The Castle Practice

Updated 21 July 2016

The Castle Practice is located in a purpose built building near the centre of Ludgershall in Wiltshire. All the consulting rooms are on the ground floor.

The practice delivers its services under a Personal Medical Services (PMS) contract (A PMS contract is a contract between NHS England and general practices for delivering personal medical services) to approximately 11,400 patients at the following address: The Castle Practice, Central Street, Ludgershall, Andover, SP11 9RA.

They also run a branch surgery at: Drummers Lane, Station Road, Tidworth, SP9 7FH. This branch was not visited during this inspection.

The practice is a registered yellow fever vaccine centre.

There are five GP partners and three salaried GPs, providing the equivalent of six and a half full time GPs. Two are male and six are female. There are six practice nurses, two health care assistants, a business manager, and a team of 17 receptionists and administrators who support the practice manager.

The practice is a training practice and at the time of our inspection they had one doctor in foundation training and two GP registrars in their last year of specialist training working with them.

The practice has a higher than average number of patients under ten years old. The general index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in the second least deprivation decile. (An area itself is not deprived: it is the circumstances and life styles of the people living there that affect its deprivation score.) Average male and female life expectancy for the area is 80 and 84 years, which is broadly in line with the national average of 79 and 83 years respectively. The practice is close to a number of military bases, the practice supported military personnel temporarily based there.

The practice has a higher than average turnover with approximately 12% of patients de-registering each year and being replaced by the same number of new patients registering.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments with GPs are from 8.30am to 5pm. Extended surgery hours were from 7am to 8.30am on Tuesdays and 6.30pm to 8pm on Thursdays. In addition to pre-bookable appointments that could be booked up to six weeks in advance, urgent appointments were also available for patients who needed them.

The practice has opted out of providing out of hours services to their patients. The out of hours service is provided by MEDVIVO and is accessed by calling NHS 111.

Updated 21 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Castle Practice on 3 May 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.
• Feedback from the lead health trainer was positive about how collective input had had a dramatic impact on patients’ lives.
• 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.

The areas where the provider should make improvements are:

• The practice should ensure that all letters responding to complaints contain details of how to escalate the issue to the ombudsman.

• The practice should ensure that the thermometers and temperature recording in the vaccine fridges comply with current guidance.

• The practice should review infection control processes to ensure a clear audit trail is maintained of cleaning carried out.

• The practice should review how they deliver services to patients with mental health problems and review their exception rates for this patient group.

• The practice should review exception rates for patients with a mental health diagnosis to increase the number of patients receiving treatment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 July 2016

The practice is rated as good for the care of patients 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.

• 99% of patients with diabetes on the register had influenza immunisation in the period 04/2014 to 03/2015, compared to the clinical commissioning group average of 96% and national average of 94%.

• 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 21 July 2016

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

• 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 patients who had a high number of A&E attendances. Immunisation rates were comparable to the clinical commissioning group (CCG) averages 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.

• 89% of women on the register aged 25 to 64 had a cervical screening test in the last five years (04/2014 to 03/2015), compared to the CCG average of 85% and 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.

Health trainers funded by the local authority did regular sessions at the practice offering advice and support to patients on a wide range of issues such as confidence and motivation healthy eating, weight loss, alcohol and general wellbeing.

Updated 21 July 2016

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

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

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

• The practice visited one local care home and two nursing homes where they did a weekly ‘ward round’.

• The practice ran an elderly care clinic once a week where patients could get social support as well as access to clinical staff for medicines reviews and dressing changes if needed.

Updated 21 July 2016

The practice is rated as good for the care of working-age patients (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.

• They offered health checks to patients aged 45 to 74 to identify patients at high risk of vascular disease, identifying patients with previously undiagnosed disease and help patients make lifestyle changes to reduce their risk of long term disease.

• 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.

Updated 21 July 2016

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

• 95% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the clinical commissioning group (CCG) average of 88% and national average of 84%.

• 96% of patients with psychoses had their alcohol consumption recorded in the last 12 months (04/2014 to 03/2015), compared to the CCG average of 93% and national average of 90%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

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

• 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.

Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 21 July 2016

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

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

• The practice offered longer appointments and annual health checks 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.

• The practice was registered with the local authority as a Safe Haven Place. This meant any person, whether a patient of the practice or not, could be directed to the surgery where they would be offered support and made safe.