Archived: Millstream Medical Centre

Updated 31 January 2017

The Millstream Medical Centre was inspected on 16 November 2016. This was a comprehensive inspection.

The practice is situated in the town centre of Salisbury. The practice provides a general medical service to about 5,460 patients covering an area from Compton Chamberlaine to West Dean and Firs Down to Charlton All Saints.

The practices population area is in the eighth decile for deprivation, which is on a scale of one to ten. The lower the decile the more deprived an area is compared to the national average. The practice population ethnic profile is predominantly White British. The average male life expectancy for the practice area is 80 years which is higher than the national average of 79 years; female life expectancy is 78 years which is lower than the national average of 83 years.

There are two GP partners, one male and one female, and two female salaried GPs providing 19 sessions a week. The GP partners hold managerial and financial responsibility for running the business. The team are supported by two practice nurses, a healthcare assistant/phlebotomist (Phlebotomists are people trained to take blood samples) a practice manager and additional administration and reception staff.

The practice reception is open between 8am and 6.30pm Monday to Friday. Appointments are offered at various times throughout the whole day. The practice offers a range of appointment types including book on the day, telephone consultations and advance appointments which can be booked eight weeks in advance. Extended hours are offered on a Saturday morning from 8am and11.30am.

Outside of these times patients are directed to contact the practice where they will be given a telephone number to call an out of hours GP.

The Millstream Medical Centre provides regulated activities from the main site at Avon Approach, Salisbury, SP1 3SL.

Updated 31 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Millstream Medical Centre on 16 November 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.
• 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.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs. The practice was clean, tidy and hygienic. We found arrangements were in place which ensured the cleanliness of the practice was maintained to a high standard.
• 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 31 January 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 for patients with long-term conditions compared with national averages. For example, 76% of patients with asthma, on the register, had had an asthma review in the preceding 12 months, compared to the national average of 75%. The review included three patient-focused outcomes that act as a further prompt to review treatment.

• Performance for diabetes related indicators were all comparable or higher than national scores. For example, the patients who had a blood test result within normal limits was 80.5% compared with a national average of 78%, and 93% of patients had received a foot examination, which compared to the national average score 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 31 January 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.

• Immunisation rates were relatively high for all standard childhood immunisations. Staff contacted patients who did not attend for appointments

• 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.

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

• Breast feeding was encouraged and a separate private room was available if needed.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

• Sexual health and contraception was offered by the clinicians. The practice supplied chlamydia kits for patients to collect and send personally

Updated 31 January 2017

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.

• The practice held a list of volunteers that were all patients of the practice who were available to help others by carrying out tasks such as changing library books, helping with trips to the surgery or shops, and visiting the housebound etc.

• Older patients with complex care needs or those at risk of hospital admissions had personalised care plans which were shared with local organisations to facilitate continuity of care.

Updated 31 January 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 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.

• Telephone appointments were offered where appropriate, as an alternative to face-to-face consultations.

• 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.

Updated 31 January 2017

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

• 91% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was higher than the national average of 84%. The practice was working towards being accredited as a Dementia friendly practice and continually monitored patients on anti dementia drugs to make sure they remained effective.

• 91% of patients diagnosed with mental health issues had received a face to face review within the last 12 months. This was higher than the national average of 88%.

• 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 31 January 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 homeless people, travellers and those with a learning disability.

• The practice provided care and treatment to a local women’s refuge.

• The practice offered longer appointments for patients with a learning disability and would provide health checks in the patient’s own home.

• The practice referred to CHAT (Community Health Awareness Team) a scheme that supported and improved the wellbeing of patients by finding the most appropriate support available for them within the community.

• 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.