The Ransome Practice

Updated 6 March 2017

The Ransome Practice is located in Bentley on the outskirts of Doncaster and has two branch surgeries at Woodside Surgery, Woodside Road, Woodlands, Doncaster, DN6 7JR and Scawthorpe Clinic, Amersall Road, Scawthorpe, Doncaster, DN5 9PJ. They provide services for 6,056 patients under the terms of the NHS Personal Medical Services (PMS) contract. The practice catchment area is classed as within the group of the second most deprived areas in England. The practice has 14% more patients with a long standing health condition registered at the practice compared to the local area and 3% more patients whose working status is unemployed. The age profile of the practice population is similar to other GP practices in the Doncaster area.

The practice has two male GP partners, a male salaried GP and they are supported by two practice nurses, two healthcare assistants a practice manager, assistant practice manager and a team of reception and administrative staff.

The sites are open as follows:

• Woodlands site is open 8am to 6pm every weekday apart from Wednesday afternoons when it closes at 1pm. Calls to the site during this time are answered by a GP. Appointments with the GP were available until 7.30pm on Friday evenings.
• The Bentley site is open 8am to 6pm every weekday apart from Wednesday afternoons when its closes at 1pm. Calls to the site during this time are answered by a GP. Appointments with the GP are available until 7.30pm on Thursday evenings.
• The Amersall Road site was open 8am to 6pm every weekday apart from Thursday afternoons when the site closes at 1pm. Calls to the site during this time are transferred to the Woodlands site. Appointments with the GP are available until 7.30pm on Monday evenings.

Appointments are available with staff in the mornings and afternoons at each site. In addition to pre-bookable appointments that could be booked up to six weeks in advance, urgent appointments were also available for people that needed them.  

When the practice is closed calls were answered by the out-of-hours service which is accessed via the surgery telephone number or by calling the NHS 111 service.

T he practice is located in three purpose built buildings with all patient facilities on the ground floor. There are a number of parking spaces available next to the practice and designated disabled parking spaces. 

Updated 6 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Ransome Practice on 22 November 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example,they were currently involved in the ‘Gold Standard Framework in Primary Care, Silver Programme for End of Life Care’. They had identified the 1% of practice population in the last year of their life and were developing advanced care plans for these patients.
• In August 2015 staff identified they had a higher ratio of patients documented as having a fall. The practice value was 51.2 per 1000 people being admitted to hospital related to a fall compared to 40.5 per 1000 people for the CCG average. A protocol was developed to review patients at risk of falls which included a blood test to detect vitamin D deficiency, standing and sitting blood pressures checks, review of medication and follow up of patients discharged from hospital. Those with a deficiency were prescribed vitamin D supplements and were also referred to a specialist falls service run by the local community NHS trust. As a result, in August 2016, the number of patients admitted to hospital related to a fall fell to 41 per 1000 people which was just above the CCG average of 40 per 1000 people.
• Feedback from patients about their care was consistently positive.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, patients and members of the group fed back they would like access to a female GP. The practice were in the process of recruiting a female GP to start the following month.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw some areas of outstanding practice:

• The partners and practice manager were committed to the continuing development of staff skills, competence and knowledge and was integral to ensuring high-quality care. Staff were proactively supported to acquire new skills and share best practice. The partners fostered a learning environment to enable the practice to both develop and learn thereby support recruitment and retention. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality. Staff were supported to communicate compassionately and effectively with patients. The practice manager had compiled a list of helpful phrases to use when dealing with patients who may be distressed, needed reassurance or during bereavement. Staff told us they found the phrases particularly useful when speaking with patients over the telephone and also provided consistency in their approach.
• The patient participation group held monthly carer's afternoons at the practice to offer advice and support. The events were well attended and staff would contact known carers to inform them of the event if they had not attended the practice recently. Speakers were invited to attend to provide advice and support. For example, representatives from charities and local support groups to provide knowledge of services available in the local area. Patient participation group members and practice staff baked cakes and provided snacks for the events. Entertainment was also provided through quizzes, bingo and raffles. The events were well established and in excess of 30 people attended each month. The group told us they received overwhelming feedback from carers how it supported them to have engagement with others in similar situations and also to find out about what is happening in the local community.
• All patients with type II diabetes were cared for at the practice. A practice nurse and GP were both trained to initiate insulin medication if required. Patients told us the service offered was very good and informative and helped them manage their condition. They received regular check ups and it was also a benefit as they could access specialist care near to home and they did not have to travel to hospital which was six miles away. 

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 6 March 2017

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

• Nursing staff had lead roles in long term condition management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was 2% above the local average and 9% above the national average. All patients with type II diabetes were cared for at the practice. A practice nurse and GP were both trained to initiate insulin medication if required. Patients told us the service offered was very good and informative and helped them manage their condition. They received regular check ups and it was also a benefit as they could access specialist care near to home and they did not have to travel to hospital which was six miles away.
• 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.
• Staff were currently involved in the ‘Gold Standard Framework in Primary Care, Silver Programme for End of Life Care’. They had identified the 1% of practice population in the last year of their life and were developing advanced care plans for these patients.

Updated 6 March 2017

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 who were at risk, for example, children and young people who had a high number of accident and emergency attendances. Immunisation rates were relatively high 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.
• The practice’s uptake for the cervical screening programme was 81%, which was comparable to the CCG average the national average of 81%.
• 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.

Updated 6 March 2017

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

• All these patients had a named GP.
• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice was working with four neighbouring  GP practices closely to avoid unnecessary hospital admissions.

Updated 6 March 2017

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 reflects the needs for this age group.

Updated 6 March 2017

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

• 80% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is just below the national average of 84%.
• 77% of patients experiencing long term poor mental health had an agreed care plan in place which was below the national average of 88%.
• The practice regularly worked with multidisciplinary 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 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 and were trained as dementia friends.

Updated 6 March 2017

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 those with a learning disability.
• The practice offered longer appointments for patients who needed them.
• Same day appointments were available for those who needed them and staff would opportunistically perform health screening tests and administer vaccinations during one appointment.
• 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.
• The patient participation group held monthly carer's afternoons at the practice to offer advice and support. The events were well attended and staff would contact known carers to inform them of the event if they had not attended the practice recently. Speakers were invited to attend to provide advice and support. For example, representatives from charities and local support groups to provide knowledge of services available in the local area. Patient participation group members and practice staff baked cakes and provided snacks for the events. Entertainment was also provided through quizzes, bingo and raffles. The events were well established and in excess of 30 people attended each month. The group told us they received overwhelming feedback from carers how it supported them to have engagement with others in similar situations and also to find out about what is happening in the local community.
• In August 2015 staff identified they had a higher ratio of patients documented as having a fall. The practice value was 51.2 per 1000 people being admitted to hospital related to a fall compared to 40.5 per 1000 people for the CCG average. A protocol was developed to review patients at risk of falls which included a blood test to detect vitamin D deficiency, standing and sitting blood pressures checks, review of medication and follow up of patients discharged from hospital. Those with a deficiency were prescribed vitamin D supplements and were also referred to a specialist falls service run by the local community NHS trust. As a result, in August 2016, the number of patients admitted to hospital related to a fall fell to 41 per 1000 people which was just above the CCG average of 40 per 1000 people.
• The practice identified those patients who were housebound or may have problems getting to the surgery due to mobility or health problems and had no regular nursing input. Initially the practice identified 123 patients under this criteria. The practice nurse would review the patient in their home setting and compile a care plan and make referrals to other services if required. This initiative has been shared with other practices to implement and resulted in the practice seeing a reduction in the number of unplanned home visits requested by this group of patients.
• Staff knew how to recognise signs of abuse in 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.