Pool Medical Centre

Updated 12 April 2017

Pool Medical Centre is a practice in the village of Studley with a catchment area also including the neighbourhoods of Mappleborough Green, Marton Bagot, Outhill, Sambourne, and Coughton. The practice operates under a Personal Medical Services (PMS) contract with NHS England. A PMS contract is one type of contract between general practices and NHS England for delivering primary care services to local communities. The practice operates from premises which were purpose built in 1991. The building has accessible facilities for patients with additional needs, such as wheelchair access and disabled parking. There is also a pharmacy on the premises although this is not run by the practice. Pool Medical Centre has a patient list size of 6,286. Pool Medical Centre is a training practice which has qualified junior doctors working under the supervision of the GPs.

Pool Medical Centre’s patient list has lower than average levels of social deprivation. There are a higher than average number of patients aged 45 and above, and a lower than average number aged 44 and below. The practice has expanded its contracted obligations to provide enhanced services to patients. An enhanced service is above the contractual requirement of the practice and is commissioned to improve the range of services available to patients. For example, the practice offers minor surgery, unplanned admissions, rotavirus and shingles immunisation and risk profiling and case management.

The clinical team includes three male GP partners, one female salaried GP, two trainee GPs, one triage nurse, two practice nurses and one healthcare assistant. The team is supported by a practice manager, an IT coordinator, two medical secretaries, one administrator, eight reception staff and one apprentice.

Pool Medical Centre is open from 8.30am to 6pm from Monday to Friday. The practice is closed between 1pm and 2pm daily and from 2pm until 4pm on Thursdays. Extended opening hours are on Monday evenings from 6.30pm until 8pm, and Wednesday mornings from 7.30am until 8am. The practice reception team is available to answer the phones during the core hours of 8am until 6.30pm from Monday to Friday, during which time a GP is always available in the event of an emergency. Outside of these hours there are arrangements in place to direct patients to out-of-hours services provided by NHS 111.

Updated 12 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Pool Medical Centre on 23 August 2016. Overall the practice is rated as Good.

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

• The system for reporting and recording significant events ensured that these were fully investigated and patients affected were notified and supported.

• Risks to staff and patients were continuously monitored to promote safety, and there were suitable arrangements to deal with emergencies and major incidents.

• Prescription stationery was stored securely but printer forms were not tracked after being removed from their boxes.

• Current evidence based guidelines were monitored and adhered to in the planning and management of patient care.

• The practice held annual staff appraisal meetings to review professional development and identify learning needs. Staff we spoke with during the inspection told us they had access to appropriate training to cover the scope of their work.

• The patients we spoke with told us they felt they were involved when it came to making decisions about the care and treatment they received. They said that clinical staff were good at listening, allowed them enough time and provided information to help them understand their options.

• Information for patients about the services available and how to complain was easy to understand and accessible.

• The practice had a lead staff member for dealing with complaints and we saw that these were properly managed and lessons were learned. The practice took action to improve the quality of care as a result of concerns raised.

• Results from the national GP patient survey showed that patients’ satisfaction with how they could access care and treatment was comparable to or higher than local and national averages.

• 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, and the practice actively sought feedback from staff and patients to improve its offering.

• The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

• The practice actively engaged with patients and was responsive to the local community. Needs were assessed and action was taken to improve care and encourage healthier lifestyles. For example the practice had worked with its Patient Participation Group (PPG) to organise activities for local over 75s as a means of reducing social isolation. This had resulted in a one third decrease in appointments made by older people, and their number of hospital admissions had also fallen. The PPG had sent a teenage survey to younger patients asking for their views; and the practice had then offered drop-in sessions for teenagers who were not registered with the practice to allow them to attend anonymously for advice. The practice had also run a men’s health evening in a local pub to promote health screening and to educate patients about alcohol intake. As a result of the event the practice identified a small number of patients with previously undiagnosed hypertension who were followed up.

The area where the provider should make improvement is:

• Continue to monitor security in the management of prescription stationery.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 April 2017

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

• The practice maintained registers of patients with long-term conditions and used these to monitor their health and ensure they were offered appropriate services.
• The nursing team had lead roles in chronic disease management.
• Performance for diabetes related indicators was similar to CCG and national averages. For example, 80% of the practices patients with diabetes had a blood glucose level within the target range in the preceding 12 months compared with the CCG average of 82% and the national average of 78%. 95% of patients with diabetes had a record of a foot examination in the preceding 12 months compared with the CCG average of 92% and national average of 88%.
• The practice ran specialist clinics and offered longer appointments for patients with long term conditions. Review appointments were coordinated for those with multiple long term conditions.
• Clinical staff engaged with healthcare professionals to provide a multidisciplinary package of care.

Updated 12 April 2017

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

• The practice maintained registers of patients with long-term conditions and used these to monitor their health and ensure they were offered appropriate services.
• The nursing team had lead roles in chronic disease management.
• Performance for diabetes related indicators was similar to CCG and national averages. For example, 80% of the practices patients with diabetes had a blood glucose level within the target range in the preceding 12 months compared with the CCG average of 82% and the national average of 78%. 95% of patients with diabetes had a record of a foot examination in the preceding 12 months compared with the CCG average of 92% and national average of 88%.
• The practice ran specialist clinics and offered longer appointments for patients with long term conditions. Review appointments were coordinated for those with multiple long term conditions.
• Clinical staff engaged with healthcare professionals to provide a multidisciplinary package of care.

Updated 12 April 2017

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

• The service provided to older people was proactive, personalised and responsive. For example the practice offered home visits and urgent appointments for those with enhanced needs.
• The practice had worked with a dedicated over 75s care coordinator to identified that 21% of older patients felt lonely. The care coordinator had worked with the practice manager and the PPG to organise activities for the over 75s. This had resulted in a one third decrease in appointments made by older people, and their number of hospital admissions had also fallen. The practice continued to work with the PPG to organise activities to support this group. It had also arranged for older people to visit local schools to talk about their lives.
• The practice participated in events organised by Silver Line charity, and had recently hired coaches to allow patients to attend a celebrity event at Stratford Civic Centre.
• Older patients who may need palliative care were promptly identified and involved in planning and making decisions about their care, including their end of life care.
• The practice monitored older patients discharged from hospital and updated their care plans to reflect their changing needs.
• Staff we spoke with demonstrated that they knew how to recognise and escalate concerns about signs of abuse in older patients.

Updated 12 April 2017

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

• The practice offered extended opening hours on Monday evenings from 6.30pm until 8pm, and Wednesday mornings from 7.30am until 8am for working patients who could not attend during normal opening hours.
• Patients could access online services such as repeat prescription ordering and appointment booking.
• Telephone consultations were available for patients who did not feel they required a physical consultation or who had difficulty in attending the practice during opening hours. There was also a triage nurse who worked on Mondays and Tuesdays to advise patients whether a physical consultation was necessary.
• A full range of health promotion and screening was available, including NHS health checks for those aged 40 to 74.

Updated 12 April 2017

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

• Quality Outcomes Framework (QOF) data showed that the practice was performing above local and national averages in its care of patients with dementia. For example, 90% of patients diagnosed with dementia had a face to face care review in the past 12 months, compared with an average 85% in the CCG area 84% nationally.
• Performance for mental health related indicators was also similar to the CCG and national averages. For instance, 91% of patients with a form of psychoses had a comprehensive, agreed care plan documented in the preceding 12 months, compared to the CCG average of 93% and the national average of 88%. 91% of the same group had also had their alcohol consumption recorded in the previous 12 months, similar to the CCG average of 94% and the national average of 90%.
• The practice liaised with multidisciplinary teams in the management of patients experiencing poor mental health and we saw that care plans were in place for those with dementia.
• The practice worked jointly with the local parish council to promote dementia friendly allotments to patients.

Updated 12 April 2017

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

• Longer appointments were offered for patients who needed them, including learning disability patients. There were 16 patients on the practice’s learning disability register at the time of the inspection, ten of whom had received a health check during the previous year.
• The practice was a member of the Safe Place Scheme for people with a learning disability. This meant there was a logo displayed identifying the practice building to those with a learning disability as a safe place to come if they needed assistance or were experiencing fear. Longer appointments were also available for patients with a learning disability.
• The practice worked with a multidisciplinary team of other health care professionals in the case management of vulnerable patients.
• Staff we spoke with during the inspection knew how to recognise signs of abuse in vulnerable adults and children and were aware of their responsibilities. All staff had additionally completed IRIS (Identification and Referral to Improve Safety) training in domestic violence and the practice had made individual arrangements to support patients as necessary.
• The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 131 patients as carers (2% of the practice list). A member of non-clinical staff had a lead role in managing the carers register and monitoring their uptake of relevant services. For example, carers were able to receive the flu vaccine. There was a board in the patient waiting area providing information for carers about avenues of support available.