Archived: Bishops Castle Medical Practice

Updated 20 February 2017

Bishops Castle Medical Practice is registered with the Care Quality Commission (CQC) as a partnership provider in Bishops Castle, Shropshire. At the time of our inspection, the practice had 5,250 patients. The practice has a higher percentage of older people than the national average for example, 30% patients are over 65 years old (17.8% nationally) and 3% patients are over 85 years (2.3% nationally). These statistics could mean an increased demand for GP services. The practice provides GP services to 158 patients who live in three care homes, looks after a 16 bedded community hospital and provides GP services to a learning disability educational establishment outside of their catchment area.

The practice is open between 8am and 6pm Monday and Thursday, 6.30am to 5pm on Tuesday, 8am to 5pm on Wednesday and 8am to 4.30pm on Friday. On Tuesday morning, from 6.30am the practice is open for prebooked appointments only, the telephones are not switched on until 8am. The practice is closed to allow for staff lunch and training Monday to Friday between 1pm and 2pm and calls to the practice during this time are taken by the GP on call. The practice does not routinely provide an out-of-hours service to their own patients but patients are directed to Shropdoc the out of hours service when the practice is closed. Patients can book appointments in advance and through the practice on-line appointment system.

The practice staff work a variety of full and part time hours, staffing comprises of:

• Two male GP partners providing 33.28 hours and 29.16 hours per week.

• Four salaried GPs (two male, providing 20.83hrs and two female, 20.83hrs).

• A clinical pharmacist/clinical and quality manager, providing 16 hours

• Two nurse practitioners

• Three nurses

• One Healthcare assistant

• One Practice Manager

• Four secretaries

• One reception manager

• Four receptionists

• One secretary/finance controller

• One cleaner

The practice holds a General Medical Services (GMS) contract with NHS England. This is a contract for the practice to deliver General Medical Services to the local community or communities. They also provide some Directed Enhanced Services, for example, they offer extended hours and identify patients who are at high risk of avoidable unplanned admissions. The practice provides a number of services, for example long-term condition management including asthma, diabetes and high blood pressure. The practice offers NHS health checks and smoking cessation advice and support.

Updated 20 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bishops Castle Medical Practice on 12 December 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.
• 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.
• Practice staff reviewed the needs of its local population to secure improvements to services where these were identified.
• 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.
• Patients said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day.
• The practice offered extended opening hours between 6.30am and 8.30am on a Tuesday.
• 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 the 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 February 2017

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.

• Performance rates for all of the diabetes related indicators were comparable to local and national averages. For example, 76% of patients with diabetes had received a recent blood test to indicate their longer-term diabetic control was below the highest accepted level, compared with the CCG average of 79% and national average of 78%.

• The percentage of patients with chronic obstructive pulmonary disease (COPD) who had had a review in the preceding 12 months was 94%; this was higher than the CCG average of 92%, and national average of 90%. The practice exception-reporting rate was 4%. This was lower than the CCG average of 12% and the national average of 11.5% meaning more patients had been included.

• Longer appointments and home visits were available when needed.

• All these patients had 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.

• The practice had recruited a clinical pharmacist who was attending a specific educational course to further support patients with diabetes at the practice.

Updated 20 February 2017

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.

• The practice’s uptake for the cervical screening programme was 76%, which was slightly lower than the CCG average of 83% and national average of 81%. However, the practice had reported fewer exceptions, 2%, when compared with the CCG average of 5% and national average, 6.5% meaning more patients had been included.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice held a monthly clinical safeguarding meeting to which the health visitor and school nurses were invited to attend.

• The practice had an effective system in place to follow up children who failed to attend for their immunisations. Children who do not attend for appointments were discussed in a weekly clinical meeting and followed-up as appropriate.

Updated 20 February 2017

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

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice provided a named accountable GP for patients aged over 75 years with urgent appointments available the same day.

• Patients had access to telephone appointments with the GP or advanced nurse practitioner if requested.

• Care plans were in place and agreed for those patients identified as being at high risk of admission / re-admission.

• The practice Community Care Co-Ordinator attended weekly meetings at the practice to ensure that signposting support was provided as necessary.

• The practice clinical pharmacist with the GP reviewed and supported patients with complicated medicine regimens.

Updated 20 February 2017

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, 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 opening hours between 6.30am and 8.30am on a Tuesday and a walk in service on a Friday as well as telephone consultations, which included this group of patients.

Updated 20 February 2017

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

• Performance for mental health related indicators showed for example, the percentage of patients with a diagnosed mental health condition who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months was 94%. This was higher than the CCG average (93%) and national average 89%. The practice exception reporting rate was 6%. This was lower than the CCG average of 12% and the national average of 13% meaning more patients had been included.

• 82% of patients diagnosed with dementia had had their care reviewed in a face-to-face meeting in the last 12 months, which was comparable with the CCG average of 85% and the national average of, 84%.

• 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 further supported by the practice Care and Community Co-Ordinator.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

• A Community Mental Health nurse reviewed patients in the practice on alternate weeks.

• A Counsellor provided weekly sessions for patients.

• A drug and alcohol service healthcare worker reviewed patients at the practice.

• A Community Consultant Psychiatrist reviewed patients at the practice rather than patients travelling to Ludlow to be reviewed.

Updated 20 February 2017

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 carers and those with a learning disability. The practice provided carer support, sign posting, information packs and completed a carer’s register.

• The practice offered longer appointments for patients with a learning disability.

• The practice provided GP services to a school which provided educational support for patients with learning disabilities outside of the practice catchment area. Patients choose to travel 37 miles to Bishops Castle Medical Practice to gain the support they required.

• 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 working closely with the practice Care and Community Co-Ordinator.

• 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 systematically identified patients who may have communication difficulties, to ensure they met their needs and the requirements of the Accessible Information Standard.

• The practice had developed strong networks within the community such as the police and housing groups and used these to identify vulnerable people.