Archived: Wallingbrook Health Group

Updated 7 July 2016

Wallingbrook Health Group has three registered locations providing general medical services at:

Wallingbrook Health Centre – Back Lane, Chulmleigh, Devon EX18 7DL

Winkleigh Surgery – 15 Southernhay, Winkleigh, Devon EX19 8DH

Okement Surgery - Cavell Way, Okehampton EX20 1PN (closing permanently on 30 April 2016)

The inspection on 5 April 2016 was of the Winkleigh Surgery and included the dispensary there. We also inspected Wallingbrook Health Centre on 23 March 2016 for which there is a separate report.

Wallingbrook Health Group practices are situated in a predominantly rural area. There were 8415 patients on the combined practice list, covering all three practices registered. The majority of patients are of white British background. All of the patients have a named GP. There is much a higher proportion of older adults on the patient list compared with other practices in the area. Nearly half (46%) of the patient population are over 65 years, with a higher prevalence of chronic disease which the practice monitors. The total patient population falls within the mid-range of social deprivation.

The practice is managed by six partners (four male and one female GPs, and a female pharmacist).They are supported by two salaried GPs (male and female). If required the practice uses the same GP locums for continuity where ever possible. The nursing team consists of four female nurses; a nurse practitioner and three practice nurses. There are three female HCAs All the practice nurses specialise in certain areas of chronic disease and long term conditions management. The nurse practitioner is able to see patients with minor illness. All of the staff work across all three practice sites run by Wallingbrook Health Group.

The practice at Winkleigh Surgery in Winkleigh is open 8.30am to 6.30pm Monday to Friday. Phone lines are open from 8.30am to 6pm, Monday, Wednesday and Thursday and 8.30-1.00pm Tuesday & Friday.  The out of hours service picks up phone calls after this time. GP appointment times are 8.30-11.45 Monday to Friday and 3.00-5.30 Monday and Thursday. On Tuesday and Friday, the practice is only open for half a day between 8.30am and 1pm. Patients are able to arrange appointments at Wallingbrook Health Centre also outside of these times. Extended opening hours are not routinely provided on a specific day. The practice has consulted patients and instead offers working patients early morning and late evening appointments by arrangement to suit their needs. Information about this is listed on the practice website and patient information leaflet.

Opening hours of the practice are in line with local agreements with the clinical commissioning group. Patients requiring a GP outside of normal working hours are advised to contact the out of hours service provided by Devon Doctors. The practice closes for three days a year for staff training and information about this is posted on the website.

The practice provides additional services, some of which are enhanced services:

• Extended hours

• Minor surgery

• Risk profiling and reducing unplanned admissions.

• Annual health checks for patients aged over 14 years with a Learning disability.

• Facilitating early diagnosis of dementia

• Influenza, pneumococcal, rotavirus and shingles immunisations for children and adults

• Patient participation in development of services.

Improving on line patient access.

Updated 7 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Wallingbrook Health Group at Winkleigh Surgery on 5 April 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 drove innovation and was proactive in influencing this at a national level by having pioneered the role of pharmacist embedded in a GP practice.  The practice had had a pharmacist as a partner since 2004 and had been an exemplar of best practice. The practice pharmacist has campaigned nationally for over a decade to promote the role of practice pharmacist as an integral part of GP practice teams.

• Staff were involved with innovation design projects such as the type 2 diabetes care pathway, which was due to be piloted across GP practices in England in the next 12 months into 2017. This resource aims to improve consistency, understanding, self care and shared decision making for patients with type 2 diabetes over the course of their life.

• The practice was proactive in identifying carers at the point of registering with them and had identified 5.1% of the practice list as carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 July 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.

• Performance for diabetes related indicators was similar to the national average. For example, 88.4% of patients on the diabetes register had a record of a foot examination and risk classification within the preceding 12 months (national average 89.4%). The practice looked into a large variance between the practice and national percentages of patients with diabetes for some blood pressure readings. A plan was in place and completed actions included the setting up of a protocol so that GPs were alerted on the patient record system when the patient’s blood pressure over 140/80 was recorded. Other actions included, ongoing reviews and audits of patient outcomes on the diabetes register.

• 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 7 July 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 comparable with those seen in the Clinical Commissioning Group (CCG) area 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’s uptake for the cervical screening programme was 79.4%, which was above the CCG average of 76.9% but below 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.

Updated 7 July 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.

• All patients had a named GP to promote continuity of care and when attending their appointments were collected by the GP or nurse from the waiting room.

• Monthly meetings were held between community staff, so that vulnerable older people were closely monitored and given timely support.

Updated 7 July 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.

• Extended opening hours were not routinely provided on a specific day. The practice had consulted patients and instead offered working patients early morning and late evening appointments by arrangement to suit their needs. Information about this is listed on the practice website and patient information leaflet.

• 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. This included, repeat prescription and appointment requests.

Updated 7 July 2016

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

• 91.7% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was above the national average of 84%.
• Performance for mental health related indicators was similar to the national average. For example, 86.1% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (national average 88.5%).

• A system of a rolling programme of appointments was in place for patients with associated anxiety disorders, which was aimed at reducing their anxiety by providing a framework of planned follow up appointments for them.

• 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 and provided 30 minute appointments for these.

• 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.

• Health Care Assistants at the practice had completed a dementia and mental health course, as some were involved in doing carers checks. All of the staff had a good understanding of how to support patients with mental health needs and dementia and shared several examples of how they had done so.

Updated 7 July 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held registers of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. At the time of the inspection, there were no homeless people or travellers registered at the practice.

• The practice offered 30 minute appointments for patients with a learning disability. Reasonable adjustments made, including providing patients with easy read health plans following their annual review.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. Being situated in a rural area, the practice recognised that community services were under pressure and had listened to patients needs. Data provided by the practice showed that within the last 12 months, practice nurses had carried out 11 home visits to patients living in and around Chulmleigh and Winkleigh who were vulnerable, frail and/or had a long term condition. Patients had been reviewed and where needed simple interventions such as ear syringing were done to alleviate discomfort for 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.