Spa Medical Centre

Updated 29 June 2016

Spa Medical Centre provides a range of primary medical service for patients in a three storey building situated in the south of Leamington Spa. The practice area covers Leamington south of the River Leam and Radford Semele (postcodes beginning CV31), Warwick Gates and Heathcote (postcodes beginning CV34).

Spa Medical Centre is a relatively small practice which covers some of the more deprived areas of the district. There were approximately 3,710 patients registered with the practice at the time of the inspection, with the majority of the population of Asian ethnic origin (60%).

The practice has two male GP partners and a salaried female GP. The GPs are supported by a practice manager, two registered nurses, a medical secretary, reception staff that includes a full time interpreter, and a cleaner.

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 opens for appointments from 8am to 6.30pm on Mondays to Fridays. Extended hours appointments are offered on Tuesday evenings from 6.30pm to 8.40pm for pre-bookable appointments only. When the practice is closed, patients can access out-of-hours care through NHS 111. The out-of-hours service is provided by Care UK which is based in the emergency department at Warwick Hospital. The practice has a recorded message on its telephone system advising patients on the numbers to call. This information is also available on the practice’s website and in the practice leaflet.

Home visits are also available for patients who are too ill to attend the practice for appointments. There is also an online service which allows patients to order repeat prescriptions and book routine GP appointments. Booking of appointments can also be made up to three months in advance.

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, well women clinics, child health surveillance and smoking cessation. The practice supports a local nursing home specialising in the care of elderly patients with dementia.

Updated 29 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Spa Medical Centre on 12 April 2016. The overall rating for this service is good.

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

• The practice provided patients with care which was planned and delivered following best practice guidance. Staff told us and records showed that training appropriate to their roles had been carried out. Staff training needs had been identified and planned for the following year.

• There was a system in place to raise concerns and report significant events. Staff understood their responsibilities to raise concerns, and to report significant events. These were discussed regularly at meetings and were a standing agenda item. Learning was shared with practice staff regularly and with other practices in the locality.

• Information was provided to help patients understand the care available to them. Patients told us they were treated kindly and respectfully by staff at the practice. Their treatment options were explained to them so they were involved in their care and decisions about their treatment.
• The practice was well equipped and had good facilities to treat patients and meet their needs.

• Information about services and how to complain was available in the reception area and patients told us that they knew how to complain if they needed to.
• There was a clear leadership structure and staff told us they felt supported by management. The practice proactively sought feedback from patients, which it acted on. Staff appeared motivated to deliver high standards of care and there was evidence of team working throughout the practice.

However there are areas where improvements are needed.

The areas where the provider should make improvements are:

• Take action to ensure that the infection control measures in place are followed and applied consistently by all staff.
• Take action to ensure that all policies and procedures are dated and kept under regular review.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 June 2016

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

• The quality monitoring data (QOF) for 2014/2015 showed that the percentage of patients with diabetes who had received a foot examination and risk classification for monitoring their conditions was 86% which was 6% below the CCG average and 3% below the national average. The practice had recruited nursing staff and restructured the nursing team to provide continuity of care and improve patient reviews.
• The practice nurses had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Longer appointments and home visits were available when needed.
• Longer appointments and home visits were available when needed for patients diagnosed with a long term condition. All these patients had a named GP and a structured annual review to check that their health and medicine needs were being met. For patients with the most complex needs, the GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 29 June 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 who were at risk of abuse. For example, children and young patients who had a high number of accident and emergency (A&E) attendances. Staff had received safeguarding training. They were aware of their responsibilities in protecting children who were at risk of harm.
• Childhood immunisation rates were higher than the local Clinical Commissioning Group (CCG) averages.
• Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence that confirmed this.
• Appointments were available outside of school hours and the premises were suitable and accessible for children.
• We saw good examples of joint working with midwives, health visitors, and district nurses.
• Appointments were available outside school hours. A number of online services including booking appointments and requesting repeat medicines were also available.

Updated 29 June 2016

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

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• It was responsive to the needs of older patients, and offered home visits and urgent appointments for those patients unable to access the practice.
• There was a dedicated nurse who worked with Age UK to provide holistic reviews of patients over the age of 75 years, and worked proactively with the practice to help patients maintain good health.
• The practice maintained a register of all patients in need of palliative care and offered home visits and rapid access appointments for those patients with complex healthcare needs.

Updated 29 June 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 offered weekly evening extended hours so that patients could access appointments around their working hours.
• 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.

Updated 29 June 2016

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

• The practice held a register of patients experiencing poor mental health including those patients with dementia. Advanced care planning and annual health checks were carried out which took into account patients’ circumstances and support networks in addition to their physical health. Longer appointments were arranged for this and patients were seen by the GP they preferred. Patients were given information about how to access various support groups and voluntary organisations.
• The percentage of patients diagnosed with dementia whose care has been reviewed for 2014/2015 was 84% which was 14% lower than the CCG average and 11% lower than the national average. The practice had recruited nursing staff, restructured the nursing team, and developed more effective recall systems to improve on these rates.
• The GPs and the 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.
• The practice had given patients experiencing poor mental health information about how to access various support groups and voluntary organisations. Staff had received training on how to care for patients with mental health needs and dementia.
• There was a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

Updated 29 June 2016

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

• The practice held a register of patients living in vulnerable circumstances including those patients with a learning disability.
• The practice offered longer appointments for patients with a learning disability, and had completed annual health checks for all 12 patients on their register. Communication aids such as easy read and picture formats were available to ensure communication opportunities were enhanced.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. It had advised vulnerable patients on how to access various support groups and voluntary organisations. Alerts were placed on these patients’ records so that staff were aware they might need to be prioritised for appointments or offered longer appointments.
• Staff had received training and knew how to recognise signs of abuse in vulnerable adults and children who were considered to be at risk of harm. Staff were aware of their responsibilities regarding information sharing and documentation of safeguarding concerns.
• The practice told us they were in the process of reviewing carers asinformation about carers had not always been collected from patients. Forms were now available for reception staff to ask patients for this information. The GPs and the nurses were to review their care plans in order to ascertain whether any carers had been missed.A poster was displayed in the waiting room advertising support for carers.