Wickham Market Medical Centre

Updated 11 January 2018

• The name of the registered provider is Wickham Market Medical Centre. The practice address is Chapel Lane, Wickham Market, Woodbridge, Suffolk, IP13 0SB. The practice has a branch location called Rendlesham Surgery. The address is 6 Acer Road, Rendlesham, Woodbridge, Suffolk, IP12 2GA.
• The practice is registered to provide diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury.
• The provider delivers regulated activities from Wickham Market Medical Centre and from Rendlesham Surgery. These locations were both visited during the inspection.
• The practice has a Personal Medical Services (PMS) contract with the local Clinical Commissioning Group (CCG).
• There are approximately 9900 patients registered at the practice.
• The practice website is http://www.wickhammarketmc.co.uk
• The practice has four GP partners, (three male and one female) and one salaried GP (female). The nursing team includes three nurse practitioners, one practice nurse, one diabetes specialist nurse and a practice nurse vacancy and three healthcare assistants. The dispensary is led by a pharmacist with five dispensary staff. There is a business manager and a team of 13 administration and reception staff and an apprentice administrator. The practice is a teaching practice although there were no medical students placed at the practice at the time of the inspection. (A teaching practice has medical students who are training to become doctors placed at the practice.)
• The practice is part of a group of eight local GP practices which form the Deben Health Group; a group brought together to work together on financial, educational and clinical matters and to share learning and development.
• According to Public Health England, the patient population has a considerably lower than average number of patients aged under 10 and between the ages of 20 to 39 compared to the practice average across England. It has a higher proportion of patients aged 40 and above compared to the practice average across England. Income deprivation affecting children and older people is significantly lower than the practice average across England.
• The practice was able to offer dispensing services at both the main and the branch practice, to those patients on the practice list who lived more than one mile (1.6km) from their nearest pharmacy.

Updated 11 January 2018

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall, with outstanding for providing well led services. (Previous inspection report published 29 September 2016 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Outstanding

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Wickham Market Medical Centre on 20 November 2017 as part of our regulatory functions.

At this inspection we found:

• The practice had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, the practice learned from them and improved their processes. The practice shared outcomes of significant events with staff and other local GP practices.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence based guidelines. Support and monitoring was in place for the nursing staff, and the monitoring of the work undertaken by the nurse practitioners was formalised and effective.
• Staff involved and treated people with compassion, kindness, dignity and respect. All staff had received equality and diversity training and reception, administration, dispensary staff and the business manager had all completed dementia awareness training.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it. Patient feedback on access to appointments was positive; this was supported by a review of the appointment system and data from the national GP Patient Survey.
• The practice had responded to the needs of patients. This included for example, providing a minor injuries service, due to the rural location of the practice. The practice also identified a high number of patients attending with musculoskeletal needs, so arranged physiotherapy services at the practice, where patients could self-refer.
• There was a clear, effective leadership structure, with a strong focus on quality and strategic leadership. The practice strategy, values and mission statement supported this focus. Practice, team and individual objectives were in place. There was evidence of cross team objective setting. Staff felt very supported by management. The practice proactively sought feedback from staff and patients, which it acted on and benchmarked with other local practices.
• There was a strong focus on continuous learning and improvement at all levels of the organisation. Innovation was encouraged and included for example, training for reception staff to signpost patients to appropriate health and social support services and triage of emergency appointment requests on behalf of four practices in the Deben Health Group. Outcomes were regularly monitored to ensure that innovation was having the desired impact and remained in line with the practice’s strategy.

We saw two areas of outstanding practice:

• The practice shared outcomes of significant events with staff and members of the Deben Health Group. (A group of eight local GP practices who work together on financial, educational and clinical matters and to share learning and development.) For example the practice shared a significant event, where they had raised a safeguarding alert in relation to a medicine issue at a care home. This raised awareness in the other practices of the need to raise a safeguarding concern in similar circumstances.

• The practice had been awarded the Investors in People award annually for the past 13 years which demonstrates the practice’s commitment to training, supporting and developing its staff. Staff confirmed that they felt empowered and involved in the practice and were supported to develop to their potential.

The areas where the provider should make improvements are:

• Continue with plans to invite patients with a learning disability for a health check.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 April 2016

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 avoidable hospital admission were identified as a priority.
• The practice performed consistently well against local benchmarking standards. It was third out of 40 for low levels of unplanned admissions to hospital, low levels of planned hospital admission and low levels of outpatient referral. It was placed 7th out of 40 on low use of A&E. This indicated that the practice was able to effectively prevent patients from being admitted to hospital when they did not need to.
• The practice used the information collected for the Quality and Outcomes Framework (QOF) to monitor outcomes for patients (QOF is a system intended to improve the quality of general practice and reward good practice). Data from 2014/2015 showed that performance for asthma related indicators was 100%, which was above the CCG average by 5.7% and above the national average by 2.6%.
• In 2014/2015 the practice achieved 95.4% of the total number of points available, which was above the national average of 94.7% and the local average of 94.1%. The practice reported 6.6% exception reporting (below CCG and national average).
• Longer appointments and home visits were available when needed.
• A practice nurse and a nurse practitioner had obtained specialist diabetes qualifications, and another practice nurse had obtained an asthma diploma. The practice’s computer system was designed so that specialist appointments for patients could only be made with those clinicians that were appropriately trained.
• Patients with long-term conditions 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.
• The practice had a robust recall system for annual health and medication reviews.

Updated 25 April 2016

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 high for all standard childhood immunisations.
• The practice ensured GPs carried out postnatal home visits or telephone calls for mothers of newborn babies.
• 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.
• A private space was available for breastfeeding mothers.

Updated 25 April 2016

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.
• Weekly ward rounds were undertaken at a local residential home.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis, were generally above local and national averages.
• An Age UK advisor visited the practice on a monthly basis, offering support and advice for patients and/or their carers.

Updated 25 April 2016

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. Extended appointments were available on Tuesday evenings and Saturday mornings, and the practice offered telephone advice for patients that chose to use this service.
• 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.
• Practice staff carried out NHS health checks for patients between the ages of 40 and 74 years.
• Four GPs provided minor surgery treatments for patients eradicating the need to travel elsewhere for this treatment.

Updated 25 April 2016

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

• The practice is rated as good for the care of people experiencing poor mental health including people with dementia.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia.
• The practice had 103 registered patients with dementia, of which 100 required a care plan. 74 of these patients had received an annual review since April 2015.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.
• The practice had 54 registered patients suffering with poor mental health, of which 30 required a care plan. 22 of these patients had received an annual review since April 2015.
• 96% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan, which was 7.5% above the England average.
• A mental health link worker visited the practice on a weekly basis.

Updated 25 April 2016

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, and patients’ notes were highlighted to make staff aware.
• It had carried out annual health checks for people with a learning disability, and 6 out of 24 patients had up to date care plans. The practice had a plan in place to undertake the outstanding 19. The practice offered longer appointments for this patient group and was flexible in offering appointments to suit the patient in or outside normal clinic hours.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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.
• The practice provided GP care to two local prisons. The practice worked with closely with the prison healthcare team and two other local practices to provide continuous GP cover.