Much Birch Surgery

Updated 16 January 2017

Much Birch Surgery is located in a rural setting and provides primary medical care to people who also live on the edge of Hereford to Ross on Wye, extending into the villages of the Golden Valley. The practice holds a General Medical Services (GMS) contract, a nationally agreed contract commissioned by NHS England.

There are 4,821 registered patients. There is a higher than average age group of registered patients of both sexes aged between 50 and 85+ years with 12% of patients aged 75+ years. There are lower than average patients registered who are new born to 39 years old for both sexes.

The practice is managed by four GP partners (one male, three female) and they are supported by two salaried GPs. The practice employs two practice nurses. They carry out reviews of patients who have long term conditions such as, diabetes, asthma and hypertension. They also provide cervical screening and contraceptive advice. A lead practice nurse has been appointed and is due to commence employment in December 2016. There are two health care assistants (HCAs) who carry out duties such as, phlebotomy (taking blood for testing), health checks and vaccinations.

There is a practice manager, two medical secretaries, two administrators and three receptionists.

There is a specialist diabetes nurse who works at the practice for one session per month. A health visitor holds a session one a week to see children and monitor their progress. The practice hosts a visiting psychiatrist for one session per month, a specialist mental health nurse for one session per week and a specialist dementia nurse for one session per month.

The practice offers a range of clinics for chronic disease management, diabetes, heart disease, cervical screening, contraception advice, minor surgery, injections and vaccinations.

There is dedicated parking for patients including disabled spaces located at the front of the premises. The premises are step free and suitable for access by wheelchair users. There is a toilet that is adapted for use by people who have restricted mobility. There are five consulting rooms and two treatment rooms available.

The practice is open from 8am until 6.30pm every weekday.

Appointments times vary between GPs:

• From 8.30am or 9am until 11.30am or 12pm.

• Clinical staff contact patients by phone and receive phone calls from patients during the morning.

• Afternoon appointments are from 3pm until 5.30pm or until all patients have been seen.

• Requests for home visits may be contacted by phone to enable GPs to prioritise which patients should be visited first.

The practice has joined up with other local practices as part of Taurus Healthcare. Patients from this and other practices can be seen at three locations (two of these are local for Much Birch patients) from 8am until 8pm every day including bank holidays. This means that patients may not be seen by a GP or nurse from their own practice but clinical staff have access to all patient’s records to ensure that appropriate assessments and treatments are provided.

Patients who live in excess of one mile from a pharmacy are eligible to have their prescribed medicines dispensed from the practice. This equates to 96% of registered patients. Medicines can also be collected a designated outlet. The dispensary has a dispensary manager and five dispensers. The opening hours are from 8am until 6.30pm each day.

The practice has opted out of providing GP services to patients out of hours during night times. During these times GP services are provided currently by a service commissioned by NHS Clinical Commissioning Group (CCG), Primecare. When the practice is closed, there is a recorded message giving out of hours’ details. The practice leaflet includes contact information and there are out of hours’ leaflets in the waiting area for patients to take away with them.

Updated 16 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Much Birch Surgery on 8 November 2016. Overall the practice is rated as good.

Our key findings across all of the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored and reviewed and the results shared with staff including lessons learned.

• Safe arrangements were in place for staff recruitment that protected patients from risks of harm. Staff numbers were regularly reviewed to enable them to meet patients’ needs and plans were in place to increase clinical sessions.

• There were robust on-going arrangements in place to protect patients and others from unnecessary infections.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training had been encouraged and planned to enhance their skills.

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

• A good neighbour scheme was provided by volunteers who provided transport for patients who found it difficult to access the practice and other social services such as; delivering food.

• Information about how to make a complaint was readily available and easy to understand. Complaints received were dealt with appropriately and clear explanations given to complainants.

• The practice had good facilities and was well equipped to assess and treat patients.

• There was a clear and open culture and staff told us they felt well supported by senior staff. Management sought feedback from patients which it acted on.

• The provider was aware of the requirements of the Duty of Candour and we saw where this had been applied concerning a complaint.

We saw an area of outstanding practice:

There had been 26 significant events recorded from April 2015 until March 2016 and we saw that they had been dealt with appropriately. These were reviewed regularly during team meetings and quarterly during full staff meetings to identify trends and ensure that no further actions were necessary. All significant events were forwarded to the National Reporting and Learning System (NRLS). This is a means of sharing lessons learned from safety incidents.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 January 2017

The practice is rated 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.

• A diabetes specialist nurse worked at the practice for one session per month. They worked alongside practice nurses who managed patients with diabetes and saw patients who had complex needs. This system also served to enhance practice nurses skills.

• Longer appointments and home visits were available when needed.

• Patients with long-term conditions had structured annual reviews to check that their health and medicine needs were being met. Where necessary reviews were carried out more often.

• Clinical staff worked with health care professionals to deliver a multidisciplinary package of care for patients.

• Where necessary patients in this population group had a personalised care plan in place and they were regularly reviewed.

Updated 16 January 2017

The practice is rated 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.

• Alerts were put onto the electronic record when safeguarding concerns were raised.

• There was regular liaison and monthly meetings with the health visitor to review those children who were considered to be at risk of harm. The health visitor worked in the practice for one session every week and saw children to check their development.

• All children up to the age of 12 years were triaged and if necessary seen the same day.

• Patients and their children told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

• Childhood vaccinations were in line with the local and national averages.

• To avoid children missing lessons appointments were also available outside of school hours via extended hours. This service was provided from 8am until the practice commences appointments until 8pm from when appointments stop. This service is provided seven days a week. Patients may be seen by a GP or nurse from another practice who had access to patient records.

Updated 16 January 2017

The practice is rated good for the care of older people.

• There were a higher than average number of older patients registered at the practice with 12% above 75 years of age. Practice staff offered proactive, personalised care to meet the needs of older patients.

• There was a higher than average uptake of flu vaccinations of patients aged 65 or more years; 74% during 2015-2016.

• Staff kept up to date registers of patients’ health conditions and information was held to alert staff if a patient had complex needs.

• Home visits were offered to those who were unable to access the practice and patients with enhanced needs had prompt access to appointments.

• Extended appointments were available to ensure all aspects of their care needs were assessed.

• GP carried out assessments and treatments for residents who lived in a care home and a nearby convent.

• Practice staff worked with other agencies and health providers to provide patient support.

Updated 16 January 2017

The practice is rated good for the care of working-age people (including those recently retired and students).

• The practice had adjusted its services to accommodate the needs of this population group.

• Telephone consultations were provided with a GP or a nurse for those patients who found it difficult to attend the practice or if they were unsure whether they needed a face to face appointment.

• Extended hours were provided to improve patient access.

• Online services were available for booking appointments and ordering repeat prescriptions and 24% of patients registered at this practice used this service.

• The practice website gave advice to patients about how to treat minor ailments without the need to be seen by a GP.

• Patients we spoke with told us that clinical staff routinely provided healthy living advice to promote their well-being.

• 85% of eligible female patients had attended for cervical screening during 2014-2015. Clinical data told us this was 4% above the CCG average and 3% above the national average.

Updated 16 January 2017

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

• 90% of patients who experienced poor mental health had received a mental and physical health check during 2014-2015 and had been involved in developing their care plans. This was in line with local and national averages.

• The practice hosted weekly sessions by a specialist mental health nurse and monthly sessions by a psychiatrist. Patients could be referred to this service.

• Practice staff regularly worked with multi-disciplinary teams in the case management of patients who experienced poor mental health, including those with dementia.

• GPs carried out assessments of patients who experienced memory loss in order to capture early diagnosis of dementia. This enabled staff to put a care package in place that provided health and social care support systems to promote patients well-being.

• A specialist dementia nurse held a session at the practice once a month. This permits face to face discussions and sharing of information with staff.

• Referrals to other health professionals were made when necessary.

• Staff had a good understanding of how to support patients with mental health needs including those with dementia.

Updated 16 January 2017

The practice is rated 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 who had a learning disability. There was a higher than average number of patients with a learning disability who were registered with the practice.

• All 36 patients who had a learning disability had received their annual health checks for 2016-2017.

• Practice staff regularly worked with multi-disciplinary teams in the case management of vulnerable patients.

• Staff knew how to recognise signs of abuse, the actions they should take and their responsibilities regarding information sharing.

• There was a clinical lead for managing vulnerable adults and children.

• Meetings were held every two months with the allocated health visitor who also held weekly sessions at the practice.

• The practice was pro-active in identifying patients who were carers and had registered 3% of the practice population as carers. Clinical staff offered them guidance, signposted them to support groups and offered them a flu vaccination each year.

• There was a register to manage end of life care and unplanned admissions to hospital.