6 October 2017
Bewdley Medical Centre is registered with the Care Quality Commission as a partnership provider. The practice holds a Personal Medical Services (PMS) contract with NHS England. This is a locally agreed alternative to the standard General Medical Services contract used when services are agreed locally with a practice which may include additional services beyond the standard contract. At the time of our inspection Bewdley Medical Centre was providing care to 15,408 patients.
The practice has a higher than average number of older people on their patient list due to the popularity of Bewdley as a retirement area. It is rated seven out of ten on the deprivation scale, where 10 is the least deprived.
The practice is the largest of the six sites which make up the Wyre Forest Health Partnership (WFHP). Functions such as human resources and finance are undertaken by WFHP staff. Policies, protocols and clinical templates are set at organisational level, but adapted to each site. Many of the governance and oversight responsibilities are carried out by the WFHP. For example, performance monitoring is done by WFHP staff.
Bewdley Medical Centre moved to its current location in July 2016. It is located in the middle of Bewdley town centre in a purpose built building. The practice is accessible to patients with disabilities and there are two lifts to the upper floors. There are three reception areas which minimise the distance to consulting rooms. A bell is provided at the front entrance so that patients can summon assistance if required. There are disabled car parking spaces in front of the building and a public car park nearby. A pharmacy, public library and café are also in the building, although the café is not yet in use.
There are nine GP partners and two associate GPs. The GPs are supported by two pharmacists, a site manager, advanced nurse practitioners (plus a visiting advanced nurse practitioner), practice nurses, health care assistants and reception and administrative teams. The practice also takes part in a scheme with Kidderminster College to host an apprentice; there is currently one apprentice working at the practice.
Bewdley Medical Centre is an approved training practice for doctors. There is currently one trainee doctor working at the practice. The practice also offers placements to one medical student at a time from the University of Birmingham.
The practice is open from 7am until 6.30pm on Mondays, Wednesdays and Fridays. On Tuesdays the practice is open from 8am until 8pm. On Thursdays the practice opens from 8am until 6.30pm (on alternate Thursdays the practice stays open until 8pm). The practice opens from 8am until 11am on alternate Saturday mornings for pre-bookable appointments only.
When the practice is closed patients are directed to the NHS 111 service. OOH services are provided by Care UK.
6 October 2017
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Bewdley Medical Centre on 23 August 2017. Overall the practice is rated as good.
Our key findings across all the areas we inspected were as follows:
- The practice was the largest of the six sites which formed the Wyre Forest Health Partnership (WFHP). Functions such as human resources and finance were carried out by staff at the WFHP main office, which was located in the Bewdley premises.
- There was a clear system for reporting and recording significant events, which was shared across the six sites in the WFHP. Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses. Learning from internal and external incidents was discussed at practice level and at monthly WFHP meetings, which were attended by key staff from the six sites.
- The practice had clearly defined and embedded systems to minimise risks to patient safety.
- Staff assessed patients’ needs and delivered care in accordance with current evidence based guidelines. Staff had the skills, knowledge and experience to deliver effective care and treatment.
- Results from the National GP Patient Survey 2017 showed that patients thought that they were treated with compassion, courtesy and respect and that clinical staff involved them in discussions about their care and treatment.
- Information about services and how to complain was available. The practice responded to complaints and made improvements to the level of service as a result.
- Patients we spoke with said that they found it easy to make an appointment with a named GP and that there was continuity of care. Urgent appointments were available the same day.
- A GP had initiated the home visiting service, which had been rolled out to all six practices in the WFHP. It was so successful that the GP had been asked to provide a service specification for two local Clinical Commissioning Groups.
- The practice had good facilities and was well equipped to treat patients and meet their needs.
- There was a clear leadership structure and staff told us that they felt supported by the GP partners and management team. The practice proactively sought feedback from staff, patients and the Patient Participation Group, which it acted on.
- The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
6 October 2017
The practice is rated as good for the care of people with long-term conditions.
- Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority. For example, nursing staff carried out reviews for patients with heart disease and chronic lung disease.
- The percentage of patients with diabetes on the register in whom the last diabetic reading was at an appropriate level in the preceding 12 months was 86%, which was 2% above the Clinical Commissioning Group average and 8% above the national average.
- The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
- There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
- All these patients had a named GP and there was a centralised system to recall patients for a structured annual review to check that 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.
- There were links on the practice website for information about long term conditions such as asthma and diabetes.
6 October 2017
The practice is rated as good for the care of families, children and young people.
- We saw that there were systems 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 (A&E) attendances.
- Immunisation rates were relatively high for all standard childhood immunisations.
- Patients told us on the day of inspection that children and young people were treated in an age-appropriate way and were recognised as individuals.
- The practice provided support for premature babies and their families following discharge from hospital.
- Appointments were available outside of school hours and the premises were suitable for children and babies. Priority was given to children under one year.
- The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
- The practice had emergency processes for acutely ill children, young people and for acute pregnancy complications.
6 October 2017
The practice is rated as good for the care of older people.
- Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
- The practice offered proactive, personalised care to meet the needs of the older patients in its population.
- The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
- A home visiting service, supported by two GPs and an advanced nurse practitioner, had been introduced for housebound patients.
- The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. The practice had adopted the gold standard framework for patients approaching the end of life. Older patients were involved in planning and making decisions about their care, including their end of life care.
- Monthly multidisciplinary meetings were held to review all patients on the palliative care register.
- The lead GP for palliative care had regular meetings with secondary care services and the local palliative care consultant to develop care for these patients.
- The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
- The practice had signed up to the admissions avoidance scheme, which identified patients who were at risk of inappropriate hospital admission.
- GPs and an advanced nurse practitioner provided care and support for patients at local care homes.
- Where older patients had complex needs, the practice shared summary care records with local care services.
6 October 2017
The practice is rated as good for the care of working age people (including those recently retired and students).
- The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. For example, extended opening hours and alternate Saturday morning appointments.
- 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 could sign up to receive text messages for appointment reminders.
- NHS Health Checks were carried out by the nursing team and there was a health and lifestyle section on the practice website, which was a source of additional advice.
6 October 2017
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).
- The practice carried out advance care planning for patients living with dementia.
- 72% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was 13% below the Clinical Commissioning Group (CCG) average and 12% below the national average.
- The practice specifically considered the physical health needs of patients with poor mental health and dementia.
- The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
- 94% of patients with poor mental health had had a comprehensive care plan documented in the last 12 months, which was 2% above the CCG average and 6% above the national average.
- The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
- Patients at risk of dementia were identified and offered an assessment.
- The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
- The practice had a system to follow up patients who had attended A&E where they may have been experiencing poor mental health.
- Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.
6 October 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.
- End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
- The practice offered longer appointments for patients with a learning disability.
- The practice leaflet, a guide to having a health check and the health check form were all available in an easy read format.
- The practice regularly worked with other health care professionals in the case management of vulnerable patients.
- The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
- Information about domestic abuse was discreetly displayed.
- Staff whom we interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.