Wells Health Centre Partnership

Updated 1 December 2017

Wells Health Centre partnership is located in the semi-rural City of Wells, Somerset and has an NHS England general medical services (GMS) contract to provide health services to approximately 11,580 patients.

The practice was based on a ‘health park’ in a building called Priory Medical Centre. The building was shared with another GP practice which operated separately to Wells Health Centre Partnership.

The practice is open between 8am and 6.30pm Mondays to Fridays. Pre-bookable appointments could be booked up to six weeks in advance. Telephone triage, econsultations and telephone appointments are also available. Urgent appointments are also available for patients that needed them.

The practice has opted out of providing out-of-hours services to their own patients and refers them to an out of hours provider via the NHS 111 service. This information is displayed on the outside of the practice and on their website.

Data from public health England showed that the mix of patient’s gender (male/female) is almost 50% each. 14% of patients were above the age of 75 which is higher than the England average of 7.8%. 4.3% of the patients are aged over 85 years old which is higher than the England average of 2.3%. There was no data on ethnicity however staff said they thought the majority of practice patients are white British. The deprivation score for the practice area is recorded as eight on a scale of one to ten. One being more deprived and ten being less deprived.

The practice is a teaching and training practice for doctors who wanted to become GPs with good feedback from trainees and the local NHS health education team.

The practice has a team of eight GPs (four male and four female). Six of these GPs are partners who hold managerial and financial responsibility for running the business. The GP partners are supported by two salaried GPs who together provide 43 sessions, just under five whole time equivalent. The GPs are supported by a practice manager, operations manager, three nurse practitioners, four practice nurses, three health care assistants, a pharmacist and 14 additional administration and reception staff.

This report relates to the regulatory activities being carried out at:

Wells Health Centre

Priory Health Park

Glastonbury Road

Wells

Somerset

BA5 1XJ

Updated 1 December 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wells Health Centre partnership on Wednesday 9 November 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.

• The practice provided daily GP services to up to 300 male and female boarders at the nearby Wells Cathedral School.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• The practice employed a clinical pharmacist to identify and act upon high risk medicines, oversee prescribing patterns, review patients who were taking 10 or more medicines, review post discharge medicines and support long term condition management.

• 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 GP and said there were urgent appointments available the same day but added that they sometimes had to wait to see a GP of their choice.

• E consultations (on line consultations) were available and acted upon promptly.

• The practice promoted sepsis assessments and used management guidelines for GPs and parents to identify sepsis.

• Wells Health Centre offered the ‘C card’ service. (The C Card scheme is where practices offer easy, discreet and confidential access to free condoms for young adults).

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice proactively identified carers within the practice patient list and signposted patients to services and provided written information.

• The practice sent a letter to all teenagers following their 16th Birthday providing information about the practice and an opportunity to update clinical records, offer online access to records and establish connection with those who need support.

• 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.

We saw one area of outstanding practice:

The practice promoted ‘health and wellbeing reviews’ at the practice. This model of care involved an hours appointment with a health coach who reviewed and scored five aspects (human 5) of the patients life and used nationally recognised tools to assess the patients wellbeing, patient awareness and loneliness. The patient then met with the GP for a 30 minute appointment to ensure the medical care was person-centred and individually tailored. The model had resulted in patients experiencing increased wellbeing, health and a reduction in medicine usage. For example, one patient was dependent upon medicines, was unemployed, a frequent attender at the practice and had multiple  hospital admissions. They had gone through the review process and as a result had requested to reduce their medicine use, demonstrated improved wellbeing and was planning voluntary work. Data showed that 30 patients had started the programme since September. Of the 12 patients on stage two of the course, eight had reduced the numbers of medicines being taken.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 December 2017

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.

• Patients with long term conditions, emergency teams, nursing homes, had priority phone access to the practice.

• 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 1 December 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 A&E 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.

• 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.

• The practice promoted sepsis assessments and used management guidelines for GPs and parents to identify sepsis.

• Wells Health Centre offered the ‘C card’ service. (The C card scheme is where practices offer easy, discreet and confidential access to free condoms for young adults).

• Young people were able to easily and discreetly access chlamydia screening kits.

• The practice sent a letter to all teenagers following their 16th Birthday providing information about the practice and an opportunity to update clinical records, offer online access to records and establish connection with those who need support.

• The practice provided a daily GP service for up to 300 male and female boarders at the nearby Wells Cathedral School.

Updated 1 December 2017

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 participated in the Avoiding Unplanned Hospital Admissions scheme for the top 2% patients most at risk of hospital admission.

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

• The practice had introduced routine 15 minute appointments for older patients and those with complex needs.

• The practice were one of two practices in Wells providing services to four care homes for older people.

• Staff sent personalised birthday cards to all patients on their 100th birthday.

• There was a telephone line for elderly/housebound to order their prescriptions.

Updated 1 December 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.

• Late extended appointments until 7.45pm were offered for people who worked. Early and late nursing appointments were also available for medicines monitoring and long term condition reviews to enable patients to better manage their health.

• A walk in blood taking clinic was available.

• 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.

• Telephone consultations were available with the GPs and nurses at the practice.

• E consultations (on line consultations) were available and acted upon promptly.

• The practice had a self-service health pod for patients to check their own weight, height and blood pressure.

• The practice had systems in place to identify military veterans and ensured their priority access to secondary care in line with the national Armed Forces Covenant 2014.

Updated 1 December 2017

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

• The practice regularly worked with multi-disciplinary 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.

• There was a dedicated counsellors room situated away from clinical consulting areas to put patients at ease.

• The practice had a nominated and trained a GP lead and a clinical pharmacist who participated in enhanced mental health medicines monitoring. There was participation in the shared care substance misuse programme and fortnightly external agency drop-in sessions from a national alcohol and drug counsellor.

Updated 1 December 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 homeless people, travellers and those with a learning disability. For example, homeless patients were issued with an address so they could access health care. Travellers were registered as temporary residents.

• The practice offered longer appointments 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.