise programme.

Updated 25 January 2017

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 the preceding five years was 85%, which was comparable to 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.
• The practice worked to provide inclusive services for younger patients. For example, the practice was a centre for the ‘C Card Scheme’, which enabled teenagers to access free methods of contraception.
• The practice was a registered location for the Breastfeeding Welcome Scheme, which aims to facilitate greater acceptance and promotion of breastfeeding.

Updated 25 January 2017

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 carer’s lead worked closely with district nurses, occupational therapists and social services agencies to avoid unplanned hospital admissions for older patients.
• The practice initiated the use of a recognised clinical measure of fitness and frailty in older people to assess their health needs.
• The practice offered home visits to review personalised care plans for older patients.

Updated 25 January 2017

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 in the morning and evening with a GP and nurse, as well as Saturday appointments for one morning a month.
• Patients were able to book appointments and order repeat prescriptions online.
• The practice offered text reminders for appointments.
• Telephone appointments were offered where appropriate, as an alternative to face-to-face consultations.

Updated 25 January 2017

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

• 80% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which compared with 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 95%, which exceeded 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.
• Patients were referred to specialist mental health services that offer assessment and treatment when children and young people have emotional, behavioural or mental health difficulties.

Updated 25 January 2017

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.