Sherbourne Medical Centre

Updated 21 December 2016

Sherbourne Medical Practice is located in Leamington Spa, Warwickshire and provides primary medical services for patients in Leamington Spa and the surrounding villages. At the time of the inspection there were 9,687patients registered with the practice. It has six GP partners (three male and three female) and a trainee GP.

The practice population was in line with local and national averages for most age groups, although there were a higher number of unemployed patients at 7% compared with local rates of 4% and the national rate of 5%.

The GPs are supported by a part time senior practice business manager, an operations manager, two practice nurses, two healthcare assistants, administrative and reception staff.

Sherbourne Medical Practice is an approved training practice for trainee GPs. A trainee GP is a qualified doctor who is training to become a GP through a period of working and training in a practice. A trainee GP was working at the practice at the time of the inspection.

The practice has a General Medical Services (GMS) contract with NHS England. The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities.

The practice reception opens from 8am to 6.30pm Monday to Friday. Appointments are available from those times. Extended hours appointments are available from 8am to 12.30pm on alternate Saturdays for pre-bookable appointments. These appointment times are available for both GPs and nurses. Appointments can be booked up to two weeks in advance.

When the practice is closed, patients can access out-of-hours care through NHS 111. The out-of-hours service is provided by Care UK. The practice has a recorded message on its telephone system advising patients on the numbers to call. This information is also available on the practice’s website and in the practice leaflet.

Home visits are also available for patients who are too ill to attend the practice for appointments. Patients can request repeat prescriptions in person or by using the online service.

The practice treats patients of all ages and provides a range of medical services. This includes disease management such as asthma, diabetes and heart disease. Other appointments are available for maternity care and family planning. Sherbourne Medical Practice also carries out minor surgery for patients.

The practice is an accredited research practice and actively engages in primary care research.

Facilities are available over two floors in the practice building. Although there is no lift available to the treatment and consultation rooms located on the first floor, arrangements are made to see patients in ground floor consultation rooms where they need easy access.

Updated 21 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sherbourne Medical Practice on 21 July 2016. The overall rating for this service is 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.
• Risks to patients were assessed and well managed.
• There were systems in place to manage patient safety alerts, including medicines alerts which were acted upon. Changes were made to treatment for those patients identified as a result of the patient safety alerts.
• Patients’ needs were assessed and care was provided in line with current guidance. Staff had the skills and expertise to deliver effective care and treatment to patients. This was maintained through a programme of continuous development to ensure their skills remained current and up-to-date.
• Patients told us GPs and nurses at the practice treated them with care, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available to patients and they told us that they knew how to complain if they needed to.
• All patients had a named GP.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff told us they felt supported by management. The practice proactively sought feedback from patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The area where the provider should make improvements are:

• The practice should continue to look for ways to improve patient experiences of access to appointments.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 December 2016

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

• There were systems in place to monitor patients with chronic diseases. The practice nurses had lead roles in chronic disease management.
• The practice ensured continuity of care in order to achieve the best outcomes for individual patients. All patients diagnosed with a long term condition had a structured regular review to check that their health and medicine needs were being met. Reviews were carried out at least annually if not more often. Holistic appointments were offered so that the number of times patients needed to attend for appointments was reduced. Longer appointments and home visits were available when needed.
• The GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care for those patients with the most complex needs.

Updated 21 December 2016

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

• There were systems in place to identify and follow up children who were at risk of abuse, including children and young patients with a high number of accident and emergency attendances. Staff had received safeguarding training. They were aware of their responsibilities in protecting children who were at risk of harm.
• Appointments were available outside of school hours and the premises were suitable and accessible for children.
• Childhood immunisation rates for the vaccinations given were comparable to local and national averages.
• We saw examples of joint working with midwives, health visitors, and district nurses.
• A number of online services including booking appointments and requesting repeat medicines were also available.
• Data for 2014/2015 showed the practice’s uptake for the cervical screening programme was 70% which was below the local average of 77% and the national average of 74%. The practice had a system in place to encourage patients to attend for screening which included letter and text reminders, telephone calls as well as opportunistic reminders for appointments when patients visited the practice. Information about the importance of screening was made available to all patients in the waiting area.

Updated 21 December 2016

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

• The practice offered proactive, personalised care to meet the needs of the older patients in its population and had a range of enhanced services such as end of life care.
• Nationally reported data showed that outcomes for patients were good for conditions commonly found in older patients.
• The practice was responsive to the needs of older patients. They offered home visits and rapid access appointments for those patients with enhanced needs.
• Health checks were carried out for all patients over the age of 75 years, with 9% completed out of 614 eligible patients so far this current year.

Updated 21 December 2016

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

• The practice offered extended hours so that patients could access appointments around their working hours. Appointment times were available from 8am to 12.30pm alternate Saturdays for pre-booked appointments only.
• The practice was proactive in offering online services as well as a full range of health promotion and screening services that reflected the needs of this age group.
• The practice nurses had oversight for the management of a number of clinical areas, including immunisations, cervical cytology and some long term conditions.
• Repeat prescriptions could be requested online at any time, which was more convenient for patients.
• A range of contraceptive services was available at the practice (including coils and implants).

Updated 21 December 2016

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

• The practice held a register of patients with poor mental health including those patients with dementia. Staff had received training on how to care for patients’ with mental health needs and dementia.
• Advanced care planning and annual health checks were carried out which took into account patients’ circumstances and support networks in addition to their physical health. Longer appointments were arranged for this and patients were seen by the GP they preferred. Patients were given information about how to access various support groups and voluntary organisations.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The GPs and practice nurses understood the importance of considering patients ability to consent to care and treatment and dealt with this in accordance with the requirements of the Mental Capacity Act 2005.
• The practice supported families in their bereavement and signposted them to support services.
• Data for 2014/2015 showed the practice achieved higher than local and national rates for support for patients with poor mental health.
• The practice had developed a dementia pathway which was being trialled. The aim of the pathway was to identify and provide earlier support for patients, from diagnosis.

Updated 21 December 2016

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

• The practice held a register of patients living in vulnerable circumstances including those patients with a learning disability. Alternative formats were available for those patients who needed these to access information such as patient leaflets in large text or alternative fonts. The practice offered longer appointments for patients with a learning disability. They had completed annual health checks for 37% of the 38 patients on their register since 1 April 2016.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. Vulnerable patients were advised on how to access various support groups and voluntary organisations. Alerts were placed on these patients’ records so that staff were aware they might need to be prioritised for appointments or offered longer appointments.
• Staff had received training and knew how to recognise signs of abuse in vulnerable adults and children who were considered to be at risk of harm. Staff were aware of their responsibilities regarding information sharing and documentation of safeguarding concerns.
• The practice treated patients of all ages and provided a range of medical services. This included vulnerable groups such as homeless people or travellers. If they approached the practice they would be registered and provided with treatment and health care according to their needs.