Park Medical Practice

Updated 31 January 2017

Park Medical Practice is located close to the centre of Shepton Mallet and there is a branch surgery in Evercreech which is approximately five miles away.

The practice serves a local and rural population of approximately 10,500 patients from the small market town and the surrounding rural area.

The practice operates from two locations:

Park Medical Practice

Cannards Grave Road

Shepton Mallet

Somerset

BA4 5RT

and

Evercreech Surgery

Prestleigh Road

Evercreech

Somerset

BA4 6JY

There is parking at both sites including allocated parking spaces for patients with a disability. The practice has a number of rooms which it makes available to other services; these include Somerset Drugs and Alcohol Service; and weekly sessions provided by Health Connections Mendip and the Citizens Advice Bureau.

The practice has eight GPs, four of whom are partners. Between them they provide 44 GP sessions each week and are equivalent to 5.5 whole time employees. Five GPs are male and three are female. There are five practice nurses, whose working hours are equivalent to 3.25 whole time employees (WTE), including two non-medical prescribers who offer six sessions per week. Three health care assistants are also employed by the practice with combined hours of 2.0 WTE. The GPs and nurses are supported by twenty management and administrative staff including a practice manager and a deputy practice manager.

The practices patient population is expanding and the number of patients between the ages of 45 and 69 years is slightly above the national average. Approximately 20% of the patients are over the age of 65 years compared to a national average of 17%. The number of patients between the ages of 20 and 39 years, is slightly below the national average.

The general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in the fourth least deprivation decile. (An area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score. It is important to remember that not everyone living in a deprived area is deprived and that not all deprived people live in deprived areas).

Both locations are open between 8.30am and 6.30pm Monday to Friday except for closure of the Evercreech surgery on Wednesday afternoons. Both sites are closed at lunch times from 1pm to 1.50pm, however, phone access for urgent calls was available from 8am and during lunchtimes. Appointments are available from 8.30am and the practice operates a mixed appointments system with some available to pre-book and others available to book on the day.

Extended hours appointments are offered at the Shepton Mallet site on Monday to Thursday evenings from 6.30pm until 7pm and the practice also offers telephone consultations. GP appointments are available from 8.30am until 11.00am and 3.30pm until 6.00pm.

The practice does not provide out of hour’s services to its patients, this is provided by Vocare. Contact information for this service is available in the practice and on the practice website. The practice offers online booking facilities for non-urgent appointments and an online repeat prescription service.

The practice has a Personal Medical Services (PMS) contract to deliver health care services; the contract includes enhanced services such as childhood vaccination and immunisation scheme, facilitating timely diagnosis and support for patients with dementia and minor surgery services. An influenza and pneumococcal immunisations enhanced service is also provided.

The practice is a training practice with one registrar GP placed with them at the time of our inspection. The practice also hosts placements for medical students. Two of the GPs are GP trainers.

Updated 31 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Park Medical Practice on 14 April 2016. Overall the practice was rated as good. The practice was rated good for providing caring, effective, responsive and well-led services. However, we found breaches of Regulation 12 (safe care and treatment) and Regulation 18 (staffing) of The Health and Social Care Act (Regulated Activities) Regulations 2014. The practice was rated as requires improvement for providing safe services.

We required the practice to make the following improvements:

• Implement a system to ensure all Patient Group Directions were current, authorised and signed before vaccinations were provided to patients.

• Ensure all staff receive up to date training in infection prevention and control.

We carried out a focused desk based inspection on 3 January 2017 to assess if the practice had implemented the changes needed to provide safe services. During this focussed inspection we found the provider had taken appropriate action to meet the requirements and following a review of evidence the practice is now rated as good for providing safe services, with the practice now being rated as good for all domains and population groups.

This report covers our findings in relation to the requirements and should be read in conjunction with the report published in October 2016. This can be done by selecting the 'all reports' link for Park Medical Practice on our website at www.cqc.org.uk.

Our key findings across all the areas which we inspected on 3 January 2017 were as follows:

• The practice provided copies of Patient Group Directions within 48hours of the inspection undertaken in April 2016. The practice had implemented a system to review Patient Group Directions to ensure they are always in date and signed by relevant staff members.

• The lead nurse and all staff have now completed infection control training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 October 2016

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.
• Performance indicators for patients diagnosed with diabetes were comparable to local and national averages.
• The practice proactively identified patients at risk of developing long-term conditions and took action to monitor their health and help them improve their lifestyle. For example, the practice had developed in house, quality assured spirometry to diagnose patients along with a monitoring scheme using micro spirometry.
• 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.
• Longer appointments and home visits were available when needed. For example, for working age patients these were not restricted to set clinic times.
• 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 27 October 2016

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

• 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. 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 provided support for premature babies and their families following discharge from hospital. There was regular liaison and communication with Health Visitors.
• Performance indicators for cervical screening of patients were comparable to local and national averages.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 27 October 2016

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

• Staff were able to recognise the signs of abuse in older people and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older people in its population. For example, the practice participated in the Mendip Symphony scheme to provide coordinated multi-disciplinary team care for patients with complex needs.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older people who may be approaching the end of life. It involved older people in planning and making decisions about their care, including their end of life care. For example, the practice had adopted the Gold Standard Framework for end of life 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, there were regular meetings with other health professionals to identify patients at risk of and take action to avoid unplanned hospital admission.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. For example, patients could access support and advice from Mendip Health Connectors service.
• The practice had carried out a review of all patients in residential and nursing homes in the previous year, resulting in an increase in numbers diagnosed with dementia.

Updated 27 October 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. For example, extended hours appointments, including phone appointments, were available from 6.30pm to 7pm Mondays to Thursdays.
• Longer appointments were available for working age patients with long term conditions in all clinical sessions.
• 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 27 October 2016

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

• The practice specifically considered the physical health needs of people with poor mental health. For example, the practice had carried out a review of all patients in residential and nursing homes in the previous year, resulting in an increase in numbers diagnosed with dementia.
• The practice had a system for monitoring repeat prescribing for people receiving medication for mental health needs.
• Mental health performance data from the Quality and Outcomes Framework (QOF) appeared to be worse than 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.
• People at risk of dementia were identified and offered an assessment.
• 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 27 October 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.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• 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.