Shawbury Medical Practice

Updated 17 March 2016

Shawbury Medical Practice is located in Shawbury, Shropshire. It is part of the NHS Shropshire Clinical Commissioning Group. The total practice patient population is 3,711. The practice is a rural dispensing practice which moved to its current purpose built building in 1990. The provider extended the building in 2003 to create a second treatment room, extra consulting room, meeting room and multifunction room with rooms for the now visiting community teams, such as Health Visitors and District Nurses. The practice also has a branch surgery at High Ercall, Shropshire, open Tuesdays and Fridays from 12pm to 1pm each week. The branch surgery provides a walk in service with no booked appointments.

The staff team comprises a full time individual GP and two part-time salaried GPs, one of whom provides three days a week and the other two and a half days, plus extra sessions where required. The clinical practice team includes two practice nurses, a phlebotomist, a senior dispenser and five dispensary staff including a locum dispenser on a regular Thursday basis. The practice is managed and supported by a practice manager, administration support staff, receptionists, a Community Care Coordinator and two cleaners. In total there are 21 full or part time staff employed.

The main practice and dispensary are open Monday, Thursday and Friday 8:30am to 6pm (excluding bank holidays) and 8:30am to 6:30pm on Tuesdays. The practice is open on a Wednesday from 8:30am to 12:30pm. On Wednesday afternoons the GP attends a local nursing home to provide a ward round and the practice answerphone is switched to a managed on call system. In addition the practice provides GP led telephone consultations to those who request the service. The practice offers a phlebotomy service every Friday morning but bloods are also taken when required by the practice nurses. The practice provides a counsellor service every Thursday morning. Pre-bookable appointments and urgent appointments are also available for patients that need them. The practice does not provide an out-of-hours service to its own patients but has alternative arrangements for patients to be seen when the practice is closed through Shropdoc, the out-of-hours service provider. The practice telephones switch to the out-of-hours service at 6pm each weekday evening and at weekends and bank holidays.

The practice provides a number of clinics, for example long-term condition management including asthma, diabetes and high blood pressure. It also offers child immunisations, minor surgery, and travel vaccinations. The practice offers health checks and smoking cessation advice and support. The practice has a General Medical Services (GMS) contract with NHS England. This is a contract for the practice to deliver General Medical Services to the local community or communities. They also provide some Directed Enhanced Services, for example they offer a dispensing service, minor surgery, and the childhood vaccination and immunisation scheme.

Updated 17 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Shawbury Medical Practice on 2 February 2016. Overall the practice is rated as good.

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

• 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.
• 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.
• 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Feedback from patients about their care was consistently positive.
• 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.
• 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 the 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 practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. For example, the provision of a dispensary service and an in house counselling service.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.

We saw an area of outstanding practice:

• The practice had ensured they reviewed their looked after children and child protection register with the Health Visitor and School Nurse at regular multi-disciplinary team meetings to ensure it was up to date. The involvement of the school nurse had improved the level of information and intelligence within the multi-disciplinary team.

There was an area of practice where the provider should make improvement:

• Consider improving the documentation of complaints to ensure that a final letter is forwarded to complainants that explains the next steps they may choose to take.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 March 2016

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

• One of the practice nurses had completed diabetic care training which provided patients with evidenced based best practice care and support. Performance for diabetes in three out of the five related indicators was better than the national average. For example; the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 91.09% when compared to the national average of, 88.3%.The percentage of patients with diabetes, on the register, in whom the last blood test was within a specific therapeutic range was 83.76% when compared to the national average of, 77.54%.

• 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.

• Longer appointments and home visits were available when needed.

• The practice provided watch blood pressure monitors for patients under investigation for high blood pressure.

• On a monthly basis the diabetic podiatrist visited the practice and the practice took responsibility for inviting patients to receive their foot care.

• Patients with Chronic Obstructive Pulmonary Disease (COPD) which is an umbrella term used to describe a number of conditions including emphysema and chronic bronchitis had an annual review and spirometry completed at the practice. The assessment of breathlessness using the Medical Research Council dyspnoea scale in the preceding 12 months was 94.03% when compared with the national average of, 89.9%.

• The practice recognised the value of patient care over and above their Quality and Outcome Framework (QOF) results. For example, they choose to maintain some former QOF requirements to ensure they captured all the quality aspects of the service they provided.

Updated 17 March 2016

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 A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• The practice held regular meetings with the Health Visitor and the School Nurse, to discuss vulnerable families, children who on the child protection list and looked after children. The practice had audited their records on an ongoing basis to ensure their list was up to date.

• The practice provided a full contraception service and family planning service.

• 78.87% of patients diagnosed with asthma, on the register, had had an asthma review in the last 12 months, which was slightly better than the national average of 75.35%.

• 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 82.23%, which was comparable to the national average of 81.83%.

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

• The practice held monthly multi-disciplinary meetings which included; District Nurses, Community Matron, Community Care Coordinator, Hospice at Home nurse and the GPs and nurses from the practice. During this meeting they discussed patients considered to be frail and vulnerable with the view to improving quality and consistent care to these patients.

• The practice had actively spent time with individual patients and their families, creating or reviewing care plans and discussing issues such as current medical concerns, ‘just-in-case’ or rescue medication, resuscitation orders and how to avoid admission to hospital in general. These patients had care plans in place with the involvement of the patient, their next of kin, carers and recorded the patients’ end of life wishes, such as resuscitation and whether they would like to avoid hospital admission.

• The practice held a register of palliative care patients the majority of which were older patients. Each patient was discussed monthly at a dedicated multidisciplinary meeting with representatives from the district nurses, local hospice and all available GPs.

• The Community Care Coordinator was a valued affiliated member of the practice team. They made contact with appropriate agencies within the local community, offered support with form filling and signposting to other external agencies.

• The practice branch surgery in High Ercall opened twice a week between 12pm and 1pm for walk in appointments for patients who could not easily get transport to Shawbury. Patients could also collect medicines from the branch.

• The practice delivered monthly medicines to the homes of patients who would find it difficult to collect their medicines from the surgery.

• The lead GP provided a weekly ‘ward round’ at a local care home with 50 patients and offered telephone access to advice and support to the home from 7am Monday to Friday. These patients were seen as urgent appointments and were dealt with within the same half day.

Updated 17 March 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 GPs provided telephone consultations where appropriate. 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 was a dispensing practice and patients seen by a doctor could collect their medicine ordinarily before leaving the practice.

• A phlebotomy service, joint injections, minor operative procedures, Help 2 Change clinics and a counselling service were provided to patients at the practice.

• The practice offered later appointments on a Tuesday evening and the dispensary was open until 6:30pm for the collection of medicines which included those for working age patients.

Updated 17 March 2016

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

• Staff had a good understanding of how to support patients with mental health needs and dementia. All staff had completed dementia awareness training and as part of the practices on-going awareness they arranged for a representative from the Alzheimer’s Society to attend one of their training afternoons to help staff recognise and communicate better with patients living with dementia.

• 82.14% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average.

• Performance for mental health related indicators were better than the national average in two out of the four indicators and comparable in the remaining two indicators. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in their record was 100% when compared to the national average of, 88.47%.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. This included meetings with the Community Mental Health Team. Of the 20 patients identified all had summaries available as to when they were last reviewed and on the care and support they received in the community and at the practice, one patient was no longer receiving active mental health treatment. Of the 19 remaining patients, two required action in respect of a review which the GP had action planned.

• 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.

• The practice provided an in house counselling service for its patients on a weekly basis.

• Close monitoring of medicines for patents at risk of overdose was supported by the dispensary service, for example with the use of three day prescriptions or dosset boxes if appropriate.

Updated 17 March 2016

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

• 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 provided medical care to a local children’s home, and appointments for these children were prioritised.
• The practice maintained a carers’ register.

• An example of co-ordinated care having a dramatic effect on patient outcomes included that of a palliative care patient who had attended the practice regularly but had not needed to be seen at home. Following multiple contacts the Community Care Coordinator was invited to their home only to find they had been without appropriate heating and hot water supply. The Community Care Coordinator with consent took the initiative and the patients’ home environment was improved with access to appropriate grant funding.
• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.