Wyndham House Surgery

Updated 17 December 2015

Wyndham House Surgery was inspected on Wednesday 26 August 2015. This was a comprehensive inspection.

The main practice is situated in the rural village of Silverton, Devon. The practice provides a primary medical service to approximately 3,600 patients of a diverse age group. The practice was a training practice for doctors who are training to become GPs and for medical students from the local medical school. Two of the GPs also taught at the medical school.

There was a team of five GPs, three male and two female. There were two GP partners and two salaried GP within the organisation. Partners hold managerial and financial responsibility for running the business. There was also a GP registrar (A qualified doctor training to become a GP). The team were supported by a practice manager, two practice nurses, a dispensary team and additional administration staff, some of whom also work in the dispensary. The practice employ an outreach nurse who visits people in their own homes and use the services of a physiotherapist.

Patients using the practice also had access to community nurses and health visitors who are based at the practice. Other health care professionals visit the practice on a regular basis. For example podiatrists and midwives.

The practice is open from Monday to Thursday – 8.30 to 6pm and Friday – 8.30 to 5pm. The GP manages calls on a Friday between 5pm and 6pm. The dispensary is open all day. Outside of these times there is a local agreement that the out of hours service take phone calls and provide an out-of-hours service.

The practice offered a range of appointment types including 'book on the day,' telephone consultations and advance appointments bookable up to six weeks in advance.

Updated 17 December 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wyndham House Surgery on Wednesday 26 August 2015. Overall the practice is rated as outstanding.

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

• There was a safe track record and staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed. Medicines were well managed and the practice had good facilities and was well equipped to treat patients and meet their needs
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• 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.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• There were clear recruitment processes in place. Staff had received training appropriate to their roles and any further training needs had been identified and planned
• The practice was well organised and there was a clear leadership structure. The practice proactively sought feedback from staff and patients, which it acted on.

We identified areas of outstanding practice:

The practice had two schemes in place that particularly supported older frail patients, housebound patients with long term conditions and vulnerable patients.

• A ‘BERTIE’ pharmacy delivery service which delivered over 1310 prescription products per month to over 300 vulnerable, isolated and housebound patients. This service had led to improved communication and feedback between patients and the practice with practice staff being alerted sooner to any special needs of patients. The service had proved popular with patients and meant that very frail patients who had their medicine organised in Dosette boxes were guaranteed a weekly visit from one of the ‘Bertie’ team. We were given examples of where these visits leading to much earlier clinical interventions and so removing need for hospital admission.

• The practice employed an outreach nurse who had been commissioned by the friends of Wyndham group. Her role was to individually target older, frail, vulnerable or isolated patients to review care plans, conduct risk assessments and provide health care advice; this scheme had helped patients to maintain their independence at home and reduce the need for hospital admission. This opportunistic visiting had led to examples of uncovering social and medical needs which can be tackled proactively and to involve reablement teams, clarify medicines and involve carer support agencies. The scheme also included falls assessments, routine health checks, advice on diet, exercise, mobility etc. The nurse also offered osteoporosis checks, dementia assessments and reviews of care plans. The nurse had also performed checks on the wellbeing of the patient during adverse weather conditions and promotion of, or the gaining of agreement to, the use of the pendant alarm system.

One of the GPs wrote regular columns in two local parish magazines. The monthly articles had included updates on public health or medical education issues. The GP also gave an annual presentations to patients in the town outlining and explaining local healthcare issues. These talks had been attended by over 100 people and have become a part of the annual community calendar.

However, there were also areas of practice where the provider needs to make improvements.

Importantly the provider should:

• Introduce a more formal record to show competency of dispensary staff had been performed in line with the dispensary safety quality scheme (DSQS)
• Records should be kept of safety alerts relating to medicines and the action, if any, that has been taken in relation to these.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 December 2015

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

The practice had systems to identify patients who might be vulnerable, have multiple or specific complex or long term needs and ensured they were offered consultations or reviews where needed. All patients with long term conditions were offered annual reviews in the month of their birthday.

A system was in place to ensure staff received regular National Institute for Health and Care Excellence (NICE) guidance updates to ensure that clinicians were managing patients with long term conditions in the most current evidence based way.

The practice staff discussed vulnerable patients or those receiving palliative care during the monthly operational meeting to ensure care is coordinated and patients access the health and social care they require.

The surgery ran Balance classes, Lifestyle sessions for patients at risk of Diabetes, Carer Support Clinics and Community activities for patients with dementia (Dementia Carer Group and Knit & Natter weekly event during winter months).

The practice provided a healthy lifestyle course for patients at risk of developing diabetes. The course was run by a registered nurse and life coach and involved discussions on diet, weight loss and exercise classes.

Updated 17 December 2015

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

The practice offered baby and child immunisation programmes so that babies and children could access a full range of vaccinations and health screening.

The local health visitor is based in the practice and has regular safeguarding meetings with the clinical staff. The practice had scheduled visits by the area midwife where she meets with mothers at the practice.

The GPs provided the contraception services and sexual health screening including chlamydia testing. Practice nurses and female GPs offered cervical screening for women. There were quiet private areas in the practice for mothers to use when breastfeeding.

Appropriate systems were in place to help safeguard children or young people who may be vulnerable or at risk of abuse. Vulnerable patients were reviewed at the practice quarterly meeting.

Updated 17 December 2015

The practice is rated as outstanding for the care of older people

The practice employed an outreach nurse who was contracted for eight hours per week to visit older patients who were vulnerable patients and unable to leave their home. This ‘Elderly Project’ had been commissioned by the Friends of Wyndham House to provide limited, non-urgent health support to patients of the Wyndham House Surgery who, through a combination of age and infirmity, had been unable to routinely travel to the practice, with the aim of reducing the likelihood of urgent or emergency intervention. The scheme included falls assessments, routine health checks, advice on diet, exercise, mobility etc. The nurse also offered osteoporosis checks, dementia assessments and reviews of care plans. The nurse had also performed checks on the wellbeing of the patient during adverse weather conditions and promotion of, or the gaining of agreement to, the use of the pendant alarm system.

Older patients at Wyndham House were able to see the same GP for continuity. Pneumococcal vaccination and shingles vaccinations were provided at the practice for older people.

The community nursing team was based within the health centre which helped communication and access to the service.

The practice systematically identified older patients and coordinated the multi-disciplinary team (MDT) for the planning and delivery of palliative care for people approaching the end of life. The practice held regular meetings with community nurses.

The practice also provide a service known as ‘BERTIE’ which had delivered prescribed medicines to over 300 patients who had been unable to leave their home. BERTIE volunteers had been used to highlight changes in the condition of the patient and had triggered home visits from GPs and medicine reviews.

The practice provided regular balance classes for older patients. The friends group also offered a ‘knit and natter’ group which helped to reduce social isolation for older patients.

The practice had set up a link up service which put patients in touch with volunteers to offering a befriending service and transport service to the practice and local hospital.

Updated 17 December 2015

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

Patients could book appointments online and order prescriptions online. The practice used a text message reminder service for patients that had signed up to the service and used a social media site to promote lifestyle advice.

There was a virtual patient participation group at the practice which had a high number of working age members. These patients used electronic communication to provide feedback to the practice.

Suitable travel advice was available from the GPs and nursing staff.

The staff took the opportunity to offer health checks to patients as they attended the practice. This included offering referrals for smoking cessation, providing health information, routine health checks and reminders to have medicines reviews. The practice also offered age appropriate screening tests such as prostate cancer screening and cholesterol levels and were actively promoting NHS Health Checks.

The practice had a visiting physiotherapist providing an on-site service via referral from the GPs.

Updated 17 December 2015

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

A register at the practice identified patients who had a mental illness or mental health problems. Patients had access to one of the GPs who offered in-house counselling. The practice had links with the local depression and anxiety service.

The clinical IT software flagged up when a patient was at risk of dementia and appropriate screening was offered by the GP. 100% of patients experiencing poor mental health had received an annual physical and mental health check.

Patients living with dementia had care plans which were reviewed regularly. In-house mental health reviews were conducted to ensure patients received appropriate doses of medicines and had their physical health assessed. Blood tests were performed on patients receiving certain mental health medicines to check that optimum levels were prescribed

There was communication, referral and liaison with the psychiatry specialist. Staff appreciated the advice and support provided.

Staff were aware of the Mental Capacity Act and deprivation of liberty and were in the process of organising further training on the subject.

Patients with mental illness and those living with dementia were discussed and reviewed during safeguarding meetings where appropriate.

Updated 17 December 2015

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

The practice had a vulnerable patient register. These patients were discussed at the monthly operation meetings if relevant.

There were a very small number of patients whose first language was not English. Practice staff said these patients had a good understanding of English but knew they had access to an interpretation service.

The practice employed an outreach nurse who visited any vulnerable patients to assess and facilitate any equipment, mobility or medicines needs they may have.

All of the patients with learning disabilities had been offered a health check within the last year when their long term care plans were discussed with the patient and their carer if appropriate.