Archived: West Cheltenham Medical

Updated 6 December 2016

Springbank is a GP partnership located on the ground floor within the Springbank Community Resource Centre in Cheltenham. The practice shares the premises with a dental practice, a pharmacy and other community services including offices. The practice has one consulting room and two treatment rooms. The reception staff also covers the dental practice and there is one waiting area which is used by both Springbank and the dental practice. There is level access to the premises and automatic doors to the main entrance.

The practice has an Alternative Provider Medical Services (APMS) contract which had been taken over in December 2015 by the current provider. (An APMS contract is a locally negotiated contract open to both NHS practices and voluntary sector or private providers e.g. walk-in centres). The practice provides its services to approximately 2,100 patients at the following location:

Springbank Community Resource Centre,

Springbank Way,

Cheltenham,

Gloucestershire,

GL51 0LG.

The partnership providing services at this practice has six GP partners and four salaried GP (six female and four male) which is equivalent to seven and a quarter whole time equivalent GPs. The clinical team include a nurse consultant, three nurse practitioners, five practice nurses and a pharmacist. Five of those GPs provide regular GP sessions (one GP covers every day of the week) at the practice and one them is the overall lead. The nurse consultant, nurse practitioner and three practice nurses undertake chronic disease, family planning, sexual health and treatment room clinics at the practice. These clinical staff work across the provider’s three sites where services are provided across Cheltenham. The practice management and administration team includes a practice manager, a lead administrator and five customer services assistants. There is also an executive manager who has overall management oversight for all of the provider’s practices.

The general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in the fourth most deprivation decile. The prevalence of patients with a long standing health condition is 53% compared to the local clinical commissioning group average of 55% and the national average of 54%. Patients living in more deprived areas and with long-standing health conditions tend to have greater need for health services. An area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score. Average male and female life expectancy for the practice is 77 and 83 years, which is comparable to the national averages of 79 and 83 years respectively.

The practice is open between 8am and 6.30pm on Mondays to Fridays. Appointments are available from 8.30am to 11.45am and 3pm to 5.45pm with a GP; 8.30am to 1pm and 2pm to 6.30pm with nurses. The practice will start providing extended hours from Tuesday 4 October 2016, every Tuesday from 6.30pm to 7pm with both GPs and nurses.

Out of hours cover is provided by South Western Ambulance Service NHS Foundation Trust and can be accessed via NHS 111.

This is the first inspection of Springbank.

Updated 6 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Springbank on 3 October 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.
• 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.
• 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.

The areas where the provider should make improvement are:

• Ensure the system for the monitoring of expiry dates of consumables such as needles and syringes are reviewed.

• Continue to improve health outcomes for patients with long term conditions.

• Continue to implement measures to improve patients’ experience and satisfaction including patients’ involvement and decisions about their care.

• Improve the uptake for childhood immunisation.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 December 2016

The practice is rated as good for the care of patients with long-term conditions.

• Nursing staff had lead roles in chronic disease management and ran clinics for: diabetes, asthma and chronic obstructive pulmonary disease (COPD). Longer appointments of 30 minutes were given for these clinics. Patients at risk of hospital admission were identified as a priority.

• The practice had tailored its appointment system to enable patients with multiple long-term conditions to be seen in a single appointment.

• Performance since April 2016 to date for overall diabetes related indicators was 77%.

• Diabetes was managed by a dedicated team at the practice with both the practice nurses and GPs with this area of expertise. Six monthly reviews with the nursing team were carried out with referral on to a GP if needed. All patients in this group were invited to an annual retinal screening appointment.

• 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 6 December 2016

The practice is rated as good for the care of families, children and young patients.

• 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 patients who had a high number of A&E attendances. The practice ran specific immunisation clinics once a week.

• Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The practice’s uptake for women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years was 80% which was comparable to both the CCG average of 84% and 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. Meetings with the health visitors were held monthly to review children on the “at risk register”.

• The practice offered a family planning and sexual health service with a fully qualified sexual health nurse and a GP with specialised interest in women’s health and family planning who assessed patient need, initiated treatments and offered ongoing monitoring.

• The practice was a C-card centre (a scheme designed to increase the access and availability to free condoms and chlamydia screening for young people under 25).

• The practice was a young person friendly practice and held weekly drop-in clinics for young people who needed treatment or advice about sexual health, contraception or general health.

Updated 6 December 2016

The practice is rated as good for the care of older patients.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population and had a range of enhanced services, for example in influenza, pneumococcal and shingles immunisations.

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

• The practice supported seven patients living in local care homes and visited these patients on a fortnightly basis to carry out annual reviews, medicine reviews and end of life planning.

• All patients over the age of 75 were invited or visited for a comprehensive assessment, including long term chronic disease management, assessment for frailty and dementia screening and individualised care planning.

Updated 6 December 2016

The practice is rated as good for the care of working-age patients (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. All patients were invited either to hypertension (high blood pressure) annual screening or if over the aged of 40 to a cardiovascular health screening assessment.

• We were told that the practice would be offering extended hours every Tuesday from 6.30pm to 7pm from the 4 October 2016.

Updated 6 December 2016

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

• Practice data as at October 2016 showed that 88which was above both the clinical commissioning group (CCG) average of 86% and the national average of 84%.

• Practice data for the overall performance for mental health related indicators as at October 2016 was 88%.

• The practice was pro-active in identifying patients who were at risk of developing dementia. For example, all patients attending long-term condition reviews were asked about memory issues and if there were any concerns, the nurses would complete an assessment using a nationally recognised template. Patients who had a positive result would be offered appropriate screening and would be referred to the relevant services.

• There was a mental health worker who held weekly clinics at the practice.

• 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. Patients and carers were invited to attend an annual review with a practice nurse who was experienced in mental health assessments.

Updated 6 December 2016

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

• The practice offered longer appointments for patients with a learning disability. Practice data showed that all patients with a learning disability on the register had a health check.

• 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.