Dr VMM Blackburn & Partners Also known as High Street Medical Centre

Updated 26 August 2016

Dr VMM Blackburn & Partners, known locally as High Street Medical Centre is located in the centre of Stonehouse, near to Stroud, a market town in Gloucestershire, and has good transport links. The practice has a slightly higher than average patient population in the 50 to 80 years age group and lower than average in the 10 to 30 years age group. The practice is part of the Gloucestershire Clinical Commissioning Group and has approximately 6,000 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, however there are pockets of high range deprivation within the practice boundaries.

The practice is managed by three GP partners (one female and two male) and supported by two practice nurses, one healthcare assistant and an administrative team led by the practice manager.

The practice is open between 7.30am and 6.30pm Monday to Friday. Reception is open from 7.30am to receive patients attending early morning appointments. Telephone lines are transferred from the out of hour’s service at 8am. GP appointments are available between 9am and 11am every morning and 4pm to 6pm every afternoon. Nurse appointments are available from 7.30am to 12pm every morning and 1pm to 5.30pm every afternoon. Extended hours appointments are offered from 7.30am each morning. 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 South West Ambulance Service (SWAST).

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

Dr VMM Blackburn & Partners is registered to provide services from the following location:

31 High Street

Stonehouse

Gloucestershire

GL10 2NG

This inspection is part of the CQC comprehensive inspection programme and is the first inspection of Dr VMM Blackburn & Partners.

Updated 26 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr VMM Blackburn & Partners on 7 July 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. However although evidence was seen of actions taken there was no evidence that lessons were shared widely enough to support improvement.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• 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. Improvements were made to the quality of care as a result of complaints and concerns. However, we saw that although were actions taken there was no evidence that lessons were shared widely enough to support improvement.
• Patients said they found it easy to make an appointment with a named GP, although the wait for these was sometimes two weeks or more. Urgent appointments were always available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

• The practice had been proactive in working collaboratively with the clinical commissioning group and midwifery services to develop a clinical pathway that identified, assessed and managed patients at risk of perinatal mental health problems. Once identified, a patient focussed, individualised care plan was developed in collaboration with the midwife. A local consultant psychiatrist with a special interest in post-natal depression was involved where appropriate. Evidence was seen from practice clinical notes that this had led to healthy pregnancies pre and post-natal for a number of at risk patients.

The areas where the provider should make improvements are:

• To ensure lessons learnt from complaints and significant events are shared widely enough to support improvement in quality of care.
• The practice should improve the identification of patients who are also carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 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 on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (04/2014 to 03/2015) was 90% which was the same as the local average and higher than the national average of 88%.

• 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 26 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.

• All young people aged under 16 requesting contraception were always seen on the day. A full Gillick competency assessment was carried out to determine ability to consent to treatment without the need for parental consent.

• The practice’s uptake for the cervical screening programme was 84%, compared to the local average of 85% 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. For example, the practice had worked effectively with midwives and hospital specialists to identify assess and manage patients at risk of perinatal depression

Updated 26 August 2016

The practice is rated as good 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.

• A named GP was responsible for the care of older patients in a nursing home and conducted fortnightly visits. Health reviews on all these patients were carried out six monthly.

• The practice piloted a social prescribing scheme prior to it being implemented county wide. Social prescribing is a way of linking patients in primary care with sources of support within the community. It provides GPs with a non-medical referral option that can operate alongside existing treatments to improve health and well-being.

Updated 26 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.

• Early morning appointments were available for both nurses and GPs to meet the needs of those patients who were working.

Updated 26 August 2016

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

• 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 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 26 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.

• The practice worked with the local community to support vulnerable patients. For example, a project entitled Shades of Green involved education at the local children’s centre and learning disability groups, regarding healthy food options. The groups then grew produce in the garden on the practice premises. The practice also hosted art projects for the socially isolated.