Archived: Worle Medical Practice

Updated 22 March 2016

Worle Medical Practice is located in Weston Super Mare, North Somerset. The practice serves a local population of approximately 4000 patients from Weston Super Mare and the surrounding area under a General Medical Services (GMS) contract. (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 shares the premises with the North Somerset Community Partnership which provides district nursing, school nursing and phlebotomy services. It has parking on site including spaces for patients with a disability.

The practice provides services at the following address:

125 High Street,

WorleWeston-Super-MareSomersetBS22 6HB .

Staff also work across the provider’s (Malling Health) other location at the following address:

St Georges Health Centre

135 Pastures Avenue,

St Georges

Weston-Super-Mare

Somerset

BS22 7SB.

Worle Medical Practice has two GPs whose working time is equivalent to one whole time employees. Both GPs are male. Another male GP who had worked at the practice as a long term locum was expected to come back from long term leave on the day following our inspection. There are three practice nurses and a clinical pharmacist prescriber whose working hours are equivalent to two whole time employees. There is also a part time health care assistant at the practice. The GPs and nurses are supported by a practice manager, a deputy practice manager, an interim practice manager and seven administration and reception staff.

The general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in the fourth least deprivation decile. (An area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score. It is important to remember that not everyone living in a deprived area is deprived and that not all deprived people live in deprived areas). Average male and female life expectancy for the area is 80 and 84 years, broadly in line with the national average of 79 and 83 years respectively.

The practice is open between 8am and 6:30pm Monday to Friday. GP appointments are available from 9am with nurse appointments from 8:30am; emergency telephone access is available from the practice between 8am and 8:30am. The practice operates a mixed appointments system with some appointments available to pre-book and others available to book on the day. GP appointments are 15 minutes each in length in the morning and 10 minutes in the afternoon and appointment sessions are typically 8:30am to 10:30am, 11am to 12 midday, 3 pm to 4:30pm and 5pm to 6pm. Later appointments are available until approximately 7pm each Tuesday and Wednesday. The practice offers online booking facilities for non-urgent appointments and an online repeat prescription service. Patients need to contact the practice first to arrange for access to these services.

The practice has opted out of providing out-of-hours services to their own patients. This service is provided by BrisDoc urgent care, patients are directed to this service by the practice outside of normal practice hours.

Updated 22 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Worle Medical Practice, Weston-Super-Mare on 7 January 2016. Overall the practice is rated as requires improvement and includes all population groups.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.

• Risks to patients were assessed and managed however, risks associated with GP staffing levels were not robust and left staff such as the health care assistant unsupported or unsupervised at times. The staffing levels also impacted on the continuity of patient care and treatment.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Most patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Most patients said they found it easy to make an appointment. However, they stated appointments with a named GP and continuity of care was often more difficult due to high locum GP use. Urgent appointments were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a leadership structure and staff felt supported by the practice management but less so by the provider organisation. The practice sought feedback from staff and patients, which it acted on.

We saw one area of outstanding practice:

• The practice had previously developed a list of frail older patients who lived in vulnerable or isolated circumstances. Some members of staff were allocated a number of these patients and made regular telephone contact with the patients to ensure they were safe.

The areas where the provider must make improvement are:

• Ensure GP staffing levels are maintained to ensure the nursing team and specifically the health care assistant, have access to clinical support throughout their patient appointments and to ensure clinical advice is available should a medical emergency arise during the practice opening hours.

• Ensure practice governance arrangements consider all aspects of the practice as part of a continuous improvement process. For example, ensuring all staff receive provider identified mandatory training and an annual appraisal, and ensuring risks related to lone working are fully assessed.

The areas where the provider should make improvement are:

• Review how continuity of GP access is provided to patients.

• Review clinical support processes for permanently employed GPs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 March 2016

The practice is rated as requires improvement for the care of patients with long-term conditions. The practice was rated as requires improvement for effective, caring and well-led as well as overall. The practice was rated as inadequate for safety. The practice was rated as good for responsive and includes this population group. The concerns which led to these ratings apply to everyone using the practice, including this population group

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

• Overall diabetes quality and outcomes framework (QOF) performance for 2014/15 was 81% compared to the clinical commissioning group average of 92% and the national average of 89%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and an 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 22 March 2016

The practice is rated as requires improvement for the care of families, children and young patients. The practice was rated as requires improvement for effective, caring and well-led as well as overall. The practice was rated as inadequate for safety. The practice was rated as good for responsive and includes this population group. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 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 relatively high for all standard childhood immunisations for under two year old, however, they were lower for five year olds compared to local averages.

• The percentage of patients with a diagnosis of asthma, on the register, who have had an asthma review in the preceding 12 months that included an assessment of asthma control using the three Royal College of Physician questions (04/2014 to 03/2015) was 69% compared to the clinical commissioning group average of 77% and the national average of 75%.

• 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.

• The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding five years (04/2014 to 03/2015) was 81% compared to the clinical commissioning group average of 82% and the 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 22 March 2016

The practice is rated as requires improvement for the care of older patients. The practice was rated as requires improvement for effective, caring and well-led as well as overall. The practice was rated as inadequate for safety. The practice was rated as good for responsive and includes this population group. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice offered personalised care to meet the needs of the older patients in its population.

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

• The practice supported patients living in local residential homes with fortnightly visits and the provision of flu vaccinations.

• The practice had previously developed a list of frail older patients who lived in vulnerable or isolated circumstances who staff contacted regularly.

• However, continuity of care was not always available.

Updated 22 March 2016

The practice is rated as requires improvement for the care of working-age patients (including those recently retired and students). The practice was rated as requires improvement for effective, caring and well-led as well as overall. The practice was rated as inadequate for safety. The practice was rated as good for responsive and includes this population group. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 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 and flexible.

• A walk in phlebotomy service was provided by the practice.

• 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.

Updated 22 March 2016

The practice is rated as requires improvement for the care of patients experiencing poor mental health (including patients with dementia). The practice was rated as requires improvement for effective, caring and well-led as well as overall. The practice was rated as inadequate for safety. The practice was rated as good for responsive and includes this population group. The concerns which led to these ratings apply to everyone using the practice, including this population group. 

• 72% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was below the national average of 84%.

• 96% of patients with severe mental health problems had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (04/2014 to 03/2015).

• 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 informed 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.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 22 March 2016

The practice is rated as requires improvement for the care of patients whose circumstances may make them vulnerable. The practice was rated as requires improvement for effective, caring and well-led as well as overall. The practice was rated as inadequate for safety. The practice was rated as good for responsive and includes this population group. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice held a register of patients living in vulnerable circumstances including homeless patients and those with a learning disability.

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

• The practice regularly worked with multi-disciplinary teams 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.