Archived: Bridgewater Family Medical Practice

Updated 25 August 2016

Bridgewater Family Medical Practice is part of the NHS Shropshire Clinical Commissioning Group. The total practice patient population is 4, 700. The practice has a higher proportion of patients aged 65 years and when compared with the practice average across England. For example, the percentage of patients aged 65 and above at the practice is 23%; the local CCG practice average is 24% and the national practice average, 17%. Bridgewater Family Medical Practice is located within easy reach of Whitchurch town centre in Shropshire and was established in 1929. In 1995, the practice was extended considerably to allow better disabled access, to provide facilities that are more modern and in 1998, they became a GP training practice. The practice had needed a few years later to increase the number of rooms to house a nursing team of three. The practice provides GP support for five of the 30-bedded community hospital beds and provides a daily hospital visit.

The staff team comprises two male GP partners, and a former partner GP who provides locum sessions when required, a salaried female GP (currently on long-term sick leave) and a female regular locum GP.

The practice is open each weekday from 8.30am to 7pm with the exception of Wednesday closure at 1pm. On Wednesday afternoons, a duty GP provides cover for the practice patients. The practice has opted out of providing cover to patients outside of normal working hours. Shropdoc provides these out-of-hours services.

There are 17 permanent staff in total, working a mixture of full and part times hours. Staff at the practice include:

• Two male GP partners providing 1.75 whole time equivalent (WTE) hours.

• One salaried female GP (0.25WTE)

• A Practice Manager providing 0.80 WTE hours.

• A Clinical Pharmacist and prescriber providing 0.5 WTE hours.

• An Advanced Nurse Practitioner and prescriber and two Practice Nurses, providing 2.05 WTE hours.

• A senior office administrator providing 0.8 WTE hours.
• Eight practice support staff including, receptionists, appointments, Community and Care Coordinator and secretarial support staff.

The practice provides long-term condition management including asthma and diabetes. It also offers child immunisations, minor surgery and travel vaccinations. The practice offers NHS health checks and smoking cessation advice and support. The practice has a General Medical Services (GMS) contract with NHS England. This is a contract for the practice to deliver General Medical Services to the local community or communities. They also provide a number of Directed Enhanced Services, for example they offer extended hours access, minor surgery and the childhood vaccinations and immunisation scheme.

One of the practice GP partners provides surgical procedures, working half a day a week in Shrewsbury performing skin surgery. The other GP partner also works in a drug and alcohol detox and rehabilitation centre. Bridgewater Family Medical Practice is a GP training Practice, the GP trainees are GP Registrars in the final part of their training.

Updated 25 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bridgewater Family Medical Practice on 11 July 2016. Overall the practice is rated as good.

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 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.

• Risks to patients and staff were comprehensively assessed and well managed.

• Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• Patients spoke of a very high level of service that was supported by a large quantity of complimentary written patient feedback. 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.

• Information about services and how to complain was available and easy to understand.

• Patients told us they could get an appointment when they needed one. Urgent appointments were available the same day.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The Advanced Nurse Practitioner and Clinical Pharmacist provided home visits to care home patients and had completed additional training in order to complete advanced care planning for these patients.

• There was a clear leadership structure and staff felt supported by management.

• The practice proactively sought feedback from staff, patients and third party organisations, which it acted on.

• Patients said they found it easy to make an appointment, patients with a named GP or preferred to see a specific GP saw them within a reasonable period of time, there was continuity of care, with urgent appointments available the same day.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 August 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The practice had developed in-house templates for each long-term condition prompting clinicians to conduct a more comprehensive review.

• 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.

• Over 95% of patients on four or more medicines have had a medicines review in the last 12 months and the practice was working towards 100% with six monthly reviews for patients with more complex medicine regimes.

• The frailest 2% of practice patients had an admission avoidance care plan in place, which included many patients with long-term conditions. The practice had systems in place to “flag” patients with chronic or life limiting conditions to the out-of-hours service and provide information to enable continuity of care.

• The practice held a list of patients who required palliative care and their GP acted as the lead. The gold standards framework was used for the coordination of end of life care. The practice provided eligible patients with anticipatory medicines as indicated by their long-term condition or end of life needs.

Updated 25 August 2016

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

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

• The practice held regular clinical meetings where children at risk, child welfare concerns and safeguarding issues were discussed to ensure awareness and vigilance. The practice had a system in place to highlight patients of concern, as well as those who were considered at risk and these were discussed at clinical multi-disciplinary meetings.

• The practice contraception and sexual health service included chlamydia screening and provision of condoms.

• 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.

• The practice’s uptake for the cervical screening programme was 87%, which was slightly higher than the local CCG average of 83% and national average of 82%.

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

Updated 25 August 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. For example, all over 75s had a named GP

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

• Patients were encouraged to see the same GP for follow-up and telephone consultations, for example for test results (by the GP or nurse requesting them) which, in turn reduced the number of practice visits the patients needed to make.

• The frailest two per cent of the practice patients had in place an admission avoidance care plan which highlighted their needs and wishes and was reviewed regularly. All admissions of patients on this plan were discussed to see if they were avoidable.

• The practice provided GP services to local care homes. Patients in care homes had a Care Home Advanced Scheme (CHAS) plan and the clinical staff analyse admissions and any deaths in these groups in order to maintain high standards of care.

• The practice worked closely with their local Community and Care Coordinator who signposted patients to supportive organisations when appropriate to do so.

Updated 25 August 2016

The practice is rated as good for the care of working-age people (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 provided a telephone consultation system. All patients requesting same day help were offered a telephone consultation and following that, a face-to-face appointment if required.

• 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. Appointments and prescriptions could be booked online and telephone language translation was available for patients with limited English.

• The practice provided an extended hours service until 7pm each weekday with the exception of Bank Holidays and Wednesdays.

• The practice provided NHS health checks to those in the over 40 to 74 age groups.

Updated 25 August 2016

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

• Patients diagnosed with dementia who had received a face-to-face review in the preceding 12 months was 84%, which was comparable with the local CCG average of 85% and national average, 84%.

• The majority of practice staff had undertaken dementia friends training to support patients living with dementia and their carers.

• Performance for poor mental health indicators was higher than the national averages. For example, 92% of patients with severe poor mental health had a recent comprehensive care plan in place compared with the CCG average of 89% and national average of 88%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• 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.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• One of the GP partners had a specialist interest qualification in substance misuse management. A small number of patients receive medicines support from this GP as part of the Shropshire shared care scheme and the practice also referred patients to the weekly substance misuse drop in clinic.

• Practice patients could access twice-weekly counselling sessions provided by the Relate service.

Updated 25 August 2016

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

• We found that the practice enabled all patients to access their GP services and assisted those with hearing and sight difficulties.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability. The practice frail and vulnerable register also included carers.

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

• The practice regularly worked with other health care professionals in the case management of vulnerable patients and 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.

• All patients on the practice palliative care register were reviewed at a monthly multidisciplinary meeting.