Abbey Medical Practice

Updated 13 May 2016

Abbey Medical Practice is registered with the Care Quality Commission (CQC) as a partnership provider. The practice holds a General Medical Services (GMS) contract with NHS England. The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities. At the time of our inspection Abbey Medical Practice was providing care to approximately 8,338 patients.

Abbey Medical Practice is located in purpose-built premises based in Evesham town centre, which is an area of lower than average deprivation.

The practice is accessible to patients with disabilities and there is a lift to the second floor. There are disabled car park spaces on site. A pay and display public car park is nearby for other patients.

There are four GP partners, two male and two female. The GPs are supported by a pharmacist, three practice nurses, three health care assistants and a dispensary team of six. Non-clinical staff includes a business manager, practice manager, reception and administrative staff.

Abbey Medical Practice is a dispensing practice, which dispenses to those patients whose home is more than one mile from the nearest pharmacy . A free home delivery service is available for those patients who cannot collect their prescriptions from the practice.

The practice is open from 8am to 6.30pm Monday to Friday. Routine and urgent appointments are available during these times. The telephone is answered from 8am to 6.30pm.

The practice does not provide an out of hours (OOH) service. When the practice is closed, patients are advised to dial 999 in an emergency or to contact the NHS 111 service. The practice does not provide an extended hours service itself, but has signed up to a pilot project at Evesham Community Hospital Hub. The Hub is an extended hours service for patients in the Evesham catchment area. Appointments are available from 6.30pm to 9pm on Monday, Wednesday and Friday and from 9am until 1pm on Saturday morning. Appointments can be booked via the reception team at Abbey Medical Practice.

Updated 13 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Abbey Medical Practice on 2 March 2016. Overall the practice is rated as good.

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

• Patients’ needs were assessed and care was planned and delivered in line with best practice guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. There was an open and transparent approach to safety and a system in place for recording and monitoring significant events.
• Risks to patients were assessed and well managed.
• Patients said that staff were compassionate, kind and professional. Patients felt that they were involved in their care and decisions about their treatment.
• The practice provided information about services and how to complain, which was easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice took part in an extended hours pilot scheme, funded by the Prime Minister's Challenge Fund. Patients could book appointments from 6.30pm to 9pm on Mondays, Wednesdays and Fridays and from 9am to 1pm on Saturdays.
• The practice was in a modern building with good facilities. It was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by their colleagues and by the management team. The practice proactively sought feedback from staff, patients and the Patient Participation Group (PPG) , which it acted on.
• The practice had a clear vision about providing high quality service in a safe manner.

We saw one area of outstanding practice:

• The business manager had worked with a patient with a rare disease and a Clinical Nurse Specialist to write a protocol for the management of breakthrough infections (May 2015). This has now been adopted by the UK Primary Immune-deficiency Patient Support organisation.

The areas where the provider should make improvements are:

• Introduce a robust system that provides a clear audit trail to ensure that all relevant staff receive NICE guidelines.

• Improve exception coding, for example with regard to chronic kidney disease.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 May 2016

The practice is rated as 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.

• 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.

• Lifestyle support was provided by the nursing team. This included advice about weight loss and exercise. Patients who needed advice on smoking cessation were referred to the dispensary team. The nursing team also carried out the NHS Health Checks.

• Data showed that 76% of patients with asthma had their care reviewed in the last 12 months, which was in line with CCG and national averages.

• The business manager had worked with a patient with a rare disease and a Clinical Nurse Specialist to write a protocol for the management of breakthrough infections. This had been adopted by UK Primary Immune-deficiency Patient Support. A poster advertising Rare Disease Day on 29 February 2016 was on display in the waiting room.

• The practice clinical team had received additional training in long term care. For example, one of the nurses held diplomas in asthma and chronic obstructive pulmonary disease.

Updated 13 May 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 accident and emergency (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.

• Cervical screening uptake was 84%, which was in line with the local and the national averages.

• Appointments were available outside of school hours and the premises were suitable for children and babies. Young children under the age of five were always given a same day appointment.

• Nurses held daily minor illness clinics for acute conditions.

• A play table was available in the waiting area.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 13 May 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.

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

• The practice maintained a register for patients who required palliative care. Home visits and urgent appointments were provided when needed for this group of patients.

• The practice had signed up to the admissions avoidance service, which identified patients who were at risk of inappropriate hospital admission.

• The dispensary provided a home delivery service for patients who were housebound.

Updated 13 May 2016

The practice is rated as good for the care of working-age people (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 reflected the needs for this age group.

• Patients could book telephone appointments as an alternative to a face-to-face consultation.

• NHS Health Checks were offered by the nursing team, who provided advice on smoking cessation, weight loss and exercise.

• A range of contraceptive services was available at the practice (including coils and implants).

• Patients could book routine GP appointments or request repeat prescriptions online at a time that suited them.

• The practice participated in the extended hours pilot, set up with funds from the Prime Minister’s Challenge Fund, at Evesham Community Hospital. Patients could book appointments from 6.30pm to 9pm on Monday, Wednesday and Friday and from 9am to 1pm on Saturday, as an alternative to attending the practice.

Updated 13 May 2016

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

• 85% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was in line with local and national averages.

• 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. Receptionists reminded patients about their appointment times and patients who did not attend their appointment were contacted.

• A pilot project was due to start in April 2016 which would involve a dementia advisor from Age UK attending the practice to support patients in this group.

• Data from the Quality and Outcome Framework (QOF) 2014/15 showed a higher than average exception rate for mental health (23% above the CCG and national averages). The partners had recognised that exception reporting was high, because it had been used inappropriately. An audit of exception reporting had been carried out in November 2015 and action taken as necessary.

Updated 13 May 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 homeless people, travellers and those with a learning disability.

• 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.

• A Community Mental Health Team (Gateway) worker reviewed patients at the practice in a weekly clinic.

• We received very positive feedback from three care home managers. They told us that the GPs were very kind and took time to involve patients in their care as much as possible.

• Regular multi-disciplinary meetings were held during which treatment for patients on the palliative care register was discussed.

• Comprehensive care plans were drawn up for these 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. We saw an example of action taken to protect a vulnerable patient; detailed written notes outlining actions had been made in meeting minutes.

• Information about support groups for domestic abuse and sexual violence was displayed in the reception area.