Malmesbury Medical Partnership Also known as Malmesbury Primary Care Centre

Updated 13 May 2016

Malmesbury Medical Partnership is located close to the centre of Malmesbury, a small town in Wiltshire. The practice has a higher than average patient population in the over 45 years age group and lower than average in the under 20 to 40 years age group. The practice is part of the Wiltshire Clinical Commissioning Group and has approximately 15000 patients. The area the practice serves is semi-rural and has relatively low numbers of patients from different cultural backgrounds. The practice area is in the low range for deprivation nationally; however there are pockets of deprivation.

The practice is managed by six GP partners (four male and two female) and a practice manager partner. The practice is supported by an additional seven salaried GP’s (three male and four female), five practice nurses, four healthcare assistants and an administrative team led by the practice manager. Malmesbury Medical Partnership is a teaching and training practice providing placements for GP registrars and medical students.

The practice is open between 8am and 7pm Monday to Friday. Appointments are available between 8.30am and 11.30am every morning and 2pm to 6.15pm every afternoon. Extended hours appointments are offered between 7.30am and 8.30am Wednesday and Thursday mornings 8.30am to 11.15am on Saturday mornings. In addition to pre-bookable appointments that could be booked up to six weeks in advance, urgent appointments were available for patients that needed them.

When the practice is closed patients are advised, via the practice website that all calls will be directed to the out of hours service. Out of hours services are provided by Medvivo.

The practice has a General Medical Services (GMS) contract to deliver health care services. This contract acts as the basis for arrangements between the NHS Commissioning Board and providers of general medical services in England.

Malmesbury Medical Partnership is registered to provide services from the following location:

Malmesbury Primary Care Centre

Malmesbury

Wiltshire

SN16 0FB

Updated 13 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Malmesbury Medical Practice on 3 February 2016. Overall the practice is rated as outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example the practice improved quality of care and improved outcomes for patients by and working collaboratively with other stakeholders and initiating an in house elderly frail service.

• Feedback from patients about their care was consistently positive.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, with the local council to provide an in house art programme. The practice had also engaged with the local wildlife trust to develop opportunities, for patients with mental health problems.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example the practice extended its opening hours further, from 8am until 7pm, following patient feedback.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.

• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw several areas of outstanding practice:

• The practice was proactive in ensuring services were delivered in ways that would improve patient outcomes. For example the practice worked effectively with the local referral support service which maximised appropriate local referral options. This had contributed to the practice being 19% below the Wiltshire average for emergency admissions, 6% below for elective admissions and 30% below for accident and emergency department attendance rates.

• The practice had identified from the Joint Strategic Needs Assessment (JSNA) high admissions of frail elderly patients. In response, funding was secured from the transforming care for elderly patients scheme, to set up a frail elderly clinic and a falls assessment service at the practice. Three elderly frail clinics were run each week. There was evidence to demonstrate positive outcomes, in a reduction in the number of falls and of a number of patients being able to continue to live safely at home with support.

• Dementia patients were identified as a target group that would benefit from changes in the way services were delivered. An in house service was initiated for the diagnosis, assessment and referral if appropriate for patients with possible dementia. The service was supported by the practices care coordinator, the Alzheimer’s society and a psychological course for patients and their carers. This service had reduced waiting times for assessment, diagnosis and time to start treatment from 12 months to one month. This has alleviated anxiety for patients and their families and also reduced the number of patients requiring referral to secondary care by 65%.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 May 2016

The practice is rated as outstanding for the care of patients 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. The nurse lead for diabetes met with the lead GP for diabetes twice a month to discuss complex cases and the practice worked closely with the local diabetic specialist nurse who ran a clinic at the practice once a month.

• The percentage of patients with diabetes, on the register, in whom blood test results were within target range in the preceding 12 months (04/2014 to 03/2015) was 91% compared to a national average of 78%

• 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 13 May 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. Immunisation rates were relatively high for all standard childhood immunisations.

• 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 percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years was 82% which was the same as 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.

Updated 13 May 2016

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

• 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.

• The practice had identified from the Joint Services Needs Assessment (JSNA) high admissions of frail elderly patients. In response to this funding was secured from the transforming care for elderly patients scheme, to set up frail elderly clinics and a falls assessment service at the practice. Staff, teams and services were committed to working collaboratively to ensure older patients received coordinated care to meet their needs. This had led to reduced hospital admissions and improved support services to maintain independent living.

• Following a pilot project with the clinical commissioning group (CCG), which the practice was the first in the area to initiate, patient consent, electronic clinical records were shared with the integrated community team, the local palliative care team, the out of hours service and the local accident and emergency department This had ensured coordinated care, particularly for older patients with complex needs.

• The practice provided medical services to two local nursing homes. The service provided, had recently been re designed in conjunction with care home staff to reduce the number of hospital admissions. GPs now visited daily. Further improvements in continuity and collaborative working between care home staff and the practice to improve patient outcomes, had led to a 20% reduction in emergency admissions in the first 6 months of the new ways of working.

• The practice was proactive in the support offered to carers. The practice had identified a member of staff who was responsible for coordinating the carers group. Meetings were held monthly at the practice and each year an annual outing during the summer was also arranged for the group. The practice had been awarded the gold award for their work with carers.

Updated 13 May 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 open 8am to 7pm each day and Saturday mornings.

• 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.

• The practice supported a local sexual health initiative for young patients and attended weekly sexual health clinics at the local school.

Updated 13 May 2016

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

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 94% which was higher than the national average of 88%.

• An in house service was available for the diagnosis, assessment and referral if appropriate for patients with possible dementia. The service was supported by the practices care coordinator, the Alzheimer’s society and a local psychological course for patients and their carers. This service had reduced waiting times for assessment and diagnosis from 12 months to 1 month and also reduced the number of requiring referral to secondary care by 65%.

• The practice regularly worked with multi-disciplinary teams in the case management of people 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. All staff had received additional training from the Alzheimer’s society.

• Three GPs had undertaken additional training in drug and alcohol misuse in order to better support patients where there was a need. The practice worked effectively with specialist workers who consulted with patients at the practice. Routine screening and vaccination was offered and the practice worked collaboratively with the local pharmacists. The care coordinator who worked with the frail and elderly had received alcohol awareness training in order to support patients she was working with.

• The practice was proactive in responding to a request by the local council for practices to consider working with local charities on art and outdoor activities projects. The practice felt this would provide support for patients experiencing mental health issues. Following a pilot project the practice continued to facilitate in house sessions for patients who it was felt would benefit from expressing themselves artistically. The practice had engaged with the local wildlife trust on a farm project for patients who would benefit from outdoor activities. 

Updated 13 May 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 a learning disability. The practice had no homeless patients registered on the day of the inspection.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• 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.