Archived: Priory Medical Centre

Updated 28 October 2016

Priory Medical Centre is located in Warwick town centre and serves the surrounding areas under a General Medical Services (GMS) contract with NHS England. This is the commonest form of GP contract and it allows the delivery of general medical services. The practice’s current premises at Cape Road were purpose built approximately 30 years ago. There is limited parking at the premises where disabled facilities are available. It also has a branch surgery located at Brese Avenue which was not visited as part of the inspection.

Priory Medical Centre is among the largest practices in South Warwickshire and has a patient list size of 13,690. It provides services to two care homes. The population has an average age range and levels of deprivation are low. The practice has expanded its contracted obligations to provide enhanced services to patients. An enhanced service is above the contractual requirement of the practice and is commissioned to improve the range of services available to patients. Enhanced services offered by the practice include for example extended hours access, family planning, annual health checks for patients with learning disabilities and phlebotomy.

The clinical team comprises seven GP partners, two advanced nurse practitioners, four practice nurses, and two healthcare assistants. Four GPs are female and three are male. The team is supported by a practice manager and a team of administrative, secretarial and reception staff. Priory Medical Centre is a training practice. Training practices help qualified doctors to complete the final stages of their GP training.

The practice’s reception operates between 8am and 6pm from Monday to Friday. Longer opening hours operate on Tuesday and Wednesday mornings from 7.15am, and on Wednesday evening until 7.30pm. Appointments are available between 8.30am and 6pm Monday to Thursday and between 8.30am and 5pm on Fridays. Extended hours appointments are also offered from 7.20am on Tuesday and Wednesday and until 7.30pm on Wednesday.

The branch surgery operates morning opening hours from 8.30am to 12pm Monday to Friday and afternoons from 2pm to 6pm Monday to Thursday. It also opens between 8am and 9.30am on a minimum of one Saturday per month. Appointments are available between these times.

The practice explained to us that on the days when the practice closes at 6pm, the reception team and an on-call GP remain in the building and are available to take patient calls until 6.30pm. There are further arrangements in place to direct patients to the NHS 111 out-of-hours service when the practice is closed.

Updated 28 October 2016

We carried out an announced comprehensive inspection at Priory Medical Centre on 10 May 2016. Overall the practice is rated as good.

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

• Staff knew how to raise concerns and report incidents and near misses. Significant events were thoroughly investigated, action was taken and lessons learned were shared with staff to improve safety in the practice.
• The practice manager was a director for a federation of 35 practices, and this had helped the practice to network and provide primary care at scale.
• Feedback from patients about their care was very positive.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs.
• 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.
• The practice’s facilities were of a good standard and it was properly equipped to treat patients and meet their needs.
• The practice had a transparent approach to dealing with errors. The practice took positive actions to improve processes and communicated appropriately with patients.
• The practice had a clear vision to deliver accessible and cohesive patient centred care in a supportive town centre environment that continually strives to improve.
• Governance and performance management arrangements had been proactively reviewed and took account of current models of best practice.
• The practice also had two asthma nurses and had recently participated in a project which involved a specialist nurse running clinics at the practice using Optimising the Review and Control in Asthma (ORCA).
• The practice had participated in the Triumvirate Leadership Programme for General Practice in 2015. This was a leadership course designed to strengthen and improve practices through the shared leadership of GPs, practice managers and practice nurses. The practice told us this experience had improved their way of working.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.

The areas where the provider should make improvement are:

• Monitor the newly introduced system to monitor the use of prescription stationery to ensure it is effective.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 28 October 2016

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

• The practice offered a range of clinical services which included care for long term conditions such as diabetes.
• The practice used the STOPP (Screening Tool of Older Person's Prescriptions) START (Screening Tool to Alert doctors to Right Treatment) initiative to focus on improving care for patients prescribed five or more medicines.
• 90% of patients on the practice’s asthma register had had a comprehensive asthma review in the previous 12 months; significantly higher than the CCG average of 77% and the national average of 75%. The practice had two asthma nurses and had recently participated in a project using a specialist nurse to run clinics at the practice using Optimising the Review and Control in Asthma (ORCA). As a result of the study the practice had trained one nurse in ORCA, created a personalised asthma action plan for each affected patient, and also produced a set of data to be re-audited the following year to track their progress.
• The practice had carried out a project to help identify patients for the Heart Failure Register. This had resulted in a 14% increase in the size of the register.
• The practice held palliative care meetings and unplanned admissions meetings monthly. The practice invited all relevant staff to meetings for share information and plan care, including Macmillan nurses. During these meetings care plans were routinely reviewed and updated for patients with complex needs.

Updated 28 October 2016

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

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

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

• 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 A&E attendances.

• The practice had employed a contractor to fit blinds with safety devices in response to a safety alert regarding the risk these posed to young children.

• Appointments were available on the same day out of school hours for children.

Updated 28 October 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 liaised with Age UK to offer support for elderly people on an over 75’s project. This involved targeted intervention to patients most in need and offering a health check for the wider population aged over 75.

• Home visits were available for older patients and patients who had clinical needs which resulted in difficulty attending the practice.

• The practice was pioneering a partnership with a local charity which had funding available to allocate to healthcare. The practice had put forward a business case for two advanced nurse practitioners to provide acute care for frail patients in their own homes and local care homes, as they wanted to do something that would benefit the whole community as well as the practice.

Updated 28 October 2016

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

• The practice had identified the needs of the working age population, those recently retired and students. Services had been adjusted 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.

• The practice offered health checks for new patients and NHS health checks for patients aged 40–74.

• The practice offered appointments from 7.20am two days a week, and extended hours until 7.30pm once a week to accommodate working patients who could not attend during normal opening hours. Pre-bookable appointments were available on a minimum of one Saturday per month at the branch surgery.

• Staff told us that ten clinics run at the practice commenced earlier than 8.30am to assist working people.

Updated 28 October 2016

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

• The practice regularly worked with multi-disciplinary teams in the case management of patients 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.
• 75% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was lower than the CCG average of 85% and the national average of 84%.
• 90% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the previous 12 months, which was similar to the CCG average of 93% and higher than the national average of 88%.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• Grab rails throughout the practice were coloured red for easy visibility and recognition. Using contrasting colours in this way has been shown to assist patients with dementia. 

Updated 28 October 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 those with a learning disability.
• There were longer appointments available for patients with complex needs such as learning disabilities.
• 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.
• Arrangements to safeguard children and vulnerable adults from abuse reflected relevant legislation and local requirements. Policies were accessible to all staff and clearly outlined who to contact for further guidance if staff were concerned about a patient’s welfare. There was a lead member of staff for safeguarding. Staff demonstrated they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role. GPs had completed level three safeguarding training in respect of child protection.
• Staff told us that translation services were available for patients who did not have English as a first language. We saw notices in the reception areas informing patients this service was available.
• The practice’s information leaflet was available in an easy read format to assist people with learning disabilities. The practice also provided their leaflet in braille to allow patients with visual impairment to access the information.
• The practice’s computer system alerted GPs if a patient was also a carer. The practice informed us that they had recently written to every carer on their register to confirm their status and inform them of the Carer’s Guide recently published by NHS England.
• Staff had undergone IRIS (Identification and Referral to Improve Safety) training in domestic violence. 
• The practice manager had attended a learning disability workshop and subsequently made changes to ensure the practice was learning disability friendly. This involved improving signage in reception, and creating an easy read accessible practice leaflet. The leaflet was then posted to all the patients on the learning disability register along with their invitation to attend their annual health check. The practice also shared an electronic template for the leaflet with other South Warwickshire practices to assist them in becoming more learning disability friendly.