Winscombe Family Practice Also known as Winscombe and Banwell Family Practice

Updated 26 January 2017

The practice is known as the Winscombe and Banwell Family Practice. The Winscombe Surgery location is situated in the village of Winscombe in a purpose-built building in the centre of the village accessed by a private residential lane. There is a parking for patients and staff including a space for blue badge holders. The practice has 9,400 patients registered between the two locations.

Winscombe Surgery

Hillyfields Way

Winscombe BS25 1AF

Banwell Surgery

Westfield Road

Banwell BS29 6AD

There are five GP partners, with two salaried GPs, two advanced nurse practitioners who are also independent prescribers, three part time practice nurses and three part time health care assistants. The clinical team are supported by an experienced practice manager and an administration and reception team. Staff can work across both locations.

The Winscombe site is open between 8am and 6.30pm Monday to Friday. Appointments are available from 8:30am and emergency telephone access is available from 8am. The practice operates a mixed appointments system with some appointments available to pre-book and others available to book on the day. Extended opening hours were offered between 7am – 8 am on Mondays, Tuesdays and Wednesdays and the practice also offers telephone consultations. The practice offers online booking facilities for non-urgent appointments and an online repeat prescription service. This site has six consulting rooms and two treatment rooms, with a patient health information room off the main waiting area where there is a blood pressure monitor for patients to access.

The practice has a Personal Medical Services (PMS) contract to deliver health care services; the practice are offering a range of additional and enhanced services such as the childhood vaccination and immunisation scheme, facilitating timely diagnosis and support for patients with dementia and minor surgery services. An influenza and pneumococcal immunisations enhanced service is also provided. These contracts act as the basis for arrangements between the NHS Commissioning Board and providers of general medical services in England.

The practice’s patient population is increasing and has slightly more older patients than the national average with 2.2% being over 90 years old. Approximately 45% of the patients are over the age of 65 years compared to a national average of 27%. Approximately 59% of patients have a long standing health condition compared to a national average of 54% which can result in a higher demand for GP and nurse appointments. These figures indicate there may well be competing demands for GP appointments however; patient satisfaction scores are high with 91% of patients describing their overall experience at the practice as good compared to a national average of 85%.

The general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in the 9th least deprivation decile. (An area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score. It is important to remember that not everyone living in a deprived area is deprived and that not all deprived people live in deprived areas).

The practice is a teaching practice and two GPs in training were placed with them at the time of our inspection. The practice also hosts placements for medical students. Three of the GPs are GP trainers and a fourth GP is a supervisor and this provides training resilience.

The practice has opted out of providing Out Of Hours services to their own patients. Patients can access NHS 111 or BrisDoc provide the out of hours GP service.However GPs visit terminally ill patients out of hours including weekends and also give these patients the GP’s home telephone number.

The practice’s patient population is increasing and has slightly more older patients than the national average with 2.2% being over 90 years old. Approximately 45% of the patients are over the age of 65 years compared to a national average of 27%. Approximately 59% of patients have a long standing health condition compared to a national average of 54% which can result in a higher demand for GP and nurse appointments. These figures indicate there may well be competing demands for GP appointments however patient satisfaction scores are high with 91% of patients describing their overall experience at the practice as good compared to a national average of 85%.

Patients at this practice have a higher than average life expectancy for men at 81years and women at 86 years.

The practice also hosted:

Monthly nurse-led urinary incontinence service.

Weekly Positive Step counselling.

Monthly Forget-me-not dementia support.

Weekly midwife sessions.

Fortnightly Age UK support services.

A podiatrist who visited weekly and a specialist NHS podiatrist visiting monthly for patients at higher risk.

There was an in-house weekly physiotherapy service partially funded by the practice.

There was in- house screening for Aortic Aneurism and diabetic retinopathy.

Updated 26 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Winscombe and Banwell Family Practice on 22 November 2016. The practice is registered as two locations, Winscombe Surgery and Banwell Surgery; patients could book an appointment at either location. All data relating to the performance of the practice has been aggregated and relates to both locations.

Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised. 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 urgent appointments were available the same day. The practice had reviewed their clinical team to improve accessibility to a clinician. All clinical members of the team carried out some of the home visits and undertook patient medication reviews. Feedback from the patient participation group (PPG) members was positive and they told us on the day of the inspection that there was continuity of care and they were able to get appointments when they needed them.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, they provided a weekly onsite clinic at an assisted living site and also arranged for a weekly community minibus service from there to the practice so patients could access other practice based services.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, they were involved in several pilot schemes to improve patient access to services such as the onsite mental health specialist nurse.
• The practice had strong and visible clinical and managerial leadership and governance arrangements. 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.

The areas where the provider should make improvement are:

• Ensure that regular fire safety drills are undertaken and involve all staff.

• The provider should ensure the electrical installation safety check is kept up to date.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 January 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority. 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 had signed up to the unplanned admissions local enhanced service and had identified the 2% of patients at higher risk of admission to hospital. Each patient had a care plan tailored to their individual needs, completed by a GP following a face-to-face meeting with them. The care plan was regularly reviewed. Each patient was assigned an appropriate care coordinator.

• There were emergency protocols for patients with long-term conditions who experienced a sudden deterioration in health such as ‘just in case’ medicines. Many of these patients were over 75 years old and were followed up on discharge from hospital which ensured that their care plans were updated to reflect any extra needs. Any unplanned admissions were discussed at a monthly meeting with the community team.

• The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c was 64 mmol/mol or less in the preceding 12 months was 73% whilst the clinical commissioning group average was 77% and the national average was 78%.

• The practice proactively identified patients at risk of developing long-term conditions and took action to monitor their health and help them improve their lifestyle. For example, the practice had planned a patient education event on diabetes on a Saturday morning in January 2017 run by their specialist diabetic nurse in conjunction with Self-Management UK (formerly the Expert Patient programme), in partnership with the specialist diabetic nurses employed by North Somerset Community Partnership and the dietitian employed by Weston Health Trust.This event is being facilitated by One Care Consortium and the practice is piloting a multi-disciplinary approach to encourage patient self-care.

• Longer appointments and home visits were available when needed.

Updated 26 January 2017

The practice is rated as good for the care of families, children and young people.

• There were systems 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 accident and emergency (A&E) attendances.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

• The practice provided support for babies and their families following discharge from hospital; new mothers were routinely contacted by their GP after birth and offered a home visit within a week of birth.

• The cervical screening data for the practice (2014/15) indicated that females aged 25-64, who attended for cervical screening within target period was 76% which was comparable with the clinical commissioning group average and higher than the national average.

• 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. There was a weekly “drop in” baby clinic staffed by a health visitor, practice nurse and GP. Immunisations were offered on a drop-in basis in order to maximise convenience and increase uptake.

• The practice were contracted for twice weekly surgeries at a local private school during term time; in addition health educational sessions were held to give the young people health advice.

• The practice had emergency processes for acutely ill children and young people.

Updated 26 January 2017

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

• Staff were able to recognise the signs of abuse in older people and knew how to escalate any concerns.

• 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 identified, at an early stage, older people who may be approaching the end of life. It involved older people in planning and making decisions about their care, including their end of life care.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Where older patients had complex needs, the practice shared summary care records with local care services such as the out of hours service.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. The practice hosted sessions from Age UK who signposted patients to relevant support services.

• GPs undertook routine weekly visits to patients in nursing homes and held a weekly clinic at an assisted living accommodation. The practice organised a weekly community minibus service from there to the practice so that patients could access other practice based services.

• The practice provided medical care for interim care beds at a local nursing home for any person admitted to the bed.

Updated 26 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. For example, early morning appointments from 7am were available, with GPs, a health care assistant and nurse practitioner; in addition, from December 2016, the practice planned to pilot evening surgeries from 6.30pm to 8pm.

• Pre-bookable appointments were available up to five weeks in advance. Telephone consultations were offered for convenience where clinically appropriate.

• 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 participated in the North Somerset Clinical Commissioning Group initiative supported by One Care Consortium to offer routine Saturday appointments with GPs, nurses and health care assistants.

• The practice held drop–in seasonal flu clinics on Saturdays which were accessible for working people.

• The practice arranged specific evening clinics for the insertion of intrauterine contraceptive devices and contraceptive implants to meet demand from patients.

Updated 26 January 2017

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

• Patients at risk of dementia were identified and offered an assessment. The practice participated in the dementia enhanced service and was pro-active in diagnosing dementia with a rate of 76% which was the second highest in the clinical commissioning group area.

• The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was 93

• The practice provided GP medical services to two care homes for people living with dementia. A member of staff had a dedicated session each week to manage prescriptions for this group of patients which promoted continuity.

• The practice carried out advance care planning for patients with dementia.

• Staff had a good understanding of how to support patients with mental health needs and dementia. There was a ‘Forget me Not’ (Alzheimer Society) session held in the practice to support patients and relatives affected by dementia and memory loss; the specialist dementia nurse from the North Somerset Memory Service attended the practice regularly.

• The practice participated in the pilot scheme to have a practice-based specialist mental health nurse who saw patients with low mood, anxiety and depression.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health. For patients who experienced a deterioration in their mental health alerts were put on the patients’ notes to ensure they were seen quickly.

• 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.

Updated 26 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 homeless people, travellers and those with a learning disability. The practice supported a learning disability care home; one GP had additional training in learning disabilities.

• Vulnerable patients were assisted to access appointments early in the morning to avoid the busiest surgery times.

• The practice had a small traveler community; the leader of which was in contact with the senior partner on a regular basis. This facilitated access to appropriate services.

• 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.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable. Patients were seen by their named GP who was accessible by mobile telephone and visited both during working hours and outside of the normal surgery times. One GP worked a session each week at the local hospice.