Spa Medical Practice

Updated 17 January 2017

The Spa Medical Practice is co-located with another GP practice in purpose-built premises in the centre of Droitwich Spa, which is in Worcestershire. The practice worked with the other medical practice, the Worcestershire Health and Care Trust, the onsite pharmacy and others in the design and construction of the new premises, which opened in September 2008.

The practice is registered with the Care Quality Commission (CQC) as a partnership provider. The practice is a member of SW Healthcare Ltd, a GP Federation of all 32 practices in South Worcestershire. A federation is a group of practices who work together to share best practice and maximise opportunities to improve patient outcomes. The Spa Medical Practice holds a General Medical Services (GMS) contract with NHS England. The GMS contract is a contract agreed nationally between general practices and NHS England for delivering primary care services to local communities. At the time of the inspection, The Spa Medical Centre was providing medical care to approximately 8,900 patients.

The practice delivers a full range of family medical services. It also provides a minor injuries service, because the practice is more than five miles from the nearest A&E department. The minor injuries service is provided between 8am and 6.30pm for any new injury that has occurred within the past 48hrs. This is a walk-in service for any patient.

The practice provides a town based diagnostic ultrasound service for patients in the town, which offers a wide range of scans on a Tuesday and Thursday. Patients are referred by their GP.

The Spa Medical Practice is the base for the town anticoagulation monitoring service. There are daily appointments in the clinic and home visits are made where necessary. The clinic provides monitoring and adjustment of the drug warfarin and provides patients with the opportunity to learn about their medications, have their blood tests evaluated, and dose adjustment made accordingly.

There is an independent pharmacy in the same building, which is convenient for patients.

All consulting rooms are situated on the ground floor of the building and there is a lift to the upper floors. There is disabled access and disabled parking close to the front entrance. Part of the reception desk is at a lower height suitable for wheelchair users. There is a room for breast feeding on the second floor and an area on the ground floor which has been decorated with a mural for use by children.

There are five GP partners (two male, three female), plus two associate GPs (one male, one female). The GPs are supported by a pharmacist, a business manager, an operations manager, one advanced nurse practitioner, three practice nurses, two anticoagulation nurses, a health care assistant and administrative and reception staff.

The Spa Medical Practice is an approved training practice for trainee GPs. A trainee GP is a qualified doctor who is training to become a GP through a period of working and training in a practice. There are currently two GP trainees working at the practice.

The practice is open from 8.30am until 6.30pm on weekdays. Administration staff answer the telephones between 8am and 8.30am. Extended hours are provided on one Monday and one Wednesday each month from 6.30pm to 8.30 pm and on one Saturday each month from 9am until 11am. Patients are also able to get appointments with the GP Access Fund scheme (previously known as the Clinical Contact Centre), which is open from 8am to 8pm during the week and from 8am to 12noon at weekends. Outside of these hours, patients are redirected to out of hours care, which is provided by the NHS111 service.

Updated 17 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Spa Medical Practice on 20 September 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There were effective systems in place to monitor and maintain patient safety in the practice.
• Staff understood their responsibilities to raise concerns and to report incidents and near misses. Incidents were regarded as opportunities for learning across the practice team and for improving patient care.
• Patients’ needs were assessed and care delivered in line with best practice guidance.
• Staff had received training to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients told us that they were treated with kindness, dignity and courtesy and that 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.
• All patients had a nominated GP, which provided continuity of care. Family members had the same nominated GP.
• Patients said they found it easy to make an appointment with a named GP and that they appreciated the continuity of care. Patients could get urgent appointments the same day.
• There was strong collaboration between the practice and the Patient Participation Group.
• There was active liaison with the Worcestershire Association of Carers. 3% of patients had been identified as carers.
• The Spa Medical Practice was the base for the town INR service (a service to monitor patients on a blood-thinning medicine).
• A GP had initiated the diagnostic ultrasound service, which was funded by the Clinical Commissioning Group.
• The practice proactively initiated alternative ways to improve patient outcomes. For example, it was the first in the county to employ an advanced nurse practitioner who was a qualified Acute Care Practitioner.
• The practice was located in purpose-built premises and was well equipped to treat patients and meet their needs.
• There was a strong and visible clinical and managerial 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. 

We saw several areas of outstanding practice including:

• The business manager had been instrumental in setting up the Social Prescribing Pilot project in the Locality. The project provided advice and support for patients with social needs or for those who had mental health issues.
• The practice provided a minor injuries service, because the practice was situated more than five miles from the nearest A&E department. The minor injuries service was open between 8am and 6.30pm for any new injury that had occurred within the past 48hrs. This was a walk-in service for any patient.
• A Gateway worker and a psychologist from the Primary Care Mental Health Service held clinics at the practice every Monday. Mental health counselling was also available every Thursday.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 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.
• Nursing staff had oversight for several clinics for patients with long term conditions such as asthma, diabetes and chronic lung disease, and had received appropriate training.
• 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 Spa Medical Practice was the base for the town INR service (a service to monitor patients on a blood-thinning medicine) for patients from three local practices. 500 patients were on the database. An average of 30 appointments were available every day with an anticoagulation nurse and an average of six home visits were provided for patients who were housebound. The clinic provided monitoring and adjustment of the drug warfarin and gave patients the opportunity to learn about their medicines, have their blood tests evaluated, and dose adjustment made accordingly.
• The in-house pharmacist carried out reviews of patients with asthma and chronic lung disease, supported by the GP lead.
• The nursing team provided healthy lifestyle advice and NHS health checks.
• The practice website had links to support services for patients with long term conditions. For example, Asthma UK, Diabetes UK and the British Heart Foundation.
• The practice clinical team had received additional training in long term care. For example, a GP had been trained to provide an insulin initiation service to diabetic patients.

Updated 17 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.
• 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.
• The practice’s uptake for the cervical screening programme was 82% which was slightly below the CCG average of 84% and the same as the national average of 82%.
• Childhood immunisation rates were comparable to local and national averages.
• Appointments were available outside of school hours with GPs and nurses. A separate area set aside for children had been decorated with a mural and a breast feeding room was provided on the second floor.
• A GP also worked at Birmingham Children’s Hospital in the ENT department, so they could bring additional expertise to the practice in this area.
• We saw positive examples of joint working with midwives, health visitors and school nurses. 

Updated 17 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 had signed up to the admissions avoidance service, which identified patients who were at risk of inappropriate hospital admission.
• The practice provided care for patients in seven local care homes. The patient’s nominated GP visited regularly, thus ensuring continuity of care.
• The practice offered a range of enhanced services, for example, in dementia and end of life care.
• A GP from the Health and Care Trust held a weekly clinic to assess frail, elderly patients. This service was funded by the Locality.
• The practice participated in a foot care clinic run by Age UK every Thursday morning.

Updated 17 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.
• Patients could book routine GP appointments online as well as request repeat prescriptions at a time that was convenient for them.
• Patients could also book or cancel appointments via Patient Partner, which was an option on the practice telephone system.
• Text messages were sent to remind patients about their appointments and to invite them to attend for chronic disease management or influenza vaccinations.
• Extended hours appointments were provided and patients could also book appointments with the GP Access Fund (previously known as the Clinical Contact Centre) service outside of the practice’s core opening hours. The GP Access Fund was open from 8am to 8pm during the week and from 8am to 12noon at weekends
• Patients who had signed up to the Electronic Prescription Service could have prescriptions sent to the pharmacy in the premises or to a pharmacy close to their home or work.
• General contraceptive advice was available at the practice as well as coil fittings.
• Health promotion information was available in the waiting room and on the practice website.
• The practice had set up a Twitter page, which was used to keep patients up to date with forthcoming events.

Updated 17 January 2017

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

• 77% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was 7% below both the Clinical Commissioning Group (CCG) and national averages. We were told that this was due to coding issues, which had now been addressed. For example, a proforma was now used for home visits, which facilitated data entry and coding. Results from 2015/16 showed that this achievement rose to 79%.
• 81% of patients with poor mental health had a care plan documented in the last 12 months, which was 8% lower than both the CCG and national averages (the number of patients on this register was 55, which was relatively small). The achievement for 2015/16 was 96%, which was 3% above the CCG average and 8% above the national average.
• 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.
• Patients experiencing poor mental health were given advice as to how they could access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended A&E 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.
• A Gateway worker and a psychologist from the Primary Care Mental Health Service held clinics at the practice every Monday. Mental health counselling was also available every Thursday.
• The business manager had been instrumental in setting up the Social Prescribing Pilot Project in the locality. The project provided advice and support for patients with social needs or for those who had mental health issues. For example, patients who were isolated or lonely could use the service. Patients could be referred into the service by their GP or self-refer. They would be given an appointment with a counsellor, who could also signpost them to external agencies like Age Concern, if appropriate. The service was open to patients from two other practices in the locality.
• GPs could refer patients with dementia to a local dementia café, or patients could self-refer.
• A GP was the lead for dementia care and a member of the Droitwich Dementia Awareness Group. The same GP was the CCG clinical lead for mental health services, so could share additional knowledge and experience with colleagues.

Updated 17 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 had a protocol for registering homeless and vulnerable patients, which outlined the way in which these patients would be registered.
• Vulnerable patients were flagged on the practice’s clinical computer system, so that they were immediately identifiable to staff and could be offered an appropriate level of service.
• The practice had 58 patients on its learning disability register and had carried out annual medication reviews on 89%.
• The practice offered longer appointments for patients with a learning disability.
• The practice leaflet and complaints leaflet were available in an easy-read format.
• Clinical staff 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 had received training in 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. There was a GP lead for safeguarding.
• A GP had undergone training in drug and alcohol misuse. A substance misuse worker from the local alcohol and drug recovery charity centre held a weekly clinic at the practice.
• Carers were coded on the practice’s clinical computer system. The practice had identified 273 patients as carers, which represented 3% of the practice list. This represented a 1% increase on the figure for 2014.