Dr Judith F Armstrong and Partners Also known as Spa Medical Centre

Updated 18 August 2016

Dr R J Matthews and Partners, known locally as Spa Medical Practice is located near to the centre of Melksham, a market town in rural Wiltshire. The practice has a slightly higher than average patient population in the 40 to 75 years age group and lower than average in the 25 to 40 years age group. The practice is part of the Wiltshire Clinical Commissioning Group and has approximately 11,000 patients. The area the practice serves is urban and semi-rural and has relatively low numbers of patients from different cultural backgrounds. The practice area is in the low to mid-range for deprivation nationally.

The practice is managed by five GP partners (two female and three male). The practice is supported by four salaried GPs, one female and three male, seven practice nurses, three health care assistants and an administrative team led by the practice manager. Spa Medical Practice is a teaching and training practice providing placements for GP registrars and medical students.

The practice is open between 8am and 6.30pm Monday to Friday. The telephone lines are transferred to a call answering service between 1pm and 2pm. Appointments are available between 8.30am and 12pm every morning and 2pm to 6pm every afternoon. Telephone appointments are also available to book. Extended hours appointments are offered from 7.30am on Tuesday mornings and until 7.30pm on either a Wednesday or Thursday evening. In addition to pre-bookable appointments that could be booked up to four weeks in advance, urgent appointments were available for patients that needed them.

When the practice is closed patients are advised, via the practice website and main telephone line that all calls will be directed to the out of hours service. Out of hours services are provided by Medvivo.

The practice has a General Medical services contract to deliver health care services. This contract acts as the basis for arrangements between the NHS England and providers of general medical services in England.

Dr R J Matthews and Partners is registered to provide services from the following location:

Snowberry Lane

Melksham

Wiltshire

SN12 6UN

Updated 18 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr R J Matthews and Partners on 23 June 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.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example the practices work with the town council had led to benefits for patients.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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 in collaboration with the PPG the practice ran a number of health educational evenings for patients.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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:

• In response to a decline in the number of practices offering minor surgery and an increase in demand in the local population, the practice had worked with the clinical commissioning group to become a provider of a community surgical service for Wiltshire. The service included, skin surgery, carpel tunnel surgery (a hand and arm condition) and male sterilisation surgery. The local population had responded to the service very positively and there was evidence of excellent feedback from patients.
• In response to high admissions from care homes the practice had successfully gained funding to appoint a team of nurse practitioners. This team delivered planned, proactive and coordinated care which ensured that the right care was delivered in the right setting by the most appropriate health care professional. This had led to a 58% reduction in admissions in 2015-16.
• The practice had implemented a service that covered assessment, diagnosis and management of uncomplicated dementia in conjunction with Alzheimer’s support. A memory awareness volunteer attended the practice one morning a week to provide informal support to those who require it. Alzheimer support featured the practice in a film highlighting cooperative working, which went on to win a national award. A GP continued to work closely with the town council to promote dementia awareness and were working towards achieving dementia friendly town status.

The areas where the provider should make improvement are:

• Ensure safeguarding policies reflect current legislation.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 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 percentage of patients with COPD (a range of chronic lung conditions) who had a review undertaken including in the preceding 12 months (04/2014 to 03/2015) was 95% compared to a local average of 91% and a 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 18 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.

• 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 percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years (2014-2015) was 86% compared to a local average of 85% and a national average of 82%.

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

• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 18 August 2016

The practice is rated as outstanding 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 had initiated an effective service for the care of the elderly at risk of hospital admissions. Weekly multi-disciplinary team meetings attended by all interested parties including social workers, occupational therapists and physiotherapists as well as nursing teams and GPs had led to a fully integrated service that avoided admissions for patients.
• In response to high admissions from care homes the practice had successfully gained funding to appoint a team of nurse practitioners. This team delivered planned, proactive and coordinated care which ensured the right care was delivered in the right setting by the most appropriate health care professional. This had led to a 58% reduction in admissions in 2015-16.

Updated 18 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 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 extended hours surgeries from 7.15am on a Wednesday morning and until 7pm on Wednesday and Thursday evenings for working patients who could not attend during normal opening hours.

Updated 18 August 2016

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

• The practice had implemented a service that covered assessment, diagnosis and management of uncomplicated dementia in conjunction with Alzheimer’s support. A memory awareness volunteer attended the practice one morning a week to provide informal support to those who require it. Alzheimer support featured the practice in a film highlighting cooperative working, which went on to win a national award. A GP continued to work closely with the town council to promote dementia awareness and were working towards achieving dementia friendly town status.

• The percentage of patients with a serious mental illness who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (2014 to 2015) was 94% compared to a local average of 93% and a national average of 90%.

• 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.

• The practice had recognised that the community adolescent mental health services was not effective and had been proactive in locality working to engage a third sector organisation, Teen Talk, to improve local services for the teenage population. The pilot scheme will be evaluated to understand the effectiveness of this service and whether it has been accessible, relevant and appropriate to the needs of this specific patient group. The potential to incorporate this service with an emotional distress service for the area had also being considered.

• 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 18 August 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 homeless people, travellers and those with a learning disability.

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

• 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.