Knightwick Surgery Also known as Drs Bywater, Salter & Hinton

Updated 11 April 2016

Knightwick Surgery provides primary medical services to approximately 4,100 people who live in the surrounding rural area. Patients are registered at the practice from the surrounding villages. There are two branch practices for ease of access for patients:

• The Village Hall, Hope Lane, Clifton on Teme.

• Heaton House, St Peters Drive, Martley. 

We did not visit the branch practices. The practice holds a General Medical Services contract. The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities.

The practice is managed by three GP partners (two male, one female) who between them provide 15 clinical sessions per week plus one clinical session each Monday split between the two branch practices. They are supported clinically by three practice nurses and three health care assistants (HCA)/receptionists. The practice nurses have specialist skills, such as diabetes, anticoagulant therapy and chronic obstructive pulmonary disease (COPD) (long term chest conditions). They also provide cervical screening and contraceptive and smoking cessation advice. The HCAs provide a phlebotomy (blood samples) service and health checks. The practice manager is supported by a reception manager, five receptionists, three HCA/receptionists and a secretary/receptionist. There is a business apprentice working at the practice to gain experience. The dispensing team consists of a dispensary manager and five dispensers.

The practice provided enhanced services such as; minor surgery, treatment of minor injuries and early diagnosis of dementia.

Patients who live in excess of one mile from a pharmacy are eligible to have their prescribed medicines dispensed from the practice. This equates to the majority of registered patients. Medicines can be collected from the practice and from Clifton on Teme and Martley village shops by prior arrangement. Controlled drugs are collected from the practice only. These are medicines that require extra checks and special storage arrangements because of their potential for misuse.

The opening times are:

• Knightwick Surgery 8am until 7pm daily and until 8.30pm on Thursdays.

Consultation times are:

• Knightwick Surgery from 8am until 1pm and from 1pm until 6.30pm Mondays and Tuesdays, from 8am until 12.30pm and from 2.30pm until 6pm Wednesdays, from 8am until 12.30pm and from 3pm until 8.30pm Thursdays, from 8am until 12.30pm and from 1pm until 6.30pm Fridays.

• Appointments are available at Heaton House from 10.30am each Monday until all patients have been seen.

• Appointments are available at Clifton Village Hall from 11.40am each Monday until all patients have been seen.

Urgent appointments are available on the day and if necessary the session size is increased to accommodate all same day requests. Routine appointments can be pre-booked in advance in person, by telephone or online. Telephone consultations and home visits are available daily as required.

The practice has opted out of providing GP services to patients out of hours such as nights and weekends. During these times GP services are provided currently by a service commissioned by NHS South Worcestershire Clinical Commissioning Group (CCG). When the practice is closed, there is a recorded message giving out of hours’ details. The practice leaflet also includes this information and there are leaflets in the waiting area for patients to take away with them.

Updated 11 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Knightwick Surgery on 1 March 2016. Overall the practice is rated as good.

Our key findings across all of the areas 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. Opportunities for learning from incidents were shared with staff during meetings and systems put in place to prevent similar recurrences.

• Risks to patients were assessed and well managed.

• There were safe systems in place for dispensing prescribed medicines to patients.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. They were very complimentary about the standards of care they received. Information was provided to help patients understand the services and care available to them.

• Practice staff worked closely with other organisations and external professionals in planning how services were provided to ensure that they met patient’s needs. Patients with complex needs had care plans in place that were regularly reviewed.

• The practice had good facilities and was well equipped to assess and treat patient’s needs.

• As a consequence of feedback from patients and the Patient Participation Group (PPG) practice staff had made improvements to the way it delivered services. The PPG were proactive in representing patients and assisting the practice in making improvements.
• Senior staff had a clear vision for taking the practice forward which had quality and safety as its priority. Plans for the future were in place to improve patient access to the premises. There was a clear leadership structure and staff felt supported by management. It was evident that there was a strongly motivated staff team.

However, there was an area of practice where the provider needs to make improvement.

The provider should:

• Review staff understanding of procedures to be followed when checking the quantities of medicines in stock.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 April 2016

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

• Nurses at the practice ran effective clinics for treatment of patients with multiple long term conditions.

• Patients who were at risk of hospital admission were identified as a priority and received health care that reduced their risk of unplanned admission to hospital.

• Patients had a structured annual review or if necessary more frequent reviews to ensure their health and medicine needs were being met.

• Clinical staff had close working relationship with external health professionals to ensure patients received up to date and joined up care.

Updated 11 April 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 also cases of domestic violence.

• Records showed the lead GP liaised and sought advice from other health and social care professionals when necessary.

• Children were given same day appointments.

• There were appointments available with the lead nurse until 7.50pm and for telephone consultations until 8.20pm. every Thursday.

Updated 11 April 2016

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

• There were higher than average numbers of older patients registered with the practice.

• The practice offered personalised care to meet the needs of the older people in its population and offered home visits to those who were unable to access the practice.

• Rapid access and longer appointments were provided for those with enhanced or complex needs.

• The practice had regular contact with district nurses and other professionals to discuss any concerns or changes that were needed to patient care.

• Patients we spoke with from this population group said there was continuity of care and that this was important to them.

Updated 11 April 2016

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

• The needs of this population group had been identified and the practice had adjusted the services it offered to ensure these were accessible.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs of this age group.

• Health promotion advice was offered and there was accessible health promotion material available at the practice and on its website.

Updated 11 April 2016

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

• Staff were trained to recognise patients presenting with mental health conditions and to carry out comprehensive assessments.

• Clinical staff carried out assessments and care planning for patients with dementia and those who experienced mental health illness.

• Referral mechanisms were in place for when staff identified deterioration in a patient’s mental health.

• Clinical staff carried out dementia screening for patients who were at risk of developing dementia to ensure early diagnosis.

Updated 11 April 2016

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

• The practice maintained a register of patients living in vulnerable circumstances including those with a learning disability.

• Annual health checks including extended appointment times for patients with a learning disability had been carried out and their health action plans updated.

• Staff had been trained to recognise signs of abuse in vulnerable adults and children.

• Clinical staff regularly worked with multidisciplinary teams in the case management of vulnerable patients.