Budbrooke Medical Centre

Updated 29 June 2017

Budbrooke Medical Centre is a semi-rural dispensing GP practice which provides primary medical services under a General Medical Services (GMS) contract to a population of approximately 4,500 patients living in Budbrooke and surrounding areas of Warwick. A GMS contract is a standard nationally agreed contract used for general medical services providers.

The practice operates from a single storey building which has has parking facilities and disabled access with electronic doors to the entrance and a spacious reception area allowing easy access for patients with mobility aids to manoeuvre.

The practice population has a higher than average number of patients aged 10 to 15 years and those aged 40 to 70 years and a lower than average number of patients in the 20 to 35 year age group. National data indicates that the area is one that does not experience high levels of deprivation. The practice population is predominantly made up of patients of white British ethnic origin.

There is one male GP provider who employs three part time female GPs. The practice employs two practice nurses, a health care assistant, a practice manager and a dispensary manager, who are supported by a team of administration and reception staff. The practice is a dispensing practice dispensing to approximately 4,000 patients who live more than one mile from a pharmacy. This is staffed by a team of four trained dispensary staff.

The practice offers a range of services including minor surgery, long term condition monitoring, cervical cytology, family planning, child health services and phlebotomy (blood taking).

The practice premises and dispensary is open on Mondays, Wednesdays and Fridays from 8am until 6pm, and Tuesdays and Thursdays from 8am until 5pm. When the practice is closed during core hours from 5pm (on Tuesdays and Thursdays) and from 6pm (on Mondays, Wednesdays and Fridays) calls are taken by the GPs at the practice until 6.30pm. When the practice is closed from 6.30pm cover is provided by the out of hours service, who can be contacted via NHS 111.

Updated 29 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Budbrooke Medical Centre on 25 April 2017. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events which all staff were aware of.

• The practice had clearly defined and embedded systems to minimise risks to patient safety. Staff were aware of current evidence based guidance and took measures to ensure that changes in guidance were discussed and shared with staff. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had achieved consistently high levels of satisfaction from the national GP patient survey and their own survey and showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment. Patients we spoke with and CQC comments cards were also unanimously positive and patients expressed how the actions and additional support of the GPs and other staff had had a positive impact on how they dealt with, and adjusted to life when coping with particularly difficult diagnoses and specific long term conditions. Patients told us how the GPs provided their own telephone number to patients during the end of life and provided additional home visits to support them. All staff we spoke with demonstrated that the caring practice ethos was embedded in their work.
• Patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day as well as telephone consultations. One hundred percent of patients said they could get through easily to the practice by phone compared to the national average of 73%.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice had made significant changes in the last two years and strengthened and developed their management team which had improved efficiency in the practice.
• The practice had an active patient participation group as well as a virtual group who worked well with the practice and provided feedback, which was well received and acted upon.
• The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

We saw areas of outstanding practice:

• The practice had a lead GP for mental health and dementia who had undertaken additional training in these areas. Their proactive approach to dementia had led them to explore their patient population and review patients who may have been at high risk of dementia. This had increased the number of patients identified as living with dementia. The practice had engaged in a local pilot project to identify and investigate patients with the potential for a diagnosis of non-complex dementia. The GPs gave several examples of how in depth consultations had resulted in significant benefits to both patients and their carers.

• The practice had engaged in two leadership programmes where key staff had developed their skills in change management, succession planning and leadership. They had introduced new systems and ways of working which enabled the practice to function more efficiently allowing more time for patients and clinical reflection. They had involved all levels of staff seeking ideas and views to ensure effectiveness, engagement and ownership.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 29 June 2017

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

• Nursing staff had lead roles in long-term disease management including hypertension, asthma, stroke, and diabetes and patients at risk of hospital admission were identified as a priority.
• Outcomes for patients with long term conditions were higher than the CCG and national averages. For example:
• 86% of patients with diabetes, on the register, had blood glucose levels within the recommended range or less in the preceding 12 months compared to the CCG average of 82% and national average of 78%.
• 85% of patients with diabetes, on the register, had a blood pressure reading within the recommended level compared to the CCG average of 80% and national average of 78%.
• The practice followed up patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• The practice had comprehensive knowledge of their practice population and patients with long-term conditions who experienced a sudden deterioration in health could access the GP urgently if necessary.
• All these patients had a named GP and there was a system to recall patients for 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.
• The practice told us they used every contact with patients to ensure that all areas of their health were addressed and encouraged attendance for review. Patients confirmed they experienced this holistic approach to their health.

Updated 29 June 2017

The practice is rated as good for the care of families, children and young people.

The practice had comprehensive systems in place for dealing with safeguarding children. All staff in the practice were appropriately trained and demonstrated confidence in their knowledge of how to deal with safeguarding concerns.

• Immunisation rates were 100% for all standard childhood immunisations. The practice was one of three practices in the CCG that had achieved this and had also achieved influenza vaccination targets both in pregnant women and children.
• The practice provided support for all babies and their families following discharge from hospital and provided children’s medical examinations at six to eight weeks of age prior to commencement of their immunisation programme.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice worked with midwives and health visitors to support this population group. For example, in the provision of ante-natal, post-natal and child health clinics.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.
• The practice had GPs with additional training in contraception and offered hormonal contraceptive implants and insertion of intrauterine devices.
• Cervical screening was offered to all women and the practice nurses had additional qualifications to perform this. The practice manager and lead nurse checked regularly for patients who had not attended for cervical screening. The lead nurse encouraged these patients to attend and explained the process to alleviate anxieties which may have affected uptake.
• 86% of women aged 25-64 years had received a cervical screening test in the preceding 5 years compared to the CCG and national averages of 83% and 81% respectively. Exception reporting was 3% compared to the CCG average of 6% and national average of 7% for this area of screening.

Updated 29 June 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• 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 identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Where older patients had complex needs, the practice shared summary care records with local care services. The practice were involved in a pilot scheme which was exploring this.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.
• The practice worked with AgeUK and had an allocated worker to receive referrals from the practice.

Updated 29 June 2017

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

The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. For example, the practice took every opportunity to promote vaccination and health screening programmes and as a result had achieved a higher than average uptake rate in all screening and vaccinations.

• The practice was one of three highest achieving practices in the CCG in flu vaccinations achieving 84% uptake for the over 65 age group and 69% for the under 65 year age group.
• There was information advertising bowel and breast screening in the waiting areas and it had been included in the practice television advertising screen. The practice had adopted a way of working which incorporated making every contact with patients count which included encouraging uptake of screening and following up patients who had not attended.

• 68% of patients aged 60-69 years, were screened for bowel cancer in last 30 months compared with the CCG and national averages of 63% and 58% respectively.
• 81% of females aged 50-70 years, were screened for breast cancer in last 36 months compared to the CCG and national averages of 75% and 72% respectively.

• 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 and there was a range of health promotion literature in the waiting area to support this. For example, NHS Health Checks and cancer awareness.

Updated 29 June 2017

The practice is rated as outstanding for the care of people experiencing poor mental health (including people with dementia). This is because the practice is rated outstanding in the area of well led as well as in providing outstanding effective care for those patients experiencing poor mental health (including people with dementia).

• The practice had a lead GP for mental health and dementia who had undertaken additional training in these areas. They were also the CCG lead for mental health and engaged with other GPs and specialists regarding development of services for patients with mental health issues. The practice had a proactive approach to mental health and had considered the number of patients identified with dementia to be low. This led the practice to explore their patient population and review patients who may have been at high risk of dementia and as a result had increased the dementia register from 11 to 20 in the previous year. This had enabled them to ensure appropriate assessment, treatment and support was in place for these patients. They had subsequently engaged in a local pilot project for dementia involving identification of patients with the potential for a diagnosis of non-complex dementia, providing investigation, diagnosis and treatment in the community by the GP. The GPs gave several examples of how these in depth consultations had resulted in significant benefits to both patients and their carers, providing the opportunity to fully explore the difficulties they were both experiencing with diagnosis as well as everyday living. They were able to direct to the appropriate support organisations and provide support and reassurance to them. Patients we spoke with referred to how the GPs actions had helped them when dealing with their relative with dementia. The GP also had a nurse who was specifically allocated to support them in this role.

• 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was higher than the national and CCG average of 86% and 84% respectively and the practice had not excepted any patients.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example, 100% of patients with schizophrenia, bipolar affective disorder and other psychoses had an agreed care plan documented in the record, in the preceding 12 months which was higher than the CCG and national averages of 93% and 89%. The practice had acknowledged the benefits of physical exercise in coping with mental health issues and had worked with a local initiative ‘Walking for Health’ which organised structured walks in the area. The practice were encouraging patients to attend the sessions and we saw this was advertised in the practice. The walks had commenced in April and the initial session resulted in 11 attendees, two of whom were patients from the practice.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs which ensured that blood tests and assessment of mental health took place before re-issuing prescriptions.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had access to the Improving Access to Psychological Therapies (IAPT) counsellors to support patients with mental health issues and patients could also access these directly.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 29 June 2017

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 those with a learning disability. They had reviewed their learning disability register to ensure records were accurate and that the appropriate care could be offered.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable. Patients were flagged on the system and all patients at the end of their life were given their GP’s mobile number to contact them if the patient or family were experiencing difficulty or their condition had deteriorated. The GPs visited these patients out of hours themselves when necessary to ensure continuity and support for the families which patients reported had been extremely beneficial and helped them during very difficult and traumatic times.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients and discussed these patients at clinical meetings as well as quarterly multi-disciplinary meetings.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations, for example domestic violence.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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. The practice had developed their own policy and we saw clear information for staff guidance in all clinical rooms. There was a complete ‘Grab folder’ in the reception area containing all information staff may need in the event of a safeguarding concern.