Archived: Colwall Surgery

Updated 30 March 2017

Colwall Surgery operates from a purpose built building providing services for patients living in Colwall and surrounding villages including parts of Malvern and Ledbury. At the time of the inspection the practice served a population of approximately 3,200 patients. It has a population of older patients that is higher than local and national averages (approximately 7% above the local average and 18% above the national average). The practice area has an average rate of deprivation of 5% compared with the local average of 4% and the national average of 5%.

Colwall Surgery is registered with the Care Quality Commission (CQC) as an individual provider and has a General Medical Services (GMS) contract with NHS England. The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities. The practice also provides minor surgery.

The practice is supported by a partner GP (female) and a regular locum (male) at the practice. The GPs are supported by a practice manager, two practice nurses, a healthcare assistant, administration staff, reception staff and a cleaner.

The practice has three ground floor consultation rooms and two treatment rooms. There is suitable access to the building for patients with a disability or those patients who use a wheelchair. A car park with disabled parking for patients is available.

Opening hours are from 8am to 6pm on Monday to Friday each week with appointments between these times. Patients are directed to a telephone number to call outside these hours and also have access to a Walk in Centre in Hereford, which is open from 8am to 8pm daily where they can see a GP or a nurse. The practice is closed at weekends. The practice is part of the local Prime Minister’s GP Challenge Fund service for extended opening hours to improve access for patients. These are available late evening and at weekends at nearby practice hubs in Hereford, Ross on Wye and Leominster.

The practice does not provide an out-of-hours service but has alternative arrangements for patients to be seen when the practice is closed. For example, if patients call the practice when it is closed, an answerphone message gives the telephone number they should ring depending on the circumstances. Information on the out-of-hours service (provided by Primecare) is available on the practice website and in the patient information leaflet.

Home visits are available for patients who are housebound or too ill to attend the practice for appointments. There is also an online service which allows patients to order repeat prescriptions book appointments and to view medical records.

The practice treats patients of all ages and provides a range of medical services. This includes disease management such as asthma, diabetes and lung diseases. Other appointments are available for health checks, childhood vaccinations and screening.

At the time of our inspection, the practice had taken steps to become a training practice for trainee GPs (qualified doctors who are training to become GPs) and the lead GP was progressing their assessment for this provision.

Updated 30 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Colwall Surgery on 10 January 2017. The overall rating for this service is good.

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

• The practice was aware of and provided services according to the needs of their patient population.
• There were processes and procedures to keep patients safe. This included a system for reporting and recording significant events, keeping these under review and sharing learning where this occurred.
• The practice was aware of the requirements of the duty of candour and systems were ensured compliance with this.
• Patients told us they were treated with dignity and respect and that they were fully involved in decisions about their care and treatment.
• Advanced care planning and annual health checks were carried out for patients with dementia and poor mental health with significantly higher than national average results.
• Regular meetings and discussions were held with staff and multi-disciplinary teams to ensure that patients received the best care and treatment in a coordinated way.
• The practice had an active Patient Liaison Group (PLG). The PLG was proactive in representing patients and assisting the practice in making improvements to the services provided.
• Staff received regular training and skill updates to ensure they had the appropriate skills, knowledge and experience to deliver effective care and treatment.
• Information about services and how to complain was available and easy to understand. Patients told us that they knew how to complain if they needed to.
• There was a clear leadership structure and staff told us they felt supported by management.
• There was a culture of openness and accountability.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 March 2017

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

• GPs had a specialist interests in dementia, asthma and heart disease. These specialisms meant that Colwall Surgery had consistently been one of the lowest referring practices to secondary care in Herefordshire.
• The practice nurses had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Nursing staff had received appropriate training in chronic disease management, such as asthma and diabetes.
• The practice had taken part in a pilot for a diabetes prevention programme in Herefordshire. Patients between the ages of 35 and 95 were invited for a health review to assess for pre-diabetes so that early intervention could be applied. Patients were invited to attend focus group meetings. The initial meeting had been held on 16 January 2017 and was attended by 11 patients, with a further focus group session scheduled for 31 January 2017.
• Longer appointments and home visits were available when needed.
• All patients diagnosed with a long term condition had a named GP and a structured annual review to check that their health and medicine needs were being met.
• Clinical staff had close working relationships with external health professionals to ensure patients received up-to-date care.
• NHS health checks were offered for early identification of chronic disease and there was proactive monitoring.
• The practice patient leaflet and website provided information about other organisations and websites patients could access.
• Telephone consultations were provided which was particularly helpful for those patients with poor mobility.

Updated 30 March 2017

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

• Same day appointments were offered to all children under the age of five.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Staff had been trained to recognise signs of abuse in vulnerable children and the action they should take if they had concerns. There was a lead GP for safeguarding children and GPs were trained to an appropriate level in safeguarding. All safeguarding concerns were discussed at the weekly GP meetings.
• There were systems to identify and follow up children living in disadvantaged circumstances and who were considered to be at risk of harm. For example, children and young people who had a high number of accident and emergency attendances.
• The practice worked with health visitors to coordinate care.
• Performance for cervical screening indicators was in line with Clinical Commissioning Group (CCG) and national averages. The percentage of women aged 25-64 who attended for a cervical screening test in the last five years was 80% compared with CCG and national averages of 80% and 81%.
• The practice nurses had oversight for the management of a number of clinical areas, including immunisations, cervical cytology and some long term conditions.
• Childhood immunisation rates for the vaccinations given were comparable to local and national averages.
• The practice offered a number of online services including requesting repeat medicines and booking appointments.

Updated 30 March 2017

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

• The practice offered personalised care to meet the needs of the older people in its population and was responsive to their needs.
• The practice offered a range of enhanced services, for example, in dementia and end of life care.
• Home visits and rapid access appointments were offered for those patients with enhanced needs.
• Nationally reported data showed that outcomes for patients were above local and national standards for conditions commonly found in older patients.
• The practice were proactive with their older patients particularly in referring patients for full assessment and treating osteoporosis (bone disease) when it was diagnosed. The practice told us they were organising hip protectors for nursing home patients to lessen the risk of hip fractures for patients in this population group.
• Telephone consultations were provided which was particularly helpful for those patients with poor mobility.
• GPs or the district nurses visited those patients who were housebound or living in nursing homes to ensure that patients received their flu injection.

Updated 30 March 2017

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.
• The practice was proactive in offering a full range of health promotion and screening services that reflected the needs of this age group.
• Health promotion advice was offered such as smoking cessation and nutrition.
• The practice offered online appointment booking and the facility to request repeat prescriptions online.
• Telephone consultations were provided which was particularly helpful for those patients who worked during appointment times.

Updated 30 March 2017

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

• The practice had a high proportion of elderly (approximately 7% above the local average and 18% above the national average) and a high number of patients with dementia on their patient list. A pre-dementia register enabled GPs to keep patients under regular review and facilitate early diagnosis and treatment for this disease. A community dementia worker provided additional support through regular monthly memory clinics held at the surgery.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• Advanced care planning and annual health checks were carried out for patients in this population group. Nationally reported data showed that outcomes for patients were significantly higher than the national average for conditions commonly found for patients with poor mental health.
• A shared care arrangement was in place with the Drugs and Alcohol Service for patients with substance misuse concerns.
• Referrals to the Improving Access to Psychological Therapies (IAPT) team were made for patients who needed psychological support or counselling services.
• Patients experiencing poor mental health were advised how to access various support groups and voluntary organisations. There was a system to follow up patients who had attended accident and emergency departments where they may have been experiencing poor mental health.
• Clinical staff were trained to recognise patients presenting with mental health conditions and to carry out comprehensive assessments.

Updated 30 March 2017

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

• Staff had been trained to recognise signs of abuse in vulnerable adults and the action they should take if they had concerns. There was a lead GP and all clinical staff were trained to an appropriate level for safeguarding adults. All safeguarding concerns were discussed at weekly GP meetings.
• The practice held a register of patients living in vulnerable circumstances including those patients with a learning disability.
• Longer appointments were available for patients with a learning disability. The practice had carried out annual health checks for 11 of the 12 patients on their register for 2015/2016.
• Health screening was available for vulnerable patients including travellers and those who were homeless.
• Vulnerable patients were informed how to access various support groups and voluntary organisations.
• Clinical staff regularly worked with multidisciplinary teams in the case management of vulnerable patients. Alerts were added to patients records for increased staff awareness so that longer appointments could be allocated if appropriate.