Archived: Church Stretton Medical Centre

Updated 19 February 2015

Church Stretton Medical Practice is a general practice located in Church Stretton in Shropshire. It is also a teaching practice for fully qualified doctors to gain experience and higher qualifications in general practice and family medicine. In addition, it provides training and supervision for medical students.

The practice has six GPs, three male and three female, all part time. There is a practice manager, an assistant practice manager, a lead nurse, three practice nurses and two healthcare assistants. There is a medical secretarial team, a reception team and administrative staff. There are in excess of 7,300 patients registered with the practice (as at 31 March 2014). The practice is open from 8.30am to 6.00pm Monday to Friday and closed for one hour from 1.00pm to 2.00 pm on a Wednesday each week.

The practice treats patients of all ages and provides a range of medical services. Church Stretton Medical Practice has a large percentage of its practice population in the older age group which is more than double the national average.

The practice provides a number of services for example reviews for asthma, chronic obstructive disease and diabetes. It also offers child immunisations, contraception advice and travel health vaccines.

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.

Updated 19 February 2015

Letter from the Chief Inspector of General Practice

We inspected this service on 11 November 2014 as part of our new comprehensive inspection programme.

The overall rating for this service is good. We found the practice to be good in the safe, effective, caring, responsive and well-led domains. We found the practice provided outstanding care to older people. They provided good care to people with long term conditions, families, children and young people, working age people, people in vulnerable groups and people experiencing poor mental health.

Our key findings were:

• Performance was consistent over time and patients were kept safe because there were arrangements in place for staff to report and learn from incidents that occurred.
• Patients received evidence based assessments and care and treatment was planned and delivered to promote a good quality of life.
• Staff treated patients with respect and kindness. Patients told us that staff were caring and compassionate. They said that they had confidence and trust in the GPs and nurses they saw or spoke with.
• Services were planned and delivered to meet the needs of the patients. Patients were positive about the access to appointments and the telephone monitoring service.
• The leadership and management within the practice promoted an open and transparent culture. Staff felt able to contribute to the running of the service. The practice sought and acted on feedback from staff and patients.

We saw areas of outstanding practice including:

• The practice was found to be extremely proactive in developing strong local and international community links for the benefit of its own and other patient population groups. For example the practice had secured funding from the Clinical Commissioning Group (CCG) to enable extra support for patients in their own home through the ‘Care 4 me at home’ project.

However, there were also areas of practice where the provider needs to make improvements. The provider should:

• Evaluate the effectiveness of the system used to store policies and procedures to ensure staff have easy access to relevant information to support their individual roles.

• Consider ways to strengthen the risk management processes within the practice to ensure that all risks are assessed and rated, with mitigating actions recorded to reduce and manage risks, including fire safety, recruitment and electrical and water testing

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 February 2015

The practice is rated as good for the population group of people with long term conditions. Emergency processes were in place and referrals made for patients in this group that had a sudden deterioration in health. When needed, longer appointments and home visits were available. All these patients had a named GP and structured annual reviews to check their health and medication needs were being met. Home visits for elderly patients with long term conditions were carried out. For those people with the most complex needs a named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 19 February 2015

The practice is rated as good for the population group of families, children and young people. Systems were in place for identifying and following up children and young people living in disadvantaged circumstances and who were at risk. Immunisation rates were relatively high for all standard childhood immunisations. Patients told us and we saw evidence that children and young people were treated in an age appropriate way and recognised as individuals. The practice provided a female health clinic and used in house expertise to reduce unnecessary referrals to other services. The practice provided chlamydia screening packs to enable young people to carry out self referrals if required. We were provided with good examples of joint working with other professionals such as midwives and health visitors. Emergency processes were in place and necessary referrals were made for children and pregnant women who had a sudden deterioration in health.

Updated 19 February 2015

The practice is rated as outstanding for the population group of older people. The practice had a large percentage of its practice population in the older age group. This was more than double the national average. An example of outstanding practice was how the practice had proactively sought to secure funding from the Clinical Commissioning Group to enable extra support for patients in their own home through the ‘Care 4 me at home’ project.

Other examples of outstanding practice were the range and number of multidisciplinary partnerships that the practice engaged with, and referred patients to their services. This included a local project which enabled and promoted vulnerable people to retain their independence which had won a national award for its work within the community. The practice also referred patients to a consultant psychogeriatric and memory assessment service. 

Nationally reported data showed the practice had good outcomes for conditions commonly found amongst older people.

Updated 19 February 2015

The practice is rated as good for the population group of the working-age population, those recently retired and students. The needs of this population group had been identified and the practice had adjusted the services it offered to ensure services were accessible, flexible and offered continuity of care. The practice was proactive in offering online services as well as a full range of health promotion and screening which reflected the needs for this age group.

Updated 19 February 2015

The practice is rated as good for the population group 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. The practice had advanced care planning in place for patients with dementia.

The practice had direct access and made referrals to a consultant psychogeriatric and memory assessment service. It also referred patients to a registered mental health liaison nurse in the local community mental health team who held regular weekly clinics at the practice. The practice held a register of patients with severe mental illness and carried out health checks with them at least annually. Some staff had received training on the Mental Capacity Act 2005 and others had training on mental health awareness.

Updated 19 February 2015

The practice is rated as good for the population group of people living in vulnerable circumstances. The practice had carried out annual health checks for people with learning disabilities in their own home and all of these patients had received a follow-up. The practice offered longer appointments for people with learning disabilities.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. GPs at the practice attended vulnerable families meetings with other health professionals such as health visitors to ensure the ongoing needs of these patients were met. The practice had signposted vulnerable patients to various support groups and third sector 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 and out of hours.