The Birchwood Practice

Updated 23 November 2016

The Birchwood Medical Centre was inspected on Tuesday 25 October 2016. This was a comprehensive inspection.

The practice is situated in Creekmoor an area of Poole in Dorset. The practice provides a general medical service to about 9,000 patients covering an area of nine square miles.

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 81 years which is higher than the national average of 79 years; female life expectancy is 85 years which is higher than the national average of 83 years.

There are two male GP partners, and five salaried GPs, 1 male and four female, providing five whole time equivalent GP posts each week. The GP partners hold managerial and financial responsibility for running the business. The team are supported by one advanced nurse practitioner, 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 is a training practice for doctors that are training to become GPs.

The practice reception is open between 8.30am and 6pm Monday to Friday. Booked appointments are offered between 8.45am and 10.45am and between 3pm and 4.55pm. The practice offers a range of appointment types including book on the day, telephone consultations and advance appointments. .Extended hours are offered on a Monday evening until 8pm, and on alternate Saturday mornings between 8.30am and 10.30am. Additionally telephone appointments are available every Monday evening between 6.30pm and 7pm and Tuesday mornings between 7.30am and 8am.

Between 8am and 8.30am and 6pm and 6.30pm Monday to Friday the telephones are answered by the South West Ambulance NHS Foundation Trust (SWASFT).

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. Details are also given on the practice website of other useful telephone numbers and addresses where patients can seek assistance when the practice is closed.

The Birchwood Medical Centre provides regulated activities from the main site at Northmead Drive, Creekmoor, Poole, Dorset BH17 7XW and their branch practice at Oakdale Surgery 327 Wimborne Road, Oakdale, Poole, Dorset BH15 3ED. We did not visit the branch practice at this inspection.

Updated 23 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Birchwood practice on 25 October 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.

• The patient reference group (PRG) were positively engaged with the practice. The PRG suggestions for changes to the practice management team had been acted upon and as well as this, the group had raised awareness about patient services.

• 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was better than both the clinical commissioning group (CCG) average of 85% and national average of 84%.

• 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 23 November 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 hospital admission were identified as a priority.

• Nationally reported data from the Quality and Outcomes Framework showed that outcomes for patients were good for patients with long term conditions.For example, 94% of patients diagnosed with chronic obstructive pulmonary disease (COPD) had received an annual health check review within the past 12 months.

• 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 89% 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%

• The practice nurses could initiate insulin therapy which saved patients attending hospital appointments.

• 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 23 November 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 relatively high for all standard childhood immunisations.
• 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.
• Patients were able to receive a contraception service in house, the practice nurses fitted implants, and one partner fitted coils.
• The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years was 86%, which was above the national average of 82%.
• 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.

Updated 23 November 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.

• All older patients had a named GP for continuity of care but were able to see a GP of their choice.

• 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 two weekly clinics for patients over 75 years to look at social and physical performance of the over 75 years. As a result of these clinics the practice then held multidisciplinary meetings with other providers, including a care of the elderly consultant, to identify potential services these patients may benefit from.

• The practice was accredited as a Dementia friendly practice and continually monitored patients on anti dementia drugs to make sure they remained effective.

Updated 23 November 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 hours were offered on a Monday evening until 8pm, and on alternate Saturday mornings between 8.30am and 10.30am. Additionally telephone appointments were also available every Monday evening between 6.30pm and 7pm and Tuesday mornings between 7.30am and 8am.

• 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.

• Telephone appointments were offered where appropriate, as an alternative to face-to-face consultations, to help improve access to healthcare particularly for working patients and students.

Updated 23 November 2016

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

• 100% 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 accredited as a Dementia friendly practice and continually monitored patients on anti dementia drugs to make sure they remained effective.

• 96% of patients diagnosed with mental health issues had received a face to face review within the last 12 months. This was significantly better 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 23 November 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.

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

• 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.