Wargrave House Surgery

Updated 6 January 2017

Wargrave House Surgery is located in the centre of Hereford and provides primary medical care to people who also live in the town and its surrounding suburbs. There are approximately 9,030 patients registered at the practice. The practice holds a General Medical Services (GMS) contract, a nationally agreed contract commissioned by NHS England. There is a slightly higher than average age group of registered female patients aged between 55 and 85 and above. There are 861 patients registered who are aged 75 and above, this equates to 10% of the practice population.

The practice is managed by five GP partners (two male, three female) and they are supported by three salaried GPs. The practice employs two nurse practitioners and an independent nurse prescriber who sees patients who have minor illnesses. They carry out reviews of patients who have long term conditions such as, diabetes, asthma and hypertension. They also provide cervical screening and contraceptive advice. There are two health care assistants (HCA) who carry out duties such as, phlebotomy (taking blood for testing), health checks and flu vaccinations.

The practice manager left the practice in July 2016. The assistant practice manager has been carrying out the practice manager role and functions for three months. They are supported by six receptionists, three administrators and one medical secretary.

There is a pharmacist who works at the practice for one session per week one day per week to carry out audits and provide guidance to GPs about appropriate prescribing of medicines for patients. A community psychiatric nurse provides one or two clinical sessions per week, a community dementia nurse provides one session on alternate weeks and a physiotherapist works at the practice twice a week.

The practice offers a range of clinics for chronic disease management, diabetes, heart disease, cervical screening, contraception advice, minor surgery, injections and vaccinations.

There is no dedicated parking for patients; there is free on street parking outside the premises for up to 30 minutes and car parks within the town. There are a number of disabled parking spaces directly outside the front of the premises. The premises have been adapted to make it wheelchair friendly for most areas of the ground floor. There is a disabled toilet.

The practice is open from 8am until 6pm Mondays and Fridays and Saturdays from 9am until 1pm.

Appointments times vary between GPs:

• From 8am until 9.30am telephone consultations are held.

• Patients have face to face appointments from 9.30am until 11.30am or 12pm.

• Patients who request same day appointments are given a half hour window when they can turn up and wait to be seen.

• From 3pmuntil 3.30pm further telephone consultations are held.

• From 5pm until 6pm patients who request same day appointments are given a half hour window when they can turn up and wait to be seen.

Extended hours are:

• From 9am until 1pm each Saturday, patients can be seen by a practice nurse and occasionally by a GP.

• From 7am each Tuesday and Friday patients can attend and be seen by a HCA. This service mainly concerns phlebotomy (taking blood samples).

The practice has joined up with other local practices as part of Taurus Healthcare. Patients from this and other practices can be seen at Wargrave House Surgery from 6am until 8pm each weekday and from 8am until 8pm during weekends and bank holidays. This means that patients may not be seen by a GP or nurse from their own practice but clinical staff have access to all patient’s records to ensure appropriate assessments and treatments are provided.

Patients who request a home visit are telephone triaged by a GP to enable them to prioritise patients.

The practice has opted out of providing GP services to patients out of hours during nigh times. During these times GP services are provided currently by a service commissioned by NHS Clinical Commissioning Group (CCG), Primecare located in the GP Access Centre. When the practice is closed, there is a recorded message giving out of hours’ details. The practice leaflet includes contact information and there are out of hours’ leaflets in the waiting area for patients to take away with them.

Updated 6 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wargrave House Surgery on 1 November 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded including lessons learned.

• Safe arrangements were in place for staff recruitment that protected patients from risks of harm. The numbers of staff were regularly reviewed to enable them to meet patients’ needs. The practice manager left in July 2016 and senior staff were in the process of recruiting. The assistant practice manager was fulfilling the role temporarily.

• There were on-going arrangements were in place to protect patients and others from unnecessary infections.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training had been encouraged and planned.

• Patients told us they were treated with compassion, dignity and respect and they were involved in decisions about their treatment.

• Senior staff had responded to the previous results of the National Patient Survey regarding access for appointments. A new appointment system was introduced in May 2016 and this was being monitored for effectiveness. All patients who requested same day appointments were triaged to ensure they received appropriate and timely care.

• Information about how to make a complaint was readily available and easy to understand. Complaints received were dealt with appropriately.

• There was a clear leadership structure and staff told us they felt well supported by senior staff. Management sought feedback from patients which it acted on.

• The provider was aware of and complied with the requirements of the duty of candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 January 2017

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

• Nursing staff had lead roles in chronic disease management.

• Patients with long-term conditions had structured annual reviews to check that their health and medicine needs were being met. Where necessary reviews were carried out more often.

• Flexible appointment times were offered to enable patients to attend the practice for their health reviews. Longer appointments and home visits were available when needed.

• Where necessary patients in this population group had a personalised care plan in place and they were regularly reviewed.

• Clinical staff worked with health and social care professionals to deliver a multidisciplinary package of care.

• Nationally reported Quality and Outcomes Framework (QOF) data for 2014-2015 showed the practice had achieved good outcomes in relation to conditions commonly associated with this population group. Performance for chronic obstructive pulmonary disease (COPD) was 96%; compared with the national average of 90%.

Updated 6 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.

• Immunisation rates for all standard childhood immunisations ranged from 94% to 99%. The Clinical Commissioning Group (CCG) results ranged from 89% to 97% and nationally from 73% to 95%.

• All children up to the age of 12 years were triaged and if necessary seen the same day.

• Our discussions held with practice staff showed that children and young people were treated in an age-appropriate way and were recognised as individuals.

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

• Family planning advice was provided. Clinical staff provided minor surgery including intrauterine device (IUD), contraceptive coil fitting.

Updated 6 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 people in its population. The practice had identified its patients who were aged over 75 and encouraged them to attend the practice for annual health checks.

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

• Practice staff worked with other agencies and health providers to provide patient support. For example, Age UK.

• The practice maintained a palliative (end of life) register and care plans were in place for those it was appropriate for. Care plans were regularly reviewed and if necessary following multidisciplinary meetings to ensure patients received seamless care.

Updated 6 January 2017

The practice is rated good for the care of working-age people (including those recently retired and students).

• The practice had adjusted its services to accommodate the needs of this population group.

• Telephone consultations were provided for those patients who found it difficult to attend the practice or if they were unsure whether they needed a face to face appointment.

• Extended hours were provided to improve patient access. This was from 6am until 8pm weekdays and 8am until 8pm during weekends; patients may be seen by a clinician from another practice.

• Online services were available for booking appointments and ordering repeat prescriptions; 36% of patients held an online account.

• The practice website and the practice leaflet gave advice to patients about how to treat minor ailments without the need to be seen by a GP. Copies of this were also available in the practice.

• Patients we spoke with told us that clinical staff routinely provided healthy living advice to promote their well-being.

Updated 6 January 2017

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

• 92% of patients who experienced poor mental health had received a mental and physical health check during 2014-2015 and were involved in developing their care plans. It compared with the CCG data of 92% and national data of 88%.

• Practice staff regularly worked with multi-disciplinary teams in the case management of patients who experienced poor mental health, including those with dementia. These patients were routinely offered same day appointments.

• There was a designated lead GP for patients who experience poor mental health.

• A community psychiatric nurse (CPN) held clinics at the practice one or two times a week. A community dementia nurse held a clinic at the practice every alternate week.

• GPs carried out assessments of patients who experienced memory loss in order to capture early diagnosis of dementia. This enabled staff to put a care package in place that provided health and social care support systems to promote patients well-being.

• Referrals to other health professionals were made when necessary. For example, the community mental health team.

Updated 6 January 2017

The practice is rated 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 who had a learning disability.

• Health checks for patients who had a learning disability took place. Data informed us that all 55 patients who had a learning disability had received their annual health check during 2014-2015. A GP partner specialised in this area.

• Practice staff regularly worked with multi-disciplinary teams in the case management of vulnerable patients.

• There was a process in place for referring patients to other agencies and support services.

• Staff knew how to recognise signs of abuse, the actions they should take and their responsibilities regarding information sharing. There was a clinical lead for dealing with vulnerable adults and children.

• The practice kept a register of carers; staff had identified 3% of patients who were carers. Clinical staff offered them guidance, suggested support groups and offered them the flu vaccination each year.

• A GP partner was in the early stage in identifying and coding patients who were military veterans to enable them to signpost these patients to a range of support services.