The Beeches Medical Practice

Updated 22 November 2016

The Beeches Medical Practice main practice is located in Bayston Hill, on the south side of Shrewsbury; its branch surgery is a dispensing practice located at Dorrington Village Hall. The main and branch practice are based in purpose built buildings. All patient areas are on the ground floor.

It is part of the NHS Shropshire Clinical Commissioning Group. The total practice patient population is 6,132. The practice has a higher proportion of patients aged 65 years and above (24.5%) compared with the practice average across England (17%) and has slightly more patients aged under 18 years (19.4%) than the local CCG (18.6%). The practice provides GP services in an area of least deprivation within its locality. The average life expectancy at the practice for males is 81 years and females 85 years both of which are higher than the local averages of 80 and 83 and national life expectancy averages of 79 and 83.

The practice is open at Bayston Hill, Monday to Friday from 8.30am to 6pm (excluding bank holidays) and every Tuesday provides extended hours between 7am and 8am with pre-booked appointments with the GP or nurse. The Dorrington dispensing branch practice is open from 9am to 1pm Monday, Tuesday, Thursday and Friday and 3pm to 6pm on Wednesdays.In addition, the practice offers pre-bookable appointments that can be booked in advance. Urgent appointments are also available for patients that need them. The practice does not provide an out-of-hours service to its own patients but has alternative arrangements for patients to be seen when the practice is closed through Shropdoc, the out-of-hours service provider. The practice is a teaching and training practice and often has GPs in training or medical students.

The staff team comprises 29 staff in total, working a mixture of full and part times hours. Staff at the practice include:

• Four GP partners (three male and one female).

• One salaried female GP providing 0.5 whole time equivalent (WTE) hours per week.

• Two GP Registrars.

• Two managerial staff including: practice manager and deputy practice manager.

• Four practice nurses, providing 2 WTE hours.

• Four dispensary staff.

• Four reception staff.

• A Care and Community Co-ordinator.

• Six administration staff two of which are also cleaning staff members.

The practice has a General Medical Services (GMS) contract with NHS England. This is a contract for the practice to deliver General Medical Services to the local community or communities. They also provide some Directed Enhanced Services, for example, they offer minor surgery, phlebotomy (taking blood samples) and extended opening hours on Tuesdays from 7am to 8am to offer patients better access. The practice provides a number of services, for example long-term condition management including asthma, diabetes and high blood pressure. The practice offers NHS health checks and smoking cessation advice and support.

Updated 22 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Beeches Medical practice on 6 October 2016. Overall, the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• 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.
• Risks to patients were assessed and well managed.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. The majority of feedback from patients about their care was positive.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure they meet people’s needs.
• 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.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had a clear vision, which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

However there were areas of practice where the provider should make improvements:

• Reduce the possibility of accidental interruption of electricity supply to the vaccine refrigerator, by installing a switchless socket or clearly labelling the plug with a cautionary notice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 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.

• Specific asthma, Chronic Obstructive Airways Disease (a respiratory condition) and diabetic clinics were run by nurses with GP support.

• 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.

• The frailest 2% of practice patients had an admission avoidance care plan in place, which included many patients with long-term conditions. The practice had systems in place to “flag” patients with chronic or life limiting conditions to the out-of-hours service and provide information to enable continuity of care.

• The practice held a list of patients who required palliative care and their GP acted as the lead. The gold standards framework was used for the coordination of end of life care.

• Physiotherapy assessment appointments were available for patients to access at the practice at the time of the inspection.

Updated 22 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.

• The practice held regular clinical meetings where children at risk, child welfare concerns and safeguarding issues were discussed to ensure awareness and vigilance.

• The practice had a family planning service, which included contraception, and sexual health service.

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

• The practice worked with two ‘Youth Champions’ to consider ways in which they could engage with young people, including family planning, healthy living/ health responsibility messages. The Youth Champions were working with the patient participation group (PPG) to develop a young person friendly practice website. As a consequence, the practice redesigned the notice boards to ensure there were notices dedicated, and specifically relevant, to young people with the application of ideas from www.mefirst.org.uk a young person’s website.

Updated 22 November 2016

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

• The practice had a higher than average older demographic when compared to national averages, and 2.11% of the patients registered resided in care homes.

• 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 regular routine weekly visits to two care homes. This involved dedicated time to provide proactive healthcare to this group of patients. In addition, the practice provided ‘step up’ beds for the Clinical Commissioning Group (CCG) via a local care home to help reduce admissions to the local hospital.

• The practice Community and Care Co-ordinator had a specific remit to engage with older people and set up a Tuesday coffee morning which was very well attended.

• The practice held a frail and vulnerable register of patients and these were discussed at regular multi-disciplinary meetings with other health and social care professionals.

Updated 22 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.

• Same day appointments were available for patients with urgent need.

• Extended pre bookable appointments were available every Tuesday from 7am to 8am with a GP or nurse.

• The practice participated in the Prime Minister’s Challenge Fund initiative whereby patients could visit a designated practice in the Shrewsbury area in the evening up to 8pm or on a Saturday morning.

• The practice had set up a Men’s Health Awareness event, in conjunction with the patient participation group (PPG) to outline the health conditions specifically for men.

• 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. Appointments and prescriptions could be booked online.

• The practice provided NHS health checks to those in the over 40 to 74 age groups.

Updated 22 November 2016

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

• Clinical staff had received training in the Mental Capacity Act and used this when assessing appropriate patients and the practice carried out advance care planning with their carers for patients with dementia.

• The practice completed dementia assessments and treatment for dementia patients at a local care home.

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

• 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.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

Updated 22 November 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• We found that the practice enabled all patients to access their GP services.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.

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

• The practice regularly worked with other health care professionals in the case management of vulnerable patients and informed vulnerable patients about how to access various support groups and voluntary organisations. The practice held routine lunchtime meetings with community nurse colleagues to discuss frail and vulnerable patients.

• The practice Community and Care Co-ordinator contacted vulnerable patients discharged from hospital to ensure they were supported in their own environment.

• The practice completed routine reviews at GP management team meetings of patients discharged from hospital to ensure appropriateness of admission.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities, such as, information sharing, the documentation of safeguarding concerns and in how to contact relevant agencies both in and out of normal working hours.

• All patients on the practice palliative care register were reviewed at least on a monthly basis at their multidisciplinary meetings.