Wellbrook Medical Centre

Letter from the Chief Inspector of General Practice

This practice is rated as Outstanding overall. (Previous inspection in May 2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Outstanding

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Outstanding

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Outstanding

Working age people (including those retired and students – Outstanding

People whose circumstances may make them vulnerable – Outstanding

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Wellbrook Medical Centre on 12 December 2017 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes. Learning was shared with local practices where relevant.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• There was a nurse lead for infection prevention and control (IPC) which was managed effectively and seen as a high priority by all staff. IPC was a standing agenda item on nurse meetings and other clinical meetings.
• There was a system in place for receptionists to alert the duty doctor to any potential concerns about urgent symptoms such as chest pain or sepsis. There was a triage system in operation to prioritise those with an urgent need and all children under the age of five had their appointment fast-tracked if there was any concern.
• The GP lead for medicines management had provided monitoring and feedback on prescribing. Thishad resulted in reduced prescribing of certain antibiotics and painkillers.
• The practice used an electronic system to record and make patient referrals to secondary care. This enabled the referral letter to reach a consultant or service straight away and also made an entry into the correct patient record automatically.
• The practice utilised a Medical Interoperability Gateway (MIG) which enabled relevant patient information to be shared with other NHS organisations to ensure immediate access to medical records and a more efficient and effective treatment for patients who required secondary care. Patient consent was obtained before access.
• Nurses had attended training to perform annual atrial fibrillation (AF) reviews alongside INR/warfarin annual reviews and referred symptomatic patients and those at risk of developing heart failure to the GP.
• Nurses provided anti-coagulation clinics and used NICE ‘Decision Aid’ to support patients when starting anti-coagulation therapy. They also maintained the INR Star registers used for monitoring anti-coagulant medicines, and contacted any patients who were overdue a test or did not attend their scheduled appointment.
• Online appointments were used by 40% of patients at the practice. This was the highest uptake of online access within the CCG.
• The practice had planned to participate in a chaplaincy project in conjunction with the end of life team and a spiritual safe care champion from DCHS starting early in 2018.
• Patients had access to CAMHS RISE (Rapid Intervention Support and Empowerment) service for young people who were experiencing suicide ideation.
• The practice utilised an alert system on patient records which identified any additional needs. This enabled reception staff to support and signpost patients without causing embarrassment, for example; privacy to discuss issues, longer appointments, chaperone, assistance with reading information, carers support.
• The practice held regular fundraising events and encouraged social interaction with patients and visitors, for example; a Macmillan coffee morning was held to raise money for cancer.
• Staff told us about a number of examples where reception and other staff went that ‘extra mile’ to accommodate patients.
• The practice made reasonable adjustments when patients found it hard to access services. For example; availability of telephone appointments, support for self-management and immunisation clinics outside of core hours. Receptionists were flexible in the booking of appointments for patients around local bus times or transport arrangements, carers, and other needs, for example, needing a lift from a neighbour.
• The practice had a large number of patients on their register from the travelling community and all staff were aware of this patient group and the challenges they faced with regards to registering and accessing care. The practice took special care to assist where required.
• The practice were committed to the development of staff and had provided financial support for the practice nurse manager to work towards achieving an MSc in Advanced Practice over a period of three years. This training was to enable an extension of her role for the benefit of patients.
• The practice provided educational support in a local care home on a voluntary basis to enable staff to improve levels of care, and enable appropriate requests to the practice for urgent visits
• Patients identified as being frail had a clinical review which included a review of medication at a consultant-led multi-disciplinary clinic. The clinic was a single point of access where patients had all their needs assessed by health and social care professionals. Patients relatives and carers were invited to be involved in the care and transport was arranged where required. The initiative was due to be evaluated in March 2018.

We saw four areas of outstanding practice:

• The leadership and culture of this practice was one of continuous development with leaders having the expertise to influence and drive improvements in the delivery of patient care.
• The practice worked with the CCG pharmacist to review prescribing at care homes aligned to the practice. This resulted in changes to 638 prescriptions, which had resulted in a reduction in prescribing costs estimated to be approximately £57,000 per year.
• Regular monitoring and feedback on prescribing performance had led to an overall reduction in antibiotic prescribing by 11% in the preceding year, and prescribing of a particular painkiller had also reduced by 90% for acute prescribing and by 68% for repeat prescriptions.
• There was a large traveller community registered with the practice which included 21 children. We saw that 18 of these children were up to date with childhood vaccinations, apart from three who had declined the MMR vaccination. The parents for the remaining three children were in close contact with the health visitor who was working with the practice to encourage uptake.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice