Shifnal Medical Practice Also known as Shifnal and Priorslee Medical Practice

Updated 20 February 2017

Shifnal Medical Practice is registered with the Care Quality Commission (CQC) as a partnership provider, which includes three GP partners. The provider holds a General Medical Services contract with NHS England. At the time of our inspection 9,990 patients were registered at the practice. The practice provides GP services at a main location and two branch sites. The main location is based at Shifnal Medical Practice in Shifnal. The branch locations are at Priorslee and at Weston Under Lizard. The practice has opted out of providing cover to patients outside of normal working hours. These out-of-hours services are provided by Shropdoc. The on call duty GP provides cover for Wednesday afternoons and cover at lunchtime, the contact details of which are provided on the practice telephone system.

The opening hours at the main Shifnal location are between 8am and 1pm and 2pm and 6pm Monday to Friday. The practice provides extended hours between 7am and 8am every weekday with the exception of Mondays. The Priorslee branch location is open Monday, Tuesday and Thursday between 8am and 1pm and 2pm and 6pm, on Friday between 8am and 1pm and 2pm and 5pm and on Wednesday from 8am to 1pm. The Priorslee branch location provides extended hours between 7am and 8am on a Thursday.

The branch location at Weston under Lizard is open from 11.30am to 11.45am on Friday mornings.

Shifnal Medical Practice is located in an older purpose built building. As well as providing the contracted range of primary medical services, the practice provides additional services including:

• Minor surgery
• Venepuncture (blood sample taking)

Staffing at the practice includes three partner GPs and a long term female locum GP. The practice employs two locum advanced nurse practitioners who provide both telephone triage and bookable appointments covering five days a week and a locum practice nurse who works two days a week. The management team includes a practice business manager and two office managers. The nursing team includes an advanced nurse practitioner who provides seven sessions a week over four days (and is undertaking a practice-sponsored degree) a practice nurse, and two healthcare assistants and a phlebotomist. The practice support team includes 10 reception/administration staff members and a community care coordinator. The practice is currently recruiting for a chronic disease management nurse and a GP partner. The practice also hosts a general surgery clinic every month with a consultant general surgeon at New Cross Hospital, Wolverhampton.

Updated 20 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Shifnal Medical Practice on 8 June 2016. The overall rating for the practice was good, with requires improvement for providing safe services. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for Shifnal Medical Practice on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 26 January 2017 to confirm that the practice had carried out their improvement plan in relation to the areas identified in our previous inspection on 8 June 2016. This report covers our findings in relation to improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• Information about services and how to complain was available and easy to understand. There was an open and transparent approach to safety and an effective system in place for reporting and recording events such as complaints. The practice had introduced six monthly reviews of all complaints received in the period for trend analysis as well as an annual review. Improvements were made to the quality of care as a result of complaints and concerns.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. A training planner was in place to ensure staff were up to date with infection prevention and control training, and this was included at staff induction and staff had attended Mental Capacity Act and Deprivation of Liberty Safeguard (DoLS) training.
• The practice had improved the maintenance of recruitment documentation to ensure staff references and clinical staff verification checks with their appropriate professional body were consistently recorded.
• 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 and the senior GP attended Patient Participation Group meetings.
• The provider was aware of and complied with the requirements of the duty of candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 July 2016

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

• Patients at the highest risk of unplanned hospital admissions were identified and care plans had been implemented to meet their health and care needs.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. There was a system in place which recalled patient non-attenders for their reviews.
• For people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• Nursing staff had lead roles in chronic disease management and had undertaken additional training.
• A practice nurse with specialist diabetic nurse training supported diabetic patients with dietary advice, referred patients to a structured education program, foot screening service and retinal screening service when they were first diagnosed.
• The practice held diabetic eye screening and podiatry foot screening clinics within the practice buildings so that patients did not need to travel far for these services.
• Named patients with complex conditions were flagged to the out of hours provider, Shropdoc, and were subject to regular review.

Updated 25 July 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’s uptake for the cervical screening programme was 95% which was higher than the CCG average of 83% and national average of 82%.

• The practice was young person-friendly and offered condoms, pregnancy testing and chlamydia testing for all aged 15-24.

• The community midwife held weekly clinics at the practice main location in Shifnal and at the Priorslee branch.

• The practice provided family planning services at both the main and branch sites.

• A GP held a child health surveillance six week check every week at Priorslee,

• The practice offered a room should a breast-feeding mother request one to feed her baby.

Updated 25 July 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. They were responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice visited local care homes to administer Influenza vaccines.

• The practice employed a community and care co-ordinator whose role included contacts with older patients within 48 hours of discharge from hospital, and an office manager who ensured that any changes to a patient’s medications were made by the GP. Admissions were reviewed in the practice monthly development meetings to see if they were avoidable.

• The practice recorded information about older patients’ carers.

• The practice provided a weekly branch surgery at Weston under Lizard (five miles from Shifnal), where the majority of patients attending were over 75 years old. The practice recently purchased a tablet computer to enable access to patients’ electronic records. The GP who held this surgery also supported routine visits to patients who live in this area.

Updated 25 July 2016

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

• The practice offered appointments outside of core working hours Tuesday to Friday from 7am.

• The practice provided online services to enable patients to book appointments, order repeat medicines and access some parts of their health records online.

• Health promotion and screening services reflected the health needs of this group.

• The practice had recently recruited an advanced nurse practitioner to meet the needs of patients and new a GP Partner was to start in August 2016.

• All GPs had at least two appointment slots available for telephone consultations in the morning and afternoon surgeries. These were helpful for reviewing results and discussion of a patient’s further management without them having to take time off work to come into Surgery.

• The practice provided telephone triage appointments with an appropriately trained nurse.

Updated 25 July 2016

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

• The practice provided access to an in-house counsellor and the practice facilitated room use for two cognitive behaviour therapists (CBT). The practice also sign-posted patients to Improving Access to Psychological Therapies (IAPT).

• The practice was used by the memory clinic for patients with dementia and the practice recorded details of patients’ carers and offered them health checks.

• Performance for poor mental health indicators in the QOF data for 2014/15 was however lower than the national averages. For example, 50% of patients with enduring mental health had a recent comprehensive care plan in place compared with the CCG average of 89% and national average of 88%. We found however that clinical exception reporting was lower at 6%, when compared with the CCG average of 12% and national average of 13%. (Clinical exception rates allow practices not to be penalised, where, for example, patients do not attend for a review, or where a medicine cannot be prescribed due to side effects). The results yet to be published for 2015/16 on the practice systems showed significant improvement in these figures.

• Staff had a good understanding of how to support patients with mental health needs and dementia. For example the percentage of patients with dementia care plans on their dementia register was 77% in the 2014/15 published QOF data and we saw that the practice had improved this to all patients, 100% in the last year.

Updated 25 July 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 known vulnerable adults, those who were housebound and patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. For example they offered a shared care system for the supervision and monitoring of patients on substance misused medicines. This prevented patients having to travel to Shrewsbury for a review and their prescription.

• In conjunction with the health visitor and Public Health the practice had been involved in immunising some traveller children when there was an outbreak of measles amongst families who were staying in the area.

• The practice provided GP services to 12 young people living with autism. This included meeting with staff who supported these young people. Arrangements were agreed that staff would notify the practice reception when the young person arrived at the practice. The young person would be called from the car and taken straight to the consulting room.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• The practice held a register of the practices’ frail and vulnerable patients and had identified patients who may be at risk of unplanned hospital admissions.

• The care co-ordinator supported patients and signposted to other allied health and social care professionals, voluntary agencies and charitable agencies when required.