Archived: Mythe Medical Practice

Updated 12 January 2017

Mythe Medical Practice consists of two long established GP practices which have recently merged and were previously known as Watlege Surgery and Jesmond House. The practices are located approximately 600 yards apart 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. On the day of our inspection we did not visit Jesmond House.

The practice is readily accessible for patients who use wheelchairs and by parents with pushchairs. A portable hearing loop system is available and there are quiet waiting facilities for patients who find the main waiting area a cause of anxiety. Private space is available for breast-feeding. Patients can check-in using a self-service kiosk, which provides instructions in several languages.

The practice provides general medical services to approximately 12,500 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 two salaried GPs (four female and four male) which is equivalent to six and three quarter’s whole time equivalent GPs. The clinical team include a clinical manager, a nurse practitioner, four practice nurses and two health care assistants (all female). One member of the nursing team is a nurse prescriber. The practice management team supporting the GPs comprises of a practice manager, a receptionist manager, an Information Technology manager, a data manager and a large administration and reception team.

Mythe Medical Practice is an approved training practice for a range of professionals including GP registrars, nurses and paramedics.

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 52% 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 84 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 5.30pm on Friday. Between 5.30pm and 6.30pm on Fridays telephone calls are diverted to the practice call handling service (Message Link). They refer urgent matters to the practice that have members of staff on standby to respond to issues if needed. Appointments are available between 8.30am to 11.40am in the morning and 2pm to 5.40pm in the afternoon. Extended surgery hours are also offered on Monday and Thursday evenings each week between 6.30pm and 7.45pm.

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 addresses:

Watledge Surgery

Barton Road

Tewkesbury

Gloucestershire

GL20 5QQ

Jesmond House (Branch Surgery)

Chance Street

Tewkesbury

Gloucestershire

GL20 5RF

This is the first inspection of Mythe Medical Practice.

Updated 12 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Mythe Medical Practice on 22 November 2016. Overall the practice is rated as outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised, staff demonstrated a detailed knowledge of learning from previous events.

• Feedback from patients about their care was consistently positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet 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 (PPG). For example, following a cease in funding for an NHS acupuncture clinic the practice and PPG worked collaboratively to source new funding to ensure the service could continue.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Due to a growing population and a recent merger the practice had secured new purpose built premises that they were due to relocate into by the end of 2016.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw several areas of outstanding practice including:

• The practice had trialled and continued to use a new model to manage non urgent paediatric outpatient referrals in Tewkesbury. Multi-agency paediatric hub team meetings were arranged on a monthly basis to discuss and plan care for children. The hub meetings enabled access to specialist advice within four weeks as opposed to waiting up to 12 weeks for a referred appointment. Due to the multi-agency representation the meetings reduced multiple referrals and inappropriate referrals. Each meeting was concluded with interactive teaching and reflections on learning.

• A practice GP was instrumental in developing the ‘Big Six’, which was a pathway toolkit designed to ensure clinicians offered appropriate and high quality care when children presented for emergency care for one of the six main clinical areas (bronchiolitis/croup, fever, gastroenteritis, head injury, asthma or abdominal pain). This pathway was actively used in practice, adopted by the local commissioning group (CCG) for use in locality practices and adopted by other CCGs in England.

• The practice had been recognised as being one of ten exemplar practices in England for supporting carers. An article was published detailing how these practices had identified and supported carers, which other practices could learn from. The practice had developed a carers group, met monthly and invited speakers to support and educate as required. All carers were invited for annual health checks. Carers worked with the PPG to improve patient care.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 January 2017

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

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

• The practice offered patients with long term conditions a structured ‘MOT’ appointment annually.

• Performance in 2015/16 for overall diabetes related indicators was 99% which was above both the clinical commissioning group (CCG) average of 94% and the national average of 90%.

• 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 12 January 2017

The practice is rated as outstanding 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 high for all standard childhood immunisations and the practice performed at 96% to 98% for all childhood immunisations for those two years old and under compared to the national average of 73% to 95%. In addition, the immunisation rates for children aged five years was 89% to 100% which was significantly higher than the national averages of 81% to 95%.

• 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.

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

• A practice GP was instrumental in developing the ‘Big Six’, which was a pathway toolkit designed to ensure clinicians offered appropriate and high quality care when children presented for emergency care for one of the six main clinical areas (bronchiolitis/croup, fever, gastroenteritis, head injury, asthma or abdominal pain).

• The practice had trialled and continued to use a new model to manage non urgent paediatric outpatient referrals in Tewkesbury. Multiagency paediatric hub team meetings were arranged on a monthly basis to discuss and plan care for children.

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

• 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 84% which was comparable to both the clinical commissioning group (CCG) average of 84% and the national average of 82%.

• 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.

• The practice was a C-card centre (a scheme designed to increase the access and availability to free condoms and chlamydia screening for young patients under 25).

• The practice offered a family planning and sexual health service with a GP that had a special interest in women’s health and family planning who assessed patient need, initiated treatments and offered on-going monitoring of all family planning and sexual health needs.

Updated 12 January 2017

The practice is rated as outstanding 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. In addition to this the practice had employed a nurse to visit patients over the age of 75 in their homes to ensure that their health and social needs were met.

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

• The practice undertook a nursing home medication review to reduce medicines related to anticholinergic burden (multiple medicines which could contribute to aggravate frequent problems to which the medicine was designed to treat such as: cognitive impairment, loss of balance, falls, constipation etc.). The practice pharmacist reviewed 24 patients and decreased the anticholinergic burden by 30%. Due to the positive results and outcome this pilot has now been implemented countywide.

• 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.

Updated 12 January 2017

The practice is rated as outstanding 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 such as ‘Ask my GP’ 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 two evenings each week from 6.30pm to 7.45pm for working age patients to attend outside of working hours.

• The practice offered telephone, Skype and face time consultations for all patients which was useful for working age patients.

• The practice engaged with patients using various streams of social media including Twitter and Facebook.

Updated 12 January 2017

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

• 93% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months (2015/16), which was above both the clinical commissioning group (CCG) average of 86% and the national average of 84%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. Staff had a good understanding of how to support patients with mental health needs and dementia.

• The practice carried out mental health reviews and had a system in place for severe and enduring conditions. Patients could self-refer to courses for anxiety, stress management, improving self-confidence and sleep management.

• The practice was participating in a research project that was designed to support patients with mild to moderate depression.

• 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.

Updated 12 January 2017

The practice is rated as outstanding 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 who were offered comprehensive annual reviews.

• The practice offered longer appointments for patients with a learning disability.

• The practice supported a school for children with severe learning disabilities and held weekly clinics at the school. The practice also cared for children from a local special needs school and held weekly clinics in the practice for these children.

• The practice regularly worked with other health care professionals such as the district nurses in the case management of vulnerable patients and met with them weekly.

• 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 monthly multi-disciplinary meetings with the health visitor to discuss at risk children.