Bewdley Medical Centre

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that staff involved patients in decisions about their care and treatment and provided them with advice and support. Staff routinely reviewed patients care and worked with other services to achieve this.

We rated this key question as Good.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The National GP Patient Survey found 87% of patients felt their needs were met during their last general practice appointment which was in line with the national average of 90%.

The practice had systems and processes in place to identify patients’ needs and preferences during the registration process. The practice used digital flags within the care records system to highlight any specific individual needs such as the requirement for longer appointments or for a translator to be present. Staff referred patients with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

Staff checked patients’ health, care, and wellbeing needs during health reviews. Clinicians used templates when conducting reviews to support the assessment of patients’ wider health and wellbeing.

We discussed how clinicians identified and monitored patients at risk of developing a long-term condition. Clinicians explained they had systems and pathways established to follow. For example, for patients identified with early hypertension (blood pressure that's higher than normal but not in the high-risk range), a clinical code would be applied to the patient’s record to monitor this, and these patients would receive an annual recall appointment even if they had not been prescribed any medicines for this condition.

We undertook clinical record searches to review these systems. Clinical searches identified 45 patients as having a potentially missed diagnosis of chronic kidney disease (Stages 3-5). We looked in detail at 5 patient records and found 3 patients did not have chronic kidney disease; 1 patient had been recently diagnosed; and 1 patient was overdue a repeat blood test but had already been invited for an appointment with the practice.

Leaders told us about initiatives they were implementing to reduce health inequalities which included Serious Mental Illness (SMI) annual health checks for patients with schizophrenia, bipolar disorder or psychosis. Staff were working to improve the uptake of SMI health checks by including home visits to undertake these reviews; using practice data to drive targeted reviews; and ensuring reviews encompassed all of core elements.

There were systems in place to ensure staff were up to date with relevant legislation, evidence-based practice and required standards. Clinical meetings were in place to keep staff up to date. For clinicians who were unable to attend this meeting in person, these meetings were minuted and disseminated to all clinicians.

The remote clinical searches we undertook of the practice’s clinical records system included reviewing the monitoring of people with long-term conditions to assess if National Institute for Health and Care Excellence (NICE) recommendations were followed.

For example, we identified 114 patients with diabetes whose last blood glucose reading was over 75. We reviewed a random sample of 5 patient records and found no issues with the care and treatment of these patients for their diabetes.

As part of our clinical records searches, we reviewed the records of patients prescribed short-acting beta-2 agonist (SABA) inhalers (“reliever" inhalers used for quick relief from asthma symptoms like wheezing and breathlessness): We identified 96 out of 2160 patients on the asthma register had been prescribed 2 or more courses of rescue steroids. We reviewed a sample of 5 patient records and found all 5 had received an adequate assessment at the time of the prescribing of rescue steroid. However, we found there were inconsistencies in the follow up of these patients to check their response to treatment in an appropriate timescale following the acute exacerbation of their asthma. National Institute for Health and Care Excellence (NICE) guidance recommends that patients receive a follow up within 48 hours. We discussed this issue with clinicians and following our inspection they took immediate action to address this issue which included: a pop up alert on the clinical system when clinicians prescribed prednisolone (a steroid medicine) to ensure a 48 hour follow up appointment is arranged for the patient; the follow up is to be a face to face or telephone appointment in the first instance where possible; if a patient declines an appointment, a text questionnaire is to be sent to them; and an administrative note is to be added to a clinicians list of tasks to ensure they check for a response to the questionnaire from the patient.

Our clinical searches also identified patients with chronic kidney disease (Stages 4 or 5) who had not had appropriate urea and electrolyte blood test monitoring in the last 9 months. This search identified 1 patient out of a total of 95 patients diagnosed with chronic kidney disease. Our review in detail of this patient’s record found the patient was currently receiving palliative care and not undertaking blood tests for this condition.

As part of our clinical searches, we reviewed the care of patients with hypothyroidism (underactive thyroid). We identified 632 patients who were diagnosed with hypothyroidism and looked in detail at the records of 5 patients and discussed their care with clinicians. We found no issues with the care and treatment of these patients for their hypothyroidism.

The practice worked well across teams and services to support patients. They made sure patients only needed to tell their story once by sharing their assessment of needs when people moved between different services. Staff had access to information they needed to assess, plan, and deliver patients’ care, treatment, and support. Systems were in place to share information about patients electronically with other services.

The practice worked with other services to ensure continuity of care and engaged in regular multi-disciplinary team (MDT) meetings. For patients identified as approaching end of life, the practice referred to and worked closely with, the community palliative care team. Home visits and care packages were implemented to ensure patients’ wishes were followed and carried out in their final stages of life.

As part of the Wyre Forest Health Partnership, practices worked together to share learning from incidents and complaints; to identify risks; monitor performance through clinical dashboards; and collaborate with joint initiatives.

The practice supported patients to manage their health and wellbeing to maximise their independence, choice and control. Staff supported national priorities and initiatives to improve population health including stopping smoking and tackling obesity.

The practice waiting area and the practice website provided a wide range of health information for patients. In addition, the practice produced health promotion articles for the ‘Bewdley Bridge Community Magazine.’

For cardiovascular disease, clinicians were undertaking a proactive recall project for patients identified at high risk of developing the disease. In addition, clinicians undertook pre-diabetes screening for patients, identifying those at risk.

For weight management, the practice referred patients to the 12-week online NHS ‘Digital Weight Management Programme’ which supports adults living with obesity who also have a diagnosis of diabetes, high blood pressure, or both, to manage their weight and improve their health.

The practice also referred people to the ‘Wyre Forest Exercise Referral Scheme’ where patients with long terms health conditions were supported to increase their physical activity levels and enhance their overall health and wellbeing.

The practice routinely monitored patients care and treatment to continuously improve it. For example, for patients with coeliac disease (an autoimmune condition where the immune system attacks healthy tissue in the small intestine when gluten is consumed), the practice ensured patients received an annual, NICE-recommended coeliac review to assess their gluten-free diet adherence, symptoms, and potential complications, to improve their long-term health.

Staff endeavoured to ensure that outcomes were positive and consistent, and that they met both the clinical expectations and the expectations of patients. Staff focused on identifying risks to patients’ health, including those in the last 12 months of their lives; patients at risk of developing a long-term condition; and those with caring responsibilities.

The practice undertook regular clinical audits which demonstrated quality improvement. One audit related to hormone replacement therapy where clinicians checked if patients were prescribed both oestrogen and progestogen medicines. Clinicians explained they had a clear template to work through with prompts. If any patients were identified as not being prescribed both oestrogen and progesterone, they were followed up.

As part of our assessment, we reviewed the practice performance data for childhood immunisations. The World Health Organisation (WHO) recommends a rate of 95% for all routine childhood vaccinations.

Published national data showed the percentage of children aged 5 who had received immunisation for measles, mumps and rubella (two doses of MMR) was 93%.

The percentage of children aged 2 who had received immunisation for measles, mumps and rubella (one dose of MMR) was 94%.

The percentage of children aged 2 who had received their booster immunisation Pneumococcal infection was 96%.

The percentage of children aged 2 who have received their immunisation for Haemophilus influenza type b and Meningitis C was 96%.

The percentage of children aged 1 who had completed a primary course of immunisation for Diphtheria, Tetanus, Polio, Pertussis, Haemophilus influenza type b (Hib), and Hepatitis B (Hep B) was 97%.

Staff told us the practice had appointed a Care Co-ordinator to engage with parents and patients and increase the uptake of childhood immunisations.

In addition to childhood immunisation data, we reviewed published national data for the uptake of cervical screening. The practice had achieved 78%, which was slightly below the national target of 80%. The practice was working to improve the cervical screening uptake, and staff told us they had appointed a Cancer Care Co-ordinator to lead on following up patients who failed to attend for screening appointments.

The practice told patients about their rights around consent and respected these when delivering person-centred care and treatment. A consent policy was in place to ensure appropriate consent was obtained from patients when receiving care and treatment. Staff understood the requirements of legislation and guidance when considering consent and decision making.

Patients were offered a chaperone for care and treatment when this was appropriate. Chaperone posters were on display in the practice to inform patients of this service and staff who provided this service had completed chaperone training.

We discussed with clinicians what was in place to ensure patients, or persons lawfully acting on their behalf (as people with legal authority or responsibility to make decisions within the requirements of the Mental Capacity Act 2005), are involved in planning, managing, and reviewing their care and treatment. Clinicians explained their processes which included ensuring coding and alerts were applied to patient records; patient information was shared via health share app; and engagement with Independent Mental Capacity Advocates (IMCA) to help with decision making. An IMCA is a legal safeguard in England and Wales for people over 16 who lack the capacity to make vital decisions, such as serious medical treatment or long-term care changes. They provide independent representation when a person has no family or friends to support them.