Lovemead Group Practice

Updated 24 June 2016

Lovemead Group Practice is located close to the centre of Trowbridge, the county town of Wiltshire. The practice average patient population is similar for all age groups to what is seen nationally. The practice is part of the Wiltshire Clinical Commissioning Group and has approximately 17,000 patients. The area the practice serves is mixed urban, semi-rural and a mixed socio economic population. The practice area is in the mid-range for deprivation nationally; however there are pockets of deprivation. The practice also has a relatively large population from Eastern Europe.

The practice is managed by seven GP partners (two male and five female). The partners are supported by an additional five salaried GP’s (two male and three female), seven practice nurses (six female and one male), four healthcare assistants (three female and one male) and an administrative team led by two practice managers; one clinical, responsible for all clinical issues and complaints, and one administrative, responsible for human resources and general administration. A practice liaison officer monitors unplanned admissions, coordinates care following discharge with a care coordinator, the GP and community teams and is a central point of contact for patients and their relatives.

Lovemead Group Practice is a teaching and training practice providing placements for GP registrars, medical and nursing students.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are available between 8.30am and 12.15pm every morning and 2pm to 6pm every afternoon. Extended hours appointments are offered between 6.30pm and 7.30pm Monday, Wednesday and Thursday and alternate Saturday mornings between 8.30am to 10.30am.In addition to pre-bookable appointments that could be booked up to six weeks in advance, urgent appointments were available for patients that needed them.

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

The practice has a Primary Medical Services (PMS) 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.

Lovemead Group Practice is registered to provide services from the following location:

Roundstone Surgery

Trowbridge

Wiltshire

BA14 7EH

Updated 24 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lovemead Group Practice on 5 May 2016. Overall the practice is rated as outstanding.

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. The practice had introduced the role of a patient liaison officer to support the practice’s vulnerable patients in admission avoidance. The role involved liaising with the community team and care coordinator and other service providers to ensure care packages were in place for these patients and also for patients post discharge from hospital. It also provided a single point of contact within the practice for patients and their relatives.
• Feedback from patients about their care was consistently positive.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. The practice had developed plans for an emergency care practitioner (ECP) role. The practice then worked with other local practices, to secure funding from the clinical commissioning group through the Transferring Care of Older People scheme to employ an ECP. The ECP worked across all local practices, visited acutely ill elderly patients promptly to prevent hospital admissions and identified and assessed elderly frail patients at risk of hospital admission.
• 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, for example, the practice had purchased raised chairs and a perch stool for the waiting room to make it easier for patients with mobility problems.
• 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. An annual audit of complaints was undertaken to identify any trends.
• 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 including:

• The practice ran a young person’s sexual health clinic called “No Worries”. The young person did not need to be registered with the practice to be able to be seen within this scheme. A young person with a sexual health need would always be seen on the same day. The proactive engagement of the practice with this service had contributed to the overall teenage pregnancy rate for the Trowbridge area being reduced by 50% since the service began 10 years ago.
• Patients who were carers were fully supported by the practice. Regular meetings were held at the practice for carers and attended by other support agencies. The practice was flexible with appointment scheduling. Carers were given a password to quote when calling for an appointment which alerted receptionists to the need to accommodate carers as a priority. Carers were invited for twice yearly health checks which included a clinical health check and a wellbeing health check with a member of Wiltshire carer support.
• A GP within the practice, who had a special interest in dermatology (skin conditions) and had undergone additional training, ran a dermatology clinic within the practice. The successful decrease in dermatology referrals to secondary care and patient satisfaction with the service has led to a successful application for future funding of the clinic by NHS England from April 2016. A second GP had recently undertaken additional training in order to accommodate the expansion of the service and triaging all secondary care referrals. The practice has plans for further expansion, enabling other practices in the area to refer their patients into the service.
• The practice had been awarded the Primary Care respiratory award by the Primary Care Respiratory Society, a national organisation, as a result of high quality care and the good practices it delivered to respiratory patients.
• The practice had been accredited with a gold award by Wiltshire Public Health for its achievements in their stop smoking targets. The latest results demonstrated that the practice was highest in the percentage of patients who had stopped smoking, for the whole of Wiltshire with a stop smoking rate of 82%.
• There was a truly holistic approach to assessing, planning and delivering care and treatment to patients who used the service. The nurses who managed patients with chronic diseases, worked with a patients’ emotional wellbeing initially in order to engage patients in being proactive and motivated to manage their own conditions before discussing problem solving with the patient. This had led to good outcomes for patients. For example, a patient on medicines to treat high blood pressure had not engaged with the benefits of lifestyle changes. The nurse applied this model of care and within a year the patient had lost weight, stopped smoking and was taking exercise which had led to the patient no longer requiring medicines to maintain blood pressure within normal limits.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 June 2016

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

• Nursing staff had lead roles in chronic disease management. They worked with patients on emotional wellbeing initially in order to engage patients in being proactive and motivated to manage their own conditions before discussing problem solving with the patient which had led to good outcomes For example, a patient on medicines to treat high blood pressure had not engaged with the benefits of lifestyle changes. The nurse applied this model of care and within a year the patient had lost weight, stopped smoking and was taking exercise which had led to the patient no longer requiring medicines to maintain blood pressure within normal limits.

• All patients with chronic obstructive pulmonary disease (COPD), a chronic lung condition who were at risk of a hospital admission were given medicines to keep at home preventing this. All these patients were offered counselling and given written and verbal instructions to prevent infections and the appropriate use of these medicines should an infection occur.

• The practice had been awarded the Primary Care Respiratory award by the Primary Care Respiratory Society for good quality of care and good practices in asthma and COPD.

• Performance for diabetes related indicators was better than local and national averages. The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (2014 to 2015) was 94% which was above the clinical commissioning group average of 91% and the national average of 88%.

• Longer appointments and home visits were available when needed. The chronic disease nurses provided home visits for patients with, diabetes, heart disease and respiratory disease who were unable to attend the practice for reviews.

• 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 24 June 2016

The practice is rated as outstanding for the care of families, children and young patients.

• 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.

• Children were kept safe from abuse by the practice’s proactive approach to monitoring patient outcomes and working with other providers. For example, when a child had not attended any immunisations, and the follow up with the family was unsuccessful, the practice collaborated with the health visitor, school nurses and social workers. Further investigation led to a formal safeguarding notification which led to all the children within the family receiving the appropriate support that was required for their safety and wellbeing.

• 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 practice ran a young person’s sexual health clinic called “No Worries”. The young person did not need to be registered with the practice to be able to be seen within this scheme. A young patient with a sexual health need would always be seen on the same day. The service was led by a Family Planning trained practice nurse who held a mobile phone that patients could contact her on at any time for appointments and advice. The nurse also held this phone outside of working hours to ensure youngsters could contact her when at their most vulnerable. The building of trust and rapport with this group of patients had led to them accessing services at the most appropriate time.The proactive engagement of the practice with this service since 2004 had contributed to the overall teenage pregnancy rate for the Trowbridge area being reduced by 50% in the last 18 years.The practice was continuing to work to improve this service to become a young people friendly accredited practice.

• 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 24 June 2016

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

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

• A patient liaison officer coordinated care following hospital discharge. Supporting vulnerable elderly patients in this way had led to positive patient impact. For example, a family was struggling to support an elderly relative at home. The patient liaison officer supported the GP to initiate, occupational therapy and physiotherapy services, communicated with the local care of the elderly consultant to optimise management and kept the family informed throughout the process. This resulted in the patients’ condition becoming far more stable and being able to remain in their own home.

• Carers were given a password to quote when calling for an appointment which alerted receptionists to the need to accommodate carers as a priority. Carers were invited for twice yearly health checks which included a clinical health check and a wellbeing health check with a member of Wiltshire carer support.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs. An emergency care practitioner (ECP), who the practice employed on behalf of the locality, visited acutely ill elderly patients at home, as soon as there was a need, which had frequently led to admission avoidance. The ECP also visited those who would benefit from a frailty assessment.

Updated 24 June 2016

The practice is rated as good for the care of working-age patients (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 to accommodate working age patients.

Updated 24 June 2016

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

• 87% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84%

• The percentage of patients with a serious mental health condition who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (2014 to 2015) was 94% compared to a the clinical commissioning group average of 93% 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 living with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice ran an in house dementia service and memory clinic which was overseen by two of the GP partners with a special interest in this aspect of care. Delivering the service in house also meant that a holistic approach to patient care was effectively managed. For example, a patient with memory problems was not taking medicines to maintain blood sugars within normal limits. Collaborative working between the practices memory clinic, the diabetic nurse, Alzheimer Society and carer support combined with the quick access to memory enhancing medicines led to the patient’s blood sugars being more stable and potential avoidance of complications.

• The practice had told 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 24 June 2016

The practice is rated as outstanding for the care of patients who 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 and monitored the needs of these patients. For example, a group of patients with a learning disability had not had bowel cancer screening. The practice referred these patients to the learning disability nurse to discuss with them the benefits and the procedures involved. This led to the bowel cancer screening being undertaken for these patients.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. For example, the patient liaison officer monitored unplanned admissions. The patient liaison officer coordinated care following discharge from hospital with the care coordinator, the patients’ own GP and community teams. Supporting vulnerable elderly patients in this way had led to positive patient impact. For example, when a family was struggling to support an elderly relative at home, the patient liaison officer supported the GP to initiate occupational therapy and physiotherapy services and communicated with the local care of the elderly consultant to optimise management of the patient’s care. They kept the family informed throughout the process and this resulted in the patients’ condition becoming far more stable and being able to remain in their own home.

• The proactive approach by the practice to support vulnerable patients’ at risk of hospital admission had led to the practice data demonstrating a lower number of emergency admissions for 19 conditions where effective community care and case management could have prevented the need for hospital admission per 1,000 population (2014 to 2015).

• 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.