Spilsby Surgery

Updated 14 December 2016

Spilsby Surgery provides primary medical services to approximately 7,350 patients from a single surgery situated in the small market town of Spilsby, Lincolnshire. 53% of the patients reside in the surrounding villages.

The nearest Accident and Emergency units are in Boston, 17 miles and Lincoln 31 miles distant. Public transport links are poor and there are pockets of rural deprivation and isolation.

The practice has a higher number of older patients than the national average. 28% are aged over 65 compared to 18% nationally. The practice has a higher number of patients with long term conditions than the national average.

At the time of our inspection the practice healthcare was provided by three GP Partners, two salaried GPs, one non-clinical partner, one advanced nurse practitioner (whole time equivalent WTE 1.00), two practice nurses (WTE 1.4) and two health care assistants (WTE 1.3). There is also a part time Care Co-ordinator who is a registered general nurse and is responsible for the management of older adults service. They are supported by a team of dispensers, management, administration, reception and housekeeping staff.

The practice is located within the area covered by NHS Lincolnshire East Clinical Commissioning Group (CCG). A CCG is an organisation that brings together local GP’s and experienced health professionals to take on commissioning responsibilities for local health services.

The practice has a General Medical Services contract. (The GMS contract is a contract between general practices , the clinical commissioning group and NHS England for delivering primary care services to local Communities). It is a dispensing practice.

The surgery is open from 8am to 6.30pm Monday to Friday and on Tuesday and Wednesday evenings and Saturday mornings for pre-booked appointments only.

The practice has opted out of providing out-of-hours services to their own patients. The out-of-hours service is provided by Lincolnshire Community Health Services NHS Trust and is accessed by NHS111.

We had not previously inspected this practice.

Updated 14 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Spilsby Surgery on 10 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 been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• The practice was responsive to the needs of patients and tailored its services to meet those needs.
• 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 there was continuity of care, access to GPs and clinicians through the telephone triage system was effective and same day appointments were available.
• 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.

The areas where the provider should make improvement are:

• The practice should ensure that the process that enabled practice staff to identify children who may be subject to safeguarding concerns is consistent and that the records of clinical meetings where safeguarding issues were discussed reflected what had taken place. The practice should also consider identifyingand monitoring children who did not attend appointments in secondary care.

• Ensure that most recent NICE guidance is disseminated and followed by GPs and staff.

• Review the process used to check dispensary stock is within expiry date and maintain appropriate records.

• Improve arrangements for dispensary ’near-miss’ recording.

• Implement a system for tracking blank prescription forms through the practice in accordance with national guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 December 2016

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

• GPs and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Data from the Quality and Outcomes framework showed that the clinical indicators for diabetes care were 100%, which was 7% above the CCG and 10% above the national average.

• The practice worked with other healthcare providers to deliver the ‘Healthier You’ diabetes prevention programme.

• Home visits to patients with long term conditions who were unable to attend the surgery were undertaken by the advanced nurse practitioner.

• 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 14 December 2016

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

• The practice offered a full range of long-acting reversible contraception, and free condoms to C-Card holders.

• Children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• Rates of cervical screening were in line with both CCG and national figures.

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

• The practice provided a full range of immunisations for babies, children and young people. Immunisation rates were relatively high for all standard childhood immunisations.

• We positive examples of working with health visitors in ensuring that parents brought their child to the practice for childhood immunisations.

Updated 14 December 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 Advanced Nurse Practitioner conducted weekly visits to the three residential homes where patients of the practice lived.

• In collaboration with East Midlands Ambulance Service the practice had developed and implemented a practice conveyance programme to give paramedics the opportunity to transport appropriate patients to the surgery instead of the hospital Emergency Department where this had been agreed with the duty clinician.

• The practice participated in the clinical commissioning group initiated Older Adults Service and provided additional care to meet the needs of this group of patients. The service was managed by a part time care co-ordinator, who was a nurse.

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

Updated 14 December 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.

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

• The practice offered extended hours appointments on two evenings a week and on Saturday mornings to help meet the needs of patients in this group.

Updated 14 December 2016

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

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive agreed care plan documented in the record in the preceding 12 months was 74%, which was comparable to other practices.

• 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.

• The practice had identified 70 patients experiencing poor mental health and told them how to access various support groups and voluntary organisations.

• There was a good understanding of how to support patients with mental health needs and dementia. Staff had received specific training in dementia awareness.

Updated 14 December 2016

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 those with a learning disability.

• The practice had 86 patients on its learning disability register and offered longer appointments for patients in this group.

• 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.