Archived: The Welby Practice

Updated 15 September 2017

The Welby Practice provides services to approximately 4,569 patients. The Welby Practice is in the village of Bottesford and is situated in the Vale of Belvoir.

The practice offered a full range of primary medical services and was able to provide pharmaceutical services to those patients on the practice list who lived more than one mile (1.6km) from their nearest pharmacy premises.

The Welby Practice Bottesford employs a GP partner (male) and full time business partner, two salaried GPs (one male and one female). There is an acting practice manager, one advanced nurse practitioner, a nurse practitioner, two practice nurses, two health care support assistants, three dispensary staff and members of the administrative team.

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

The Welby Practice has one location registered with the Care Quality Commission (CQC) which is: - The Welby Practice, 25 Walford Close, Bottesford. NG13 0AN. They also have two branch surgeries, at Swine Hill, Harlaxton, Grantham. NG32 1HT and Bescaby Lane, Waltham On The Wolds, Melton Mowbray, LE14 4AB.

The location we inspected on 9 August 2017 was The Welby Practice, 25 Walford Close, Bottesford. NG13 0AN We also visited the branch surgeries at Swine Hill, Harlaxton, Grantham. NG32 1HT and Bescaby Lane, Waltham On The Wolds, Melton Mowbray, LE14 4AB.

The Welby Practice was open from 8am to 6.30pm Monday, Tuesday, Thursday and Friday. Wednesday 8am to 12.30pm. Extended hours every Thursday from 6.30pm to 8pm.

The branch surgery at Swine Hill, Harlaxton, Grantham. NG32 1HT was open Monday, Wednesday and Thursday 8am to 12.30pm, Tuesday 8.30am to 12.30pm and all day Friday.

The branch surgery at Bescaby Lane, Waltham On The Wolds, Melton Mowbray, LE14 4AB. was open Monday 8am to 6pm, Tuesday and Friday 8.30am to 6pm, Wednesday 8.30am to 6.30pm and Thursday 8am to 12.30pm.

There were various options available which enable patients to get advice or appointments with the clinical team. GP and Nurse Practitioner appointments can be booked in advance along with a number of same day only and telephone consultations.

The practice is located within the area covered by SouthWest Lincolnshire Clinical Commissioning Group (SWLCCG). The CCG is responsible for commissioning services from the practice. A CCG is an organisation that brings together local GP’s and experienced health professionals to take on commissioning responsibilities for local health services.

The Welby Practice had opted out of providing out-of-hours services (OOH) to their own patients. The OOH service is provided by Lincolnshire Community Health Services NHS Trust.

Updated 15 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Welby Practice on 9 August 2017.

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 a system in place for reporting and recording significant events.

• Risks to patients were assessed and well managed, with the exception of those relating to fire safety and legionella.
• Staff we spoke with were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the July 2017 national GP patient survey showed patients felt involved in planning and making decisions about their care and treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Quality improvement had been carried out but we saw limited evidence that audits were driving improvements to patient outcomes.
• 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvement are:

• Complete the work required to ensure staff and patients are safe. For example, in regard to remedial actions for fire safety and legionella. Advise the Care Quality Commission when the work has been completed.

• Complete the medication reviews for patients on medicines for NSAIDS and anti-coagulation medicines to ensure the safe prescribing and monitoring of medicines for patients.

• Review the current systems in place to ensure all clinicians are kept up to date with national guidance and guidelines embed the new process for clinical meeting minutes to include safety alerts and updates on NICE guidance.

• To strengthen the system for clinical audits and include more structure and a fuller analysis to ensure quality improvement.

• Ensure all staff have completed safeguarding training relevant to their role.

• Ensure all staff have access to meeting minutes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 September 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less was 74% which was 17% below the CCG average and 17.3% below the national average. Exception reporting was 6.7% which was 2.2% above the CCG average and 1.2% above the national average.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• All patients with a long term condition had a named GP and there was a system to recall patients for 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 15 September 2017

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

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.

• Childhood immunisations were carried out in line with the national childhood vaccination programme. Uptake rates for the vaccines given were comparable to CCG/national averages. For example, rates for the vaccines given to under two year olds was 100% and 92% for five year olds age group.

• The practice’s uptake for the cervical screening programme was 76%, which was slightly below the CCG average of 80% and the national average of 81%.

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

• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of antenatal, postnatal and child health surveillance clinics.

Updated 15 September 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

• 9% of patients are over 75 years of age.

• 4.1% of patients who had been assessed as being at risk had a care plan in place which was above the national target of 2%.

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

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Where older patients had complex needs, the practice shared summary care records with local care services. For example, the out-of-hours service.

Updated 15 September 2017

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

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours.

• 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 15 September 2017

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

• The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months the CCG average and 3.9% above the national average

• On the day of the inspection we found that the practice had 15 patients who experienced Mental Health and 93% had receive a review of their care in the preceding 12 months.

• The percentage of patients diagnosed with depression whose care has been reviewed in the preceding 12 months was 96% which was comparable with CCG and national averages.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

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

Updated 15 September 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.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable and 100% of patients had received a review in the last 12 months.

• The practice offered longer appointments for patients with a learning disability. The practice had seven patients with a learning disability and 43% had received a review of their care in the last 12 months.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.