Church Street Practice

Updated 28 June 2017

Church Street Practice is a long established GP practice, it is currently located on the west side of

Tewkesbury town centre.

At the time of our inspection, we were informed that new purpose built premises were

almost ready for the team to relocate to by the end of 2016. The practice is wheelchair accessible with automatic doors.

The practice provides general medical services to approximately 13,100 patients. Services to patients are provided under a General Medical Services (GMS) contract with NHS England. (A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract).

The practice has six GP partners and four salaried GPs (six female and four male) which is equivalent to seven and a quarter whole time equivalent GPs. The clinical team include a nurse consultant, three nurse practitioners, five practice nurses, one health care assistant and a pharmacist (all female). Five members of the nursing team are nurse prescribers. The practice management team supporting the GPs comprises of a practice manager, two assistant practice managers, and a large administration and reception team.

Church Street Practice is an approved training practice for a range of professionals including GP registrars, nurses, paramedics and student nurses.

The general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in the third least deprivation decile. The prevalence of patients with a long standing health condition is 66% compared to the local CCG average of 55% and the national average of 54%. Patients living in more deprived areas and with long-standing health conditions tend to have greater need for health services. An area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score. Average male and female life expectancy for the practice is 79 and 85 years, which is comparable to the national averages of 79 and 83 years respectively.

The practice is open between 8am and 6.30pm on Monday to Thursday and 8am to 4pm on Friday. Between 4pm and 6.30pm on Fridays telephone calls are answered within the practice and diverted to the duty GP if necessary. Appointments are available between 8.30am to 12pm in the morning and 3pm to 5.50pm in the afternoon. Extended surgery hours are also offered on Tuesday and Thursday evenings each week between 6.30pm and 8pm.

Out Of Hours cover is provided by South Western Ambulance Service NHS Foundation Trust and can be accessed via NHS 111.

The practice provided its services from the following address:

Church Street Practice,

77 Church Street,

Tewkesbury,

Gloucestershire,

GL20 5RY.

This is the first inspection of Church Street Practice.

Updated 28 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Church Street Practice on 11 October 2016. 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 an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients 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.
• 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 proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The area where the provider should make improvement is:

• Continue to monitor and ensure actions are taken to improve patient satisfaction with access to routine appointments and answering of the reception telephones.

• Ensure that infection control standards are reviewed and maintained and that staff toilet facilities have hot water.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 June 2017

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

• Nursing staff had lead roles in chronic disease management and ran the following clinics: diabetes, asthma and chronic obstructive pulmonary disease (COPD). Longer appointments of 30 minutes were given for those clinics. Patients at risk of hospital admission were identified as a priority.

• Performance in 2014/15 for overall diabetes related indicators was 90% which was below the clinical commissioning group (CCG) average of 95% and above the national average of 89%.

• Diabetes was managed by a dedicated team at the practice with some of the practice nurses and a GP who had expertise in this area. Six monthly reviews with the nursing team were carried out with referral on to a GP if needed. All patients in this group were invited to an annual retinal screening appointment.

• 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 28 June 2017

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 practice’s uptake for women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding five years was 91% which was above both the clinical commissioning group (CCG) average of 84% and the national average of 82%.

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

• A midwife team held clinics at the surgery once a week.

• The practice held weekly sexual health drop in clinics and had received a “You’re Welcome” award in recognition of the service they provided to young patients. (A Department of Health initiative to encourage young people to utilise a friendly health service and has a set of criteria that health services must to meet to be accredited).These patients did not have to be registered at the practice to be seen .

• We saw positive examples of joint working with midwives, health visitors and school nurses, multi-disciplinary meetings attended by community staff were held every six weeks.

• The practice offered a family planning and sexual health service with a fully qualified sexual health nurse and a GP with specialised interest in women’s health and family planning who assessed patient need, initiated treatments and offered ongoing monitoring of all family planning and sexual health needs.

Updated 28 June 2017

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

• The practice offered proactive, personalised care to meet the needs of the older patients in its population and had a range of enhanced services, for example in influenza, pneumococcal and shingles immunisations.

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

• Weekly meetings took place that included discussions of hospital admissions, hospital discharges and palliative care patients.

• The practice visited four local care homes on a fortnightly basis to see patients and carry out annual reviews, medication reviews and end of life planning.

• All patients over the age of 75 were invited or were visited by a GP for a comprehensive assessment, including long term chronic disease management, assessment for frailty and dementia screening, and individualised personal care planning.

Updated 28 June 2017

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 proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• Extended hours appointments were available on Tuesday and Thursday evenings for working age patients to attend outside of working hours.

• The practice offered telephone consultations for all patients which was useful for working age patients.

• Patients were invited either to hypertension annual screening, or if aged over 40. patients were invited for a vascular health screening assessment.

Updated 28 June 2017

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

• 92% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months (2014/15), which was above both the clinical commissioning group (CCG) average of 86% and the national average of 84%.

• Overall performance for mental health related indicators in 2014/15 was 100% compared to the CCG average of 97% and national average of 82%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. The practice hosted a weekly clinic led by a mental health gateway worker.

• The practice carried out advance care planning for patients with dementia. Patients were invited to attend a specialised clinic for an annual review with a nurse. This clinic helped manage patients with complex care needs including dementia, frailty or multiple long term conditions.

• 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.

Updated 28 June 2017

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 those with a learning disability. Patients and carers were invited to attend an annual review with a practice nurse who was experienced in learning disability and mental health assessments.

• The practice offered longer appointments for patients with a learning disability and 91% of these patients on their register had received an annual health check and 81% had a written care plan in 2015/16.

• The practice regularly worked with other health care professionals in the case management of vulnerable 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. The practice held quarterly multi-disciplinary meetings with the health visitor to discuss at risk children.