Spring Gardens Group Medical Practice

Updated 30 June 2016

Spring Gardens Group Medical Practice provides care for approximately 15,800 patients. There is a high number ethnic minority patients registered including patients who originated from Eastern Europe. The service is located in and covers Worcester City. The practice holds a General Medical Services contract and provides GP services commissioned by NHS England.

The practice is managed by nine GP partners (four males, five females) who between them provide 59 clinical sessions per week. There is a vacancy for a GP who will provide eight sessions per week and senior staff were seeking to fill the vacancy. Those sessions are currently covered by locum GPs who regularly work at the practice who also provide cover for annual leave. GPs are supported by two advanced nurse practitioners, five practice nurses and two health care assistants (HCA). They provide cervical screening, vaccinations, reviews of long term conditions, health checks and phlebotomy (taking blood samples) services. The practice employs a practice manager, a part time acting deputy practice manager, a reception manager, 12 receptionists, six administration staff, a health promotion manager and two secretaries.

The practice offers a range of clinics for chronic disease management, diabetes, heart disease, cervical screening, contraception advice, minor surgery, injections and vaccinations.

The practice is open from 8am until 6.30pm every weekday with the exception of Wednesdays when the practice closes at 8pm.

Appointments vary slightly between GPs but are generally available:

• From 8am until 12pm and from 3pm until 6pm daily.

Extended hours include:

• Appointments available from 7.30am every Tuesday.

• Appointments commence at 9am every Wednesday to allow time for meetings to be held.

• Patients can be seen by GPs and nursing staff between 6.30pm and 8pm every Wednesday.

• Saturday sessions are held between 8am and 11 am on a few Saturdays each year. Reception staff are told about these dates.

The practice accepts medical students for experience and teaching purposes. It also accepts up to two trainee GPs.

The practice has opted out of providing GP services to patients out of hours such as nights and weekends. During these times GP services are provided currently by a service commissioned by NHS Redditch and Bromsgrove Clinical Commissioning Group (CCG). When the practice is closed, there is a recorded message giving out of hours’ details. The practice leaflet also includes this information and there are leaflets in the waiting area for patients to take away with them.

Updated 30 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Spring Gardens Group Medical Practice on 4 May 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded.

• The practice was using the National Reporting and Learning System (NRLS). This is a means of sharing lessons learned from safety incidents.

• Staffing levels were monitored to ensure they matched patients’ needs. Due to some staff leaving the practice there was a shortage of clinical staff. Recently an advanced nurse practitioner and a practice nurse had been recruited and efforts were being made to employ a GP.

• Safe arrangements were in place for staff recruitment that protected patients from risks of harm. Risks to patients were assessed and well managed.

• The practice used innovative and proactive methods to improve patient outcomes. Clinical research and audits led to improved patient care.

• Research was on-going regarding patients who experienced poor mental health. Personalised care plans were put in place and a support system for relatives of these patients.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training had been identified and planned. The roles of nursing staff were constantly being expanded following appropriate training. This resulted in a positive impact on GPs’ workloads.

• Patients told us they were treated with compassion, dignity and respect and they were involved in decisions about their treatment.

• Information about how to make a complaint was readily available and easy to understand.

• There was a clear leadership structure and staff told us they felt well supported by senior staff. Management proactively sought feedback from patients which it acted on.

• A number of initiatives completed had resulted in improved outcomes for patients. For example, the developed template for patients who required end of life care. An on-going initiative involved a senior manager working with other practices to ensure there was a consistent approach for the use of computer flagging for identification of patients who had specific needs. This would be beneficial to patients who moved between practices.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 June 2016

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

• Nursing staff had lead roles in chronic disease management.

• A senior nurse had provided two presentations to patients who had diabetes and stressed the importance of attending for their reviews. Plans were in place to repeat these events.

• Longer appointments and home visits were available when needed.

• Patients with long-term conditions had structured annual reviews to check that their health and medicine needs were being met. Where necessary reviews were carried out more often.

• Patients who had more than one long term condition received their reviews through single appointments to reduce the number of times they needed to visit the practice.

• Clinical staff worked with health and care professionals to deliver a multidisciplinary package of care.

• An officer from Age UK regularly attended the practice to provide a translation service and to emphasize why reviews were necessary.

• All patients had a review following their discharge from hospital to ensure that all of their care needs were met.

Updated 30 June 2016

The practice is rated 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.

• Alerts were put onto the electronic record when safeguarding concerns were raised.

• There was regular meetings and liaison with the health visitors to review those children who were considered to be at risk of harm.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

• Extended hours were in place that allowed children to be seen outside of school hours. Appointments were available from 7.30am every Tuesday and until 8pm every Wednesday. Patients could be seen during a number of Saturdays each year between 8am and 11am.

Updated 30 June 2016

The practice is rated good for the care of older people.

• Practice staff offered proactive, personalised care to meet the needs of older patients.

• Staff kept up to date registers of patients’ health conditions and information was held to alert staff if a patient had complex needs.

• Home visits were offered to those who were unable to access the practice and patients with enhanced needs had prompt access to appointments.

• Practice staff worked with other agencies and health providers to provide patient support. The Proactive Care Team (PACT) assessed frail patients in their own home and those in care homes to ensure their health needs were met.

• Practice staff worked with other agencies and health providers to provide patient support.

• GPs made regular visits to a care home where practice patients resided to monitor their health needs.

Updated 30 June 2016

The practice is rated good for the care of working-age people (including those recently retired and students).

• The practice had adjusted its services to accommodate the needs of this population group.

• Extended hours were available and telephone consultations for those patients who found it difficult to attend the practice or if they were unsure whether they needed a face to face appointment.

• Online services were available for booking appointments and ordering repeat prescriptions.

• The practice website gave advice to patients about how to treat minor ailments without the need to be seen by a GP.

• Data told us that some patients had failed to attend for cervical screening. Staff had adopted various methods in explaining the necessity of this service and encouraged patients to attend.

Updated 30 June 2016

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

• Most patients who experience poor mental health had received an annual physical health check.

• Practice staff regularly worked with multi-disciplinary teams in the case management of patients who experience poor mental health, including those with dementia.

• GPs carried out assessments of patients who experienced memory loss in order to capture early diagnosis of dementia. Data published in January 2016 told us that 97% of these patients had attended the practice for their reviews. Patients who had dementia were investigated and referred to the early intervention service for advice and support. They were encouraged to attend exercise classes to help them in maintaining healthy lifestyles.

• Sessions were held twice a week at the practice by the Gateway mental health team who provided advice, support and signposting for patients who were experiencing poor mental health.

• Clinical staff were carrying out research projects. One concerned physical health checks for a specific disorder of patients’ who experienced poor mental health. This enabled staff to put a care package in place that provided health and social care support systems in place to promote patients well-being.

• Another project involved the assessment of cardiovascular risk to these patients. The other research concerned Relatives Education and Coping Toolkit (REACT). It provided on-line peer support and a toolkit for assistance with the aim of reducing the stress levels experienced by relatives.

• All patients who experienced severe mental health illness had care plans in place that were regularly reviewed. Care plans included physical health disorders. These patients were seen by their own GP for continuity of care and were offered same day appointments to ensure they received a prompt service.

• Referrals to other health professionals were made when necessary.

• Data published in January 2016 informed that 25% of patients who experienced depression had not attended the practice for their reviews. Although staff encouraged patients to attend the practice they told us that patients did not attend. The attendance rates had been discussed with other practices in an effort of finding ways of addressing this problem.

Updated 30 June 2016

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

• The practice held a register of patients living in vulnerable circumstances including those who had a learning disability. Patients who had a learning disability received their reviews by the same nurse and GP each time in order to build their confidence and communications with staff. All patients who had a learning disability had received their annual reviews.

• Practice staff regularly worked with multi-disciplinary teams in the case management of vulnerable patients.

• These patients had been signposted to additional support services. The community champions (‘time to talk’) pilot supported this process.

• Staff had visited a nearby traveller’s campsite and provided advice about how the practice could support them.

• Staff knew how to recognise signs of abuse, the actions they should take and their responsibilities regarding information sharing.

• There was a clinical lead for dealing with vulnerable adults and children.