Archived: Drs H.M.A.Stephens & T.S. Humphrey Also known as Lechlade Medical Centre

Updated 27 September 2016

Lechlade Medical Centre is a purpose-built, semi-rural primary care facility. The centre is based in Lechlade, a town at the southern edge of the Cotswolds area of Gloucestershire.

The centre was built in 1982 and extended in 1997. The two-storey building has rooms for consulting, treatment and phlebotomy services on the ground floor, with a room used by community district nurses on the first floor. There is full disabled access. As well as district nurses, the centre is used by community health visitors and midwives.

Lechlade Medical Centre has around 4,805 registered patients, most of whom live within a five mile radius of the practice. The practice has lower than national average patient populations for all age groups from 0 up to 39 years. The patient populations aged from 40, to 85 years and over, are all higher than the national average. Lechlade Medical Centre is one of 85 GP practices in the NHS Gloucestershire Clinical Commissioning Group (CCG) area. The practice population is 98% white, with the largest minority ethnic population (around 1.6%) being Asian or Asian British. A measure of deprivation in the local area recorded a score of 9, on a scale of 1-10. A higher score indicates a less deprived area. (Note: an area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score. Not everyone living in a deprived area is deprived and not all deprived people live in deprived areas).

The practice team consists of two GP partners (both male) and one salaried GP (female). In addition, three practice nurses, one health practitioner and one health care assistant are employed. The clinicians are supported by a practice manager, a deputy practice manager, and a team of medical secretaries and receptionists. The practice has a General Medical Services contract with NHS England (a locally agreed contract negotiated between NHS England and the practice).

The practice is open from 8.30am to 6.30pm, Monday to Friday. The practice has an emergency switchboard number between 8am and 8.30am, Monday to Friday. Appointments are available from 8.30am to 6.30pm, with extended hours appointments available from 6.30pm to 7.30pm on Monday and Tuesday. All appointments can be pre-booked up to four weeks in advance.

The practice has opted out of providing Out Of Hours services to its own patients. Outside of normal practice hours, patients can access NHS 111 and an Out Of Hours GP service. Information about the Out Of Hours service was available on the practice website, and as an answerphone message.

Lechlade Medical Centre provides regulated activities from its location at Oak Street, Lechlade GL7, 3RY.

Updated 27 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lechlade Medical Centre on 25 August 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 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.
• 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.
• 93% of patients said they would recommend their GP practice to someone who has just moved to the local area, compared with the clinical commissioning group (CCG) average of 84% and national average of 79%.
• 96% of patients found it easy to get through to the practice by telephone compared with the clinical commissioning group (CCG) average of 83% and national average of 73%.
• 99% of patients were able to get an appointment to see or speak to someone the last time they tried compared with the CCG average of 84% and national average of 76%.
• The patient participation group (PPG) were well engaged and represented across all age groups, and across a diverse range of professional backgrounds. The PPG suggestions for changes to the practice management team had been acted upon and as well as this, the group had raised awareness about patient services. For example, PPG members met with a social prescriber and set up a social prescribing sub-group. Information about social prescribing is now available on the information screen in the waiting room, and on the practice website.
• 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.
• When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology and were told about any actions to improve processes to prevent the same thing happening again.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 September 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.
• Performance for patients with long-term conditions compared with national averages. For example, 74% of patients with asthma, on the register, had had an asthma review in the preceding 12 months, compared to the national average of 75%. The review included three patient-focused outcomes that act as a further prompt to review treatment.
• 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.
• The practice increased the length of individual appointment times for patients with complex medical conditions.

Updated 27 September 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.
• 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 assessed the capability of young patients using Gillick competencies. These competencies are an accepted means to determine whether a child is mature enough to make decisions for themselves.
• The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding 5 years was 82%, consistent with the 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.
• The practice hosts a mother and baby clinic with a resident health visitor, to advise mothers of children up to the age of five.
• The practice runs midwifery classes on one morning per week, and ante-natal classes on one evening per week.

Updated 27 September 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.
• Older patients with complex care needs or those at risk of hospital admissions had personalised care plans which were shared with local organisations to facilitate continuity of care.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice offers a range of services to avoid unplanned hospital admissions for elderly patients, such as in-house collection of blood samples and ambulatory heart monitoring.

Updated 27 September 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 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.
• Patients were able to order repeat prescriptions on-line.
• The practice did not close for lunch, and patients were able to book and attend appointments throughout the day.

Updated 27 September 2016

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

• 79% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was below the clinical commissioning group (CCG) average of 86% but compared with the national average of 84%.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose level of alcohol consumption had been recorded over the course of a year was 100%, which was better than the national average of 90%.
• The practice regularly worked with multi-disciplinary teams in the case management of people 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.
• A primary care nurse from a local mental health trust sees patients at the practice on Wednesday mornings.

Updated 27 September 2016

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 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 proactive in ensuring that vulnerable patients who did not attend their scheduled appointments were visited by the practice nurse, assessed and if necessary, booked for a same day appointment at the practice.