Waterside Medical Centre

Updated 1 November 2016

Waterside Medical Centre is located at the end of Court Street in Leamington Spa and has excellent public transport links with bus stops and a train station within short walking distance from the practice. Waterside Medical Centre serves a mixed population from the town of Leamington Spa, the rural villages and hamlets within a five mile radius of the town.

The practice has seen a steady rise in patient numbers over the past five years due to a number of housing developments in the area and patient migration. The current patient population is almost 12,500 and this is expected to rise further on the completion of several large housing developments in the area over the next decade. The majority of patients are aged between 20 and 59 years of age (65%), with ages up to 19 years at 18%, older patients from 60 to 79 years at 13% and patients over 80 years at 4%. The majority of patients registered with the practice are white British with smaller ethnic groups including Asian and Eastern European patients.

There are four GPs partners (two male and two female), two salaried GPs, three nurses and two healthcare assistants, who are all supported by a large team of receptionists and admin staff.

The practice has a General Medical Services (GMS) contract with NHS England. The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities. The practice is also a member of the South Warwickshire GP Federation.

The practice opens from 8am to 6.30pm Monday to Friday with appointments available from those times on these days. Extended hours appointments are available on Monday evenings from 6.30pm to 8.30pm and Saturday mornings from 8.15am to 12.15pm for pre-bookable appointments up to a week in advance.

The practices offers a full range of services to all their patients from their purpose-built premises, and patients can access the practice throughout the day in person, by telephone, by e-mail or via the internet. The practice offers on-line appointment booking, online prescription requests, a text messaging service and full online access to medical records via the internet and an app.

The practice treats patients of all ages and provides a range of medical services. This includes disease management such as asthma, diabetes and heart disease. Other appointments are available for services such as minor surgery, smoking cessation, maternity care and family planning.

The practice does not provide an out-of-hours (OOHs) service but has alternative arrangements in place for patients to be seen when the practice is closed. For example, if patients call the practice when it is closed, an answerphone message gives the telephone number they should ring depending on the circumstances or dial NHS 111. Information on the OOHs service (provided by CareUK) is provided to patients on the practice’s website and in the patient practice leaflet.

The practice is a research ready practice. They routinely take part in primary care research in order to expand knowledge for their staff towards improving services for patients.

Updated 1 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Waterside Medical Centre on 3 and 11 May 2016. The overall rating for this service is outstanding.

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

• Patients’ needs were assessed and care was provided to meet those needs in line with current guidance. Staff had the skills and expertise to deliver effective care and treatment to patients, and this was maintained through a programme of continuous development to ensure their skills remained current and up-to-date.
• Information was provided to help patients understand the care available to them. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. There was an open and transparent approach to reporting and recording these and learning was shared with staff at meetings relevant to their roles and responsibilities.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• A staff briefing newsletter was produced weekly which encouraged staff to complete their online training.
• The practice had a clear vision which had quality and safety as its top priority. Planning was in place to demonstrate the intended development of the services provided by the practice.
• The practice had recognised that 15% of their patients had problems with obesity and associated lifestyle problems. They had participated in a pilot activity project for high risk patients such as those with diabetes, who had suffered a stroke, chronic heart disease or obesity with positive results.
• The practice had initiated weekly journal meetings with all clinicians to ensure that improvements made as a result of the reviews were shared and monitored. Two other local practices joined these meetings to enable wider cross practice learning and information sharing.
• Monthly newsletters were produced for patients with mental health concerns which promoted support services they could access.
• There was a strong focus on continuous learning and improvement at all levels, with involvement in research and engagement in pilot opportunities.

We saw several areas of outstanding practice including:

• The practice worked with Warwickshire College to provide apprenticeships at the practice. The practice had extended their role in becoming an ambassador for apprenticeships working with Health Education England and the National Skills Academy both locally and nationally. This involved taking part in activities to promote the employment of apprentices. Promotional videos had been completed by the practice staff at the academy for this.
• The practice had initiated and produced birthday cards for patients reaching their 40 and 75 birthdays to raise awareness of health checks and remind patients of the benefits of these. The birthday cards had been shared and adopted by other local practices. The practice had performed over 2,500 health checks since the promotion began in late 2013 and records showed that they had maintained the top practice position within the local area since.
• Facilities were available for patients who had hearing impairments. They were routinely given a double appointment; sign language interpreter services were available; the patient call system was audio and visual; and all signs in the reception and waiting area had been produced in Braille.
• The practice had recently devised a practical guide for clinicians on the management of Vitamin D deficiency and shared this with other practices.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 November 2016

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

• The practice nurses had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Nursing staff had received appropriate training in chronic disease management, for example asthma and diabetes.
• Longer appointments and home visits were available when needed.
• All patients diagnosed with a long term condition had a named GP and a structured annual review to check that their health and medicine needs were being met.
• Clinical staff had close working relationships with external health professionals to ensure patients received up to date care.
• A dietician based at the practice provided educational sessions for patients. This had been run on a four monthly basis and focused on patients taking dietary supplements. Sessions were open for any patients to attend for dietary advice and support. Attendance had been good with 14 attendees at the last session.
• The practice held three educational clinics over the past nine months for patients with diabetes. These were used to promote self-monitoring, better control and compliance of their condition, with 48 patients attending.
• A self-care area on the practices website was available to help patients address minor ailments as well as providing information to help patients manage their long term conditions.
• Facilities were available for patients with hearing impairments. They were routinely given a double appointment; sign language interpreter services were available; the patient call system was audio and visual; and all signs in the reception and waiting area had been produced in Braille.

Updated 1 November 2016

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

• Same day appointments were offered to all children under the age of five.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Children had access to a play area in the waiting area.
• Childhood immunisation rates for the vaccinations given were comparable to local and national averages.
• 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 accident and emergency attendances.
• The practice’s uptake for the cervical screening programme was in line with local and national averages. Patients were actively encouraged to attend for screening.
• The practice also offered a number of online services including requesting repeat medicines and booking appointments.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• A midwife worked at the practice three days per week to provide services as the practice had a higher than average birth rate in their locality.

Updated 1 November 2016

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

• The practice offered personalised care to meet the needs of the older people in its population. It was responsive to the needs of older patients, and offered home visits and rapid access appointments for those with enhanced needs.
• The practice offered a range of enhanced services, for example, in dementia and end of life care.
• Nationally reported data showed that outcomes for patients were good for conditions commonly found in older patients.
• GPs provided care and support for patients at a local care home with weekly visits, and responses to urgent heath care needs when required.
• The practice had signed up to the admissions avoidance service, which identified patients who were at risk of inappropriate hospital admission.
• Support and weekly ward rounds were provided routinely for patients who lived in a nearby care home for the elderly.
• Multi-disciplinary meetings for older patients took place. These were attended by a geriatrician, community matrons and consultants.
• A domiciliary flu vaccination service was provided for those patients unable to attend the clinics at the practice.

Updated 1 November 2016

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 as well as a full range of health promotion and screening services that reflected the needs of this age group.
• The practice nurses had oversight for the management of a number of clinical areas, including immunisations, cervical cytology and some long term conditions.
• Health promotion material was accessible at the practice and on its website.
• Repeat prescriptions could be requested online at any time, which was more convenient for patients.
• Patients could sign up to receive text messages for appointment reminders and health care.
• NHS Health Checks were offered by the nursing team, who also gave advice on smoking cessation, weight loss and exercise.
• Flu clinics were held on a Saturday which provided an alternative option for those patients who could not attend during normal surgery hours.

Updated 1 November 2016

The practice is rated as outstanding for the care of patients experiencing poor mental health (including patients 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• 93% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was 8% above the CCG average and 9% higher than the national average.
• Patients experiencing poor mental health were given advice about how to access various support groups and voluntary organisations.
• The GPs and practice nurses understood the importance of considering patients ability to consent to care and treatment and dealt with this in accordance with the requirements of the Mental Capacity Act 2005.There was a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Access to an in-house counsellor and local counselling services provided by the NHS was provided.
• Monthly newsletters were produced for patients with mental health concerns which promoted support services.

Updated 1 November 2016

The practice is rated as outstanding for the care of patients whose circumstances may make them vulnerable.

• Staff had been trained to recognise signs of abuse in vulnerable adults and children and the action they should take if they had concerns. There were lead members of staff for safeguarding, and GPs were trained to an appropriate level (level three) in safeguarding adults and children.
• The practice held a register of patients living in vulnerable circumstances including those patients with a learning disability.
• Longer appointments were available for patients with a learning disability. The practice had carried out annual health checks for 100% of the patients on their register (22).
• Clinical staff regularly worked with multidisciplinary teams in the case management of vulnerable patients. Alerts were placed on these patients’ records so that staff knew they might need to be prioritised and offered additional attention such as longer appointments.
• The practice engaged in local initiatives to provide additional services such as the Identification and Referral to Improve Safety (IRIS) scheme (a domestic violence and abuse training, support and referral programme). The project provided staff with training to help them with detecting any signs of abuse so patients could be sign-posted to support agencies.
• Palliative care meetings were attended by district nurses and Macmillan care nurses. Staff also worked together with other health and social care services to understand and meet the range and complexity of patients’ needs and to assess and plan ongoing care and treatment.